理学療法ジャーナル41巻6号

2007年06月発行

特集 NST（nutrition support team）と理学療法

慢性心不全における栄養管理と運動療法の関わり

著者： 飯田有輝¹² 山田純生³

所属機関： ¹名古屋大学大学院医学系研究科博士前期課程リハビリテーション療法学専攻 ²厚生連海南病院リハビリテーション科 ³名古屋大学大学院医学系研究科リハビリテーション療法学

ページ範囲：P.471 - P.478

はじめに

　慢性心不全は，様々な基礎疾患による心筋損傷を契機として心機能障害が進行し，徐々に労作時の息切れや疲労感などの臨床症状を呈する進行性の症候群と考えられている．その病態は，心筋損傷による心機能低下が神経体液性因子の賦活化，炎症性サイトカインの産生，心室リモデリングなどの適応反応を引き起こし，経過と共にそれらがストレス刺激となって作用し，心機能障害をさらに進行させていくというものである^1）．先進国における慢性心不全の総有病率は2～6％で，その4分の1は65歳以上の高齢者であるとの報告があり^2,3），今後は高齢化と共にさらにその数は増え続けると予想されている^3）．また慢性心不全の予後は，発症からの死亡率が1年以内で男性28％，女性24％，5年以内では男性59％，女性45％と高く^4），治療は病態進行をいかに予防するかが主関心事となっている．栄養状態の維持・改善は，薬物療法，運動療法と並んで慢性心不全の管理上重要な位置づけにある．本稿では，特に心臓悪液質（cardiac cachexia）をもたらす心不全の病態を中心に，栄養管理と運動療法の関わりについて基本的考え方を概括したい．

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