臨床外科64巻10号

2009年10月発行

特集 消化器外科における経腸栄養の意義と役割

重症救急患者における早期経腸栄養法

著者： 小谷穣治¹ 橋本篤徳¹ 寺嶋真理子¹ 山田大平¹ 上田敬博¹

所属機関： ¹兵庫医科大学救急・災害医学講座，救命救急センター

ページ範囲：P.1383 - P.1395

文献概要

要旨：重症病態では生体のエネルギー代謝が亢進するが，急性期にはむしろunderfeedingであることが病態の改善に有効である．重症病態では静脈栄養に比べ経腸栄養が感染性合併症の軽減やICU・入院日数の軽減の点で有効であるが，最終転機を改善した報告は少ない．しかし重症病態とは様々な病態を含んでいるので，今後，病態別に検証すべきである．

　経腸栄養の早期導入は，栄養投与をしない場合に比べてむしろ病態を悪化させるとの報告が続いたが，急性期に消費カロリーに見合う栄養量を投与したことがその理由であった可能性がある．事実，栄養管理の条件をつけない後ろ向き研究では経腸栄養が静脈栄養より生存率を改善している．一方で，近年，アルギニンが外傷症例，ω-3系多価不飽和脂肪酸がARDSの病態を改善するなど，各種の免疫栄養素が重症病態の改善に著しい効果を持つ報告が相次ぎ，これらの多くが経腸的に投与される点で経腸栄養法・剤が注目されている．また，アルギニンは重症感染症では逆に予後を悪化させるなど，重症病態の中でも病態が異なれば効果も異なることも明らかにされ，病態別に免疫栄養素を使い分ける時代がやってきたといえる．

参考文献

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