遷延性意識障害患者の栄養状態と簡易栄養評価指標の検討

Abstract

This study was aimed to evaluate the nourishment of patients with a disturbance of consciousness who received tube feeding, and to discuss nutritional markers to simplify evaluation in these patients at home or at facilities for the elderly. The nourishment of 46 patients with a disturbance of consciousness who received tube feeding was evaluated by performing 1) physical measurements, 2) blood test, and 3) measurement of resting metabolic rate. Furthermore, the anemia-like symptoms of the palpebral conjunctiva, which were supposed to be related with nourishment, were subjectively evaluated to clarify their relevance to the results of physical measurements and blood test. The average of triceps skinfold thickness (%TSF), which shows relative physical measurement data of patients with a disturbance of consciousness when compared to those of healthy people, was 105.7 +/- 39.8, which was almost equivalent to that of healthy people. The arm muscle circumference (%AMC) and calf circumference (%CC) were 87.5 +/- 11.5 and 73.6 +/- 9.4, respectively. In the blood test, the average Alb value was 3.3 +/- 0.5 g/dl, suggesting that 35 (76.1%) of the 46 patients with disturbance of consciousness had protein energy malnutrition (PEM). Since the relationship between anemia-like symptoms of the palpebral conjunctiva and Hb/Ht (p < 0.01, p < 0.01) and Alb (p < 0.05) was confirmed, there is a high possibility that these markers can be useful for easy evaluation of nourishment. Because hypoalimentation is a more serious problem than overnutrition in patients with a disturbance of consciousness, we consider that the calorie count should be adjusted based on the measurement results of resting energy expenditure (REE) in individual patients, although the count for patients with tube feeding was set at individual levels of basal metabolism in the conventional method. Moreover, further discussion is required regarding alternative markers for nutritional evaluation to blood test data.