経腸栄養管理から見た褥瘡ケアと発生予防の検討

Material type: 文書・図像類

Author: 大木, いづみ

Publisher: 慶應義塾大学

Publication date: 2020

Material Format: Digital

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Note (General)：: type:text近年、急性期の栄養管理においては、腸管使用が可能な場合は、早期経腸栄養の開始が推進される。一方で、褥瘡管理においては、経腸栄養に由来する下痢により、皮膚の湿潤環境が悪化し、褥瘡の治癒が遅延する症例が見られる。当院の褥瘡保有患者の背景を分析し、経腸栄養管理の点から、褥瘡の発生予防や栄...

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Material Type: 文書・図像類
Title: 経腸栄養管理から見た褥瘡ケアと発生予防の検討
Author/Editor: 大木, いづみ
Author Heading: 大木, いづみ
Publication, Distribution, etc.: 慶應義塾大学
Publication Date: 2020
Publication Date (W3CDTF): 2020
Alternative Title: ケイチョウエイヨウカンリカラミタジョクソウケアトハッセイヨボウノケントウ
Keichō eiyō kanri kara mita jokusō kea to hassei yobō no kentō
Examination of pressure ulcer care and prevention of outbreak from the viewpoint of enteral nutrition management
Periodical title: 学事振興資金研究成果実績報告書
Text Language Code: jpn
eng
Target Audience: 一般
Note (General): type:text
近年、急性期の栄養管理においては、腸管使用が可能な場合は、早期経腸栄養の開始が推進される。一方で、褥瘡管理においては、経腸栄養に由来する下痢により、皮膚の湿潤環境が悪化し、褥瘡の治癒が遅延する症例が見られる。当院の褥瘡保有患者の背景を分析し、経腸栄養管理の点から、褥瘡の発生予防や栄養状態の改善について検討を行った。当院の2020年度褥瘡保有患者数は154例、平均年齢は69.4歳であった。このうち118例（77％）において栄養状態の低下を認めた。入院期間中、経腸栄養剤単独での栄養管理を行った症例は44例（29％）であり、褥瘡発生の主な要因が下痢、低栄養、栄養不良である症例は7例で、下痢の難渋例では在院日数が長期化した。当院の褥瘡保有者のうち、経腸栄養管理中の下痢を認める症例においては、栄養サポートチーム（以下NST）が介入するケースが多く、患者の病態や消化吸収能・消化器症状（下痢など）を考慮した経腸栄養剤の選択、投与速度や投与量の変更、浸透圧の低い製品への変更、食物繊維（水溶性食物繊維やペクチン）の追加投与、整腸剤や止痢剤の投与等、対策が実施されていた。しかし、下痢対策に難渋してからNSTへ依頼される場合が多く、経腸栄養開始時より、早期の段階で下痢の対策を講じる必要性が感じられた。 2020年度は新型コロナウイルス感染症の予防対策として、褥瘡対策チームでの回診が中止した期間もあり、例年に比べてチーム活動が縮小され、当初目標とした経腸栄養管理のフローの作成には至らなかった。下痢対策の視点から、適正な経腸栄養剤の選択や投与方法について、今後、症例を蓄積して後ろ向きに検証を行い、当院における経腸栄養管理のフローの作成、および実施後の評価に取り組み、栄養管理から褥瘡治癒の促進に貢献できる体制を整えていく。 In recent years, in nutritional management in the acute phase, the start of early enteral nutrition is promoted when the intestinal tract can be used. On the other hand, in pressure ulcer management, there are cases in which healing of pressure ulcers is delayed due to deterioration of the moist environment of the skin due to diarrhea derived from enteral nutrition. We analyzed the background of pressure ulcer-bearing patients at our hospital, and examined prevention of pressure ulcer development and improvement of nutritional status from the viewpoint of intestinal nutritional management. The number of patients with pressure ulcers in 2020 at our hospital was 154, and the average age was 69.4 years. Of these, 118 cases (77%) showed a decrease in nutritional status. During the hospitalization period, 44 cases (29%) underwent nutritional management with enteral nutritional supplements alone, and 7 cases had diarrhea, malnutrition, and malnutrition as the main causes of pressure ulcer development. In difficult cases, the length of hospital stay was prolonged. Among the patients with decubitus in our hospital, in cases where diarrhea is observed during enteral nutrition management, the nutrition support team (NST) often intervenes, and the patient's condition, digestive absorption ability, digestive symptoms (diarrhea, diarrhea, etc.) Various measures were taken, such as selection of enteral nutritional supplements considering (digestive symptoms), change of administration rate and dose, change to products with low osmotic pressure, additional administration of dietary fiber (water-soluble dietary fiber and pectin), intestinal regulator and antidiarrheal agent. However, in many cases, NST was requested after having difficulty in taking measures against diarrhea, and it was felt that it was necessary to take measures against diarrhea at an early stage from the start of intestinal nutrition. In 2020, as a preventive measure for the new coronavirus infection, there was a period when the rounds of the pressure ulcer control team were stopped, and the team activity was reduced compared to usual years. From the viewpoint of diarrhea countermeasures, we will accumulate cases and retrospectively verify the selection and administration method of appropriate intestinal nutritional supplements, create a flow of enteral nutritional management at our hospital, and evaluate after implementation. We will work on it and establish a system that can contribute to the promotion of pressure ulcer healing from nutritional management.
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Data Provider (Database): 国立情報学研究所 : 学術機関リポジトリデータベース（IRDB）（機関リポジトリ）
https://irdb.nii.ac.jp
Original Data Provider (Database): 慶應義塾大学 : 慶應義塾大学学術情報リポジトリ