| 特集名 | リハビリ・運動療法を活用した高齢腎不全患者の栄養管理 | |
|---|---|---|
| 題名 | 高齢腎不全・透析患者への栄養指導の実際 (1) 摂食・嚥下障害のある患者 | |
| 発刊年月 | 2016年 11月 | |
| 著者 | 安原 みずほ | 松江赤十字病院栄養課・管理栄養士 |
| 著者 | 漆谷 義徳 | 松江赤十字病院膠原病・腎臓内科 |
| 【 要旨 】 | 透析患者の脳出血発症率は高く，脳梗塞も増加傾向にある．経口摂取困難例の場合，急性期から経管栄養を行い，栄養状態を保ちながら摂食・嚥下リハビリテーションを行い，経口摂取可能になることを目指す．摂食嚥下障害に対する食事の対応で効果的なものは嚥下機能に合わせた形態調整である．嚥下しやすいようにゼリー状にしたり，とろみをつけたり，また，補助食品の利用により必要栄養量を確保する．言語聴覚士による段階的摂食訓練などにより嚥下機能は改善し，常菜食が食べられるようになることも多い．転院に際しては情報提供が重要であり，多職種連携による継続的なケアが必要である． | |
| Theme | Nutritional care for elderly chronic kidney disease patients utilizing rehabilitation and kinestology | |
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| Title | The case of a hospitalized hemodialysis patient with a subarachnoid hemorrhage where enteral nutrition and oral ingestion became possible due to swallowing rehabilitation | |
| Author | Mizuho Yasuhara | Department of Nutrition, Matsue Red Cross Hospital |
| Author | Yoshinori Urushidani | Department of Connective Tissue Diseases and Nephrology, Matsue Red Cross Hospital |
| [ Summary ] | Dialysis patients have a higher rate of cerebral hemorrhage onset and an increased susceptibility for cerebral infarction. Patients with difficulty in oral ingestion require the placement of a feeding tube during the acute stage to maintain a good nutritional status and undergo swallowing rehabilitation aimed at achieving oral ingestion. An efficient treatment for difficulty in oral ingestion is to modify the meal texture in accordance with the patients' swallowing function, for example, jellying or thickening meals to aid swallowing, or nutritional supplements to ensure that the patients receive the required nutrition. A step-by-step swallowing rehabilitation, provided by a speech therapist, improves patients' swallowing function, and many patients have recovered enough to partake regular diet. When being transferred to a different hospital, sharing the patient's medical history and treatment information is important, and continuous care by a team of specialists is necessary. |
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