脳血管障害
脳血管障害の栄養管理の目的は、現存する低栄養の治療と、今後低栄養に陥る危険のある患者の発症予防の2点である。脳血管障害の栄養管理の特徴として、嚥下障害、運動麻痺などの機能障害が栄養状態悪化につながること、高血圧、糖尿病、脂質代謝異常など、複数の併存疾患を抱える高齢の患者が多いこと、病態・病期の変化に応じて、投与経路や栄養投与量を経時的に見直す必要があることが挙げられる。脳血管障害患者の経腸栄養剤の選択は、病態別経腸栄養法の“応用問題”的な側面があり、適切な栄養療法の実施と栄養療法の合併症への対応は、患者の生命予後・機能予後を改善する可能性がある。...
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| Published in | 静脈経腸栄養 Vol. 27; no. 2; pp. 697 - 701 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本静脈経腸栄養学会
2012
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 1344-4980 1881-3623 |
| DOI | 10.11244/jjspen.27.697 |
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| Abstract | 脳血管障害の栄養管理の目的は、現存する低栄養の治療と、今後低栄養に陥る危険のある患者の発症予防の2点である。脳血管障害の栄養管理の特徴として、嚥下障害、運動麻痺などの機能障害が栄養状態悪化につながること、高血圧、糖尿病、脂質代謝異常など、複数の併存疾患を抱える高齢の患者が多いこと、病態・病期の変化に応じて、投与経路や栄養投与量を経時的に見直す必要があることが挙げられる。脳血管障害患者の経腸栄養剤の選択は、病態別経腸栄養法の“応用問題”的な側面があり、適切な栄養療法の実施と栄養療法の合併症への対応は、患者の生命予後・機能予後を改善する可能性がある。 |
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| AbstractList | 脳血管障害の栄養管理の目的は、現存する低栄養の治療と、今後低栄養に陥る危険のある患者の発症予防の2点である。脳血管障害の栄養管理の特徴として、嚥下障害、運動麻痺などの機能障害が栄養状態悪化につながること、高血圧、糖尿病、脂質代謝異常など、複数の併存疾患を抱える高齢の患者が多いこと、病態・病期の変化に応じて、投与経路や栄養投与量を経時的に見直す必要があることが挙げられる。脳血管障害患者の経腸栄養剤の選択は、病態別経腸栄養法の“応用問題”的な側面があり、適切な栄養療法の実施と栄養療法の合併症への対応は、患者の生命予後・機能予後を改善する可能性がある。 |
| Author | 片多, 史明 |
| Author_FL | KATADA Fumiaki |
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| References | 2) Horn SD, DeJong G, Smout RJ, et al. Stroke rehabilitation patients, practice, and outcomes: is earlier and more aggressive therapy better? Arch Phys Med Rehabil. [Multicenter Study Research Support, N.I.H., Extramural Research Support, U.S. Gov't, Non-P.H.S.]. 86 (12 Suppl 2) : S101-S114, 2005. 6) Lucas C, Rodgers H. Variation in the management of dysphagia after stroke: does SLT make a difference? Int J Lang Commun Disord. [Research Support, Non-U.S. Gov't]. 33 Suppl : 284-289, 1998. 14) Park RH, Allison MC, Lang J, et al. Randomised comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with persisting neurological dysphagia. Bmj. [Clinical Trial Comparative Study Randomized Controlled Trial Research Support, Non-U.S. Gov't]. 304 (6839) : 1406-1409, 1992. 3) James R, Gines D, Menlove A, et al. Nutrition support (tube feeding) as a rehabilitation intervention. Arch Phys Med Rehabil. [Multicenter Study Research Support, N.I.H., Extramural Research Support, U.S. Gov't, Non-P.H.S.]. 86 (12 Suppl 2) : S82-S92, 2005. 15) 田中育太、村松博士、久居弘幸ほか. 栄養材の形状機能の追求 PEG患者に対する半固形化栄養材の有効性に関する多施設共同比較臨床試験. 静脈経腸栄養. [会議録]. 26 (1) : 232, 2011. 7) Kanie J, Suzuki Y, Akatsu H, et al. Prevention of late complications by half-solid enteral nutrients in percutaneous endoscopic gastrostomy tube feeding. Gerontology. [Case Reports]. 50 (6) : 417-419, 2004. 11) Volkert D, Berner YN, Berry E, et al. ESPEN Guidelines on Enteral Nutrition: Geriatrics. Clin Nutr. [Consensus Development Conference Practice Guideline]. 25 (2) : 330-360, 2006. 4) Odderson IR, Keaton JC, McKenna BS. Swallow management in patients on an acute stroke pathway: quality is cost effective. Arch Phys Med Rehabil. 76 (12) : 1130-1133, 1995. 8) Nishiwaki S, Araki H, Shirakami Y, et al. Inhibition of gastroesophageal reflux by semi-solid nutrients in patients with percutaneous endoscopic gastrostomy. JPEN J Parenter Enteral Nutr. 33 (5) : 513-519, 2009. 10) Dennis MS, Lewis SC, Warlow C. Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial. Lancet. [Clinical Trial Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov't]. 365 (9461) : 764-772, 2005. 9) Dennis M, Lewis S, Cranswick G, et al. FOOD: a multicentre randomised trial evaluating feeding policies in patients admitted to hospital with a recent stroke. Health Technol Assess. 10 (2) : iii-iv, ix-x, 1-120, 2006. 5) Hinchey JA, Shephard T, Furie K, et al. Formal dysphagia screening protocols prevent pneumonia. Stroke; a journal of cerebral circulation. [Multicenter Study Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S.]. 36 (9) : 1972-1976, 2005. 13) Norton B, Homer-Ward M, Donnelly MT, et al. A randomised prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic stroke. Bmj. [Clinical Trial Comparative Study Randomized Controlled Trial]. 312 (7022) : 13-16, 1996. 1) Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke; a journal of cerebral circulation. [Research Support, Non-U.S. Gov't]. 30 (4) : 744-748, 1999. 12) Bath PM, Bath FJ, Smithard DG. Interventions for dysphagia in acute stroke. Cochrane Database Syst Rev. [Review] (2) : CD000323, 2000. |
| References_xml | – reference: 8) Nishiwaki S, Araki H, Shirakami Y, et al. Inhibition of gastroesophageal reflux by semi-solid nutrients in patients with percutaneous endoscopic gastrostomy. JPEN J Parenter Enteral Nutr. 33 (5) : 513-519, 2009. – reference: 13) Norton B, Homer-Ward M, Donnelly MT, et al. A randomised prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic stroke. Bmj. [Clinical Trial Comparative Study Randomized Controlled Trial]. 312 (7022) : 13-16, 1996. – reference: 11) Volkert D, Berner YN, Berry E, et al. ESPEN Guidelines on Enteral Nutrition: Geriatrics. Clin Nutr. [Consensus Development Conference Practice Guideline]. 25 (2) : 330-360, 2006. – reference: 10) Dennis MS, Lewis SC, Warlow C. Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial. Lancet. [Clinical Trial Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov't]. 365 (9461) : 764-772, 2005. – reference: 4) Odderson IR, Keaton JC, McKenna BS. Swallow management in patients on an acute stroke pathway: quality is cost effective. Arch Phys Med Rehabil. 76 (12) : 1130-1133, 1995. – reference: 7) Kanie J, Suzuki Y, Akatsu H, et al. Prevention of late complications by half-solid enteral nutrients in percutaneous endoscopic gastrostomy tube feeding. Gerontology. [Case Reports]. 50 (6) : 417-419, 2004. – reference: 2) Horn SD, DeJong G, Smout RJ, et al. Stroke rehabilitation patients, practice, and outcomes: is earlier and more aggressive therapy better? Arch Phys Med Rehabil. [Multicenter Study Research Support, N.I.H., Extramural Research Support, U.S. Gov't, Non-P.H.S.]. 86 (12 Suppl 2) : S101-S114, 2005. – reference: 14) Park RH, Allison MC, Lang J, et al. Randomised comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with persisting neurological dysphagia. Bmj. [Clinical Trial Comparative Study Randomized Controlled Trial Research Support, Non-U.S. Gov't]. 304 (6839) : 1406-1409, 1992. – reference: 1) Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke; a journal of cerebral circulation. [Research Support, Non-U.S. Gov't]. 30 (4) : 744-748, 1999. – reference: 3) James R, Gines D, Menlove A, et al. Nutrition support (tube feeding) as a rehabilitation intervention. Arch Phys Med Rehabil. [Multicenter Study Research Support, N.I.H., Extramural Research Support, U.S. Gov't, Non-P.H.S.]. 86 (12 Suppl 2) : S82-S92, 2005. – reference: 9) Dennis M, Lewis S, Cranswick G, et al. FOOD: a multicentre randomised trial evaluating feeding policies in patients admitted to hospital with a recent stroke. Health Technol Assess. 10 (2) : iii-iv, ix-x, 1-120, 2006. – reference: 12) Bath PM, Bath FJ, Smithard DG. Interventions for dysphagia in acute stroke. Cochrane Database Syst Rev. [Review] (2) : CD000323, 2000. – reference: 15) 田中育太、村松博士、久居弘幸ほか. 栄養材の形状機能の追求 PEG患者に対する半固形化栄養材の有効性に関する多施設共同比較臨床試験. 静脈経腸栄養. [会議録]. 26 (1) : 232, 2011. – reference: 5) Hinchey JA, Shephard T, Furie K, et al. Formal dysphagia screening protocols prevent pneumonia. Stroke; a journal of cerebral circulation. [Multicenter Study Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S.]. 36 (9) : 1972-1976, 2005. – reference: 6) Lucas C, Rodgers H. Variation in the management of dysphagia after stroke: does SLT make a difference? Int J Lang Commun Disord. [Research Support, Non-U.S. Gov't]. 33 Suppl : 284-289, 1998. |
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