リハビリテーション病棟における身体活動制限の異なる入院患者の口腔衛生状態．横断的研究

Oral health status of inpatients with varying physical activity limitations in rehabilitation wards: A cross-sectional study.

抄録

ABSTRACT:

入院患者の口腔衛生状態の悪化は、生命を脅かす可能性がある。しかし、入院患者に合わせた口腔衛生に関する基本的なプロトコルは存在せず、介護者の口腔ケアに関する知識、態度、スキルの欠如は患者の一般的な健康に悪影響を及ぼす可能性がある。本研究では，リハビリテーション病棟に入院中の様々な身体活動制限のある患者の口腔ケアの実践と口腔の健康状態を明らかにすることを目的とした．リハビリテーション病棟の入院患者 61 名を対象に，内科的・身体的状態および口腔の健康状態について評価した．本研究では，男性 40 名，女性 21 名（平均年齢 56.6 歳）を対象とし，ベッドサイド口腔検査，虫歯，欠損，充填歯指数，歯垢指数，歯肉指数，う蝕活性試験により評価し た．その中で，50.8％の患者は一人で歯磨きができたが，49.2％の患者は口腔ケアに助手の介助が必要であった．経鼻胃管栄養を受けている患者の割合は，口腔セルフケアができない群で高く，ベッドサイドの口腔検査では，中等度，重度の機能障害がそれぞれ36.7％，33.3％にみられた．ベッドサイド口腔検査では，嚥下，舌，全領域のスコアが，口腔内セルフケアができない患者で低かった（P < 0.01）．この結果から，リハビリテーション病棟の入院患者の身体活動制限を考慮した口腔ケアプロトコールが，全身状態への悪影響を最小限に抑えるために必要であることが示唆された．

ABSTRACT: Poor oral hygiene can be potentially life-threatening in inpatients. However, no basic protocol on oral hygiene customized for inpatients exists, and lack of oral care related knowledge, attitude, and skills among caregivers could be detrimental to the general health of patients. This study sought to identify the oral care practices and oral health status of inpatients with varying physical activity limitations in a rehabilitation ward.Sixty-one inpatients in a rehabilitation ward were evaluated for their medical and physical conditions and oral health status. These were assessed using the bedside oral exam, decayed, missing, filled teeth index, plaque index, gingival index, and caries activity test.In total, 40 men and 21 women (mean age, 56.6 years) were included in this study. Among them, 50.8% of the patients could brush their teeth unassisted, whereas 49.2% required assistance from an assistant for oral care. The proportion of patients receiving nasogastric tube feeding was higher in the group that could not provide oral self-care; 36.7% and 33.3% of these patients showed moderate and severe dysfunction, respectively, based on bedside oral exam. Scores for the swallowing, tongue, and total domains of bedside oral exam were poorer for patients who could not provide oral self-care (P < .01). The caries activity test indicated a moderate risk for both groups.Our findings suggest that an oral care protocol that considers the physical activity limitations in inpatients in rehabilitation wards is necessary to minimize negative influences on the systemic health of these patients.