NSTで言語聴覚士が期待される役割

The role of speech-language-hearing therapists (SLHTs) in Nutrition Support Teams (NSTs)

　NST(栄養サポートチーム)は低栄養患者の栄養状態改善をはかる多職種チーム医療である．NSTが低栄養患者の身体状態と予後を改善することは多くの報告で実証されている．NSTはまた，医療費削減にも貢献する．

　低栄養の主因の1つに嚥下障害がある．嚥下障害は3つの主な原因，すなわち機能性障害(脳血管障害など)，機械的障害(腫瘍など)，加齢により生じる．

　嚥下障害の診断は，さまざまな手技〔問診，診察，血液尿検査，画像診断(CTなど)，嚥下造影(VF)，嚥下内視鏡(VE)など〕を駆使して行われる．

　嚥下障害の治療には，原疾患の治療と摂食・嚥下訓練が重要である．SLHTは嚥下障害の診断・治療に活躍するため，NSTの主要メンバーたりうる．当院では5名のSLHTがNSTで活動中だが，高く評価されている．残念ながら本邦では，NSTに参加するSLHTはまだきわめて少ない．近い将来，多くのSLHTが低栄養患者のためにNSTで活躍することを願ってやまない．

　An NST is a multi-professional team which works together to improve the nutritional status of malnutrition patients.　It has been established that NSTs improve a patient's physical status and prognosis.　NSTs also contribute to reducing medical expenses.

　Swallowing disorders are one of the major causes of malnutrition.　The three main causes of swallowing disorder are functional disorders such as those caused by a Cerebro-vascular accident, mechanical disorders for example those caused by a tumor, and disorders caused by aging.

　For the diagnosis of a swallowing disorder, several procedures are needed.　These include a medical examination by interview, a physical examination, laboratory tests, a videofluoroscopic examination of swallowing (VF) and a videoendoscopic examination of swallowing (VE).

　To treat a swallowing disorder, treatment of the primary diseases and swallowing training are important.　An SLHT plays a major role both in the diagnosis and treatment of swallowing disorders.　Therefore, SLHTs must be key players in NSTs.　In our hospital, five SLHTs work actively in NSTs and their work is highly regarded.　But unfortunately, nowadays, very few SLHTs participate in NSTs in Japan as a whole.　We sincerely hope that more SLHTs will join NSTs for malnutrition patients in Japan in the near future.