食道がん術後患者の食行動に関する看護プログラムの有効性の検討：単一施設における非ランダム化比較試験

Efficacy of a Nursing Program on Patients' Eating Behaviors After Surgery for Esophageal Cancer: A Single-Center Non-randomized Controlled Trial

要旨

　目的：食道がん術後患者の食行動に関する看護プログラムの有効性を検討した．

　方法：食道がんで食道亜全摘術予定の患者を対象とし，病棟にプログラムを導入する前を対照群，導入後を介入群とした．プログラムは，フローチャートによる嚥下訓練の実施と，患者が食後の不快症状を予防し食事摂取量を調整するための指導で構成された．術前・退院時に嚥下機能検査を，術前から術後3か月間に体重，食事摂取量，食事回数およびQOLを調査し分析した．

　結果：対照群26名と介入群25名の反回神経麻痺は各4名であった．介入群は，対照群と比較し食事摂取量にあわせて食事回数を調整できたが，食事摂取量や術前体重比に有意差はなかった．しかし，介入群は，術後3か月には嚥下時のむせの症状スコアが有意に低下し，精神機能のQOLが有意に高くなった．

　結論：プログラムは，嚥下時のむせを減少させ，精神機能のQOLを高めることが示唆された．

　Purpose: We examined the efficacy of a nursing program on patients' eating behaviors after surgery for esophageal cancer.

　Methods: The subjects were patients who had undergone subtotal esophagectomy under right thoracotomy/laparotomy for esophageal cancer and gastric tube reconstruction. Patients before the introduction of this program were assigned to a control group, and those after its introduction to an intervention group. This program consisted of swallowing training for postoperative dysphagia according to a flow chart, and patient guidance to prevent postprandial discomfort and adjust dietary intake. Swallowing function tests were performed before surgery and on discharge. The body weight, dietary intake, daily number of meals, and EORTC QLQ-C30/QLQ-OES18 from the preoperative baseline until 3 months after surgery were investigated and analyzed.

　Results: Of 26 subjects in the control group and 25 in the intervention group, recurrent laryngeal nerve paralysis was observed after surgery in 4 each. The intervention group was able to control the number of meals in accordance with food intake compared to the control group, but there was no significant difference in dietary intake and preoperative weight ratio. However, 3 months after surgery, the QLQ-OES18 scores for choking when swallowing significantly decreased and the QLQ-C30 scores for mental functions significantly increased.

　Conclusion: These results suggest that this program reduces symptoms, such as choking when swallowing, improving mental functions of quality of life.