口腔癌治療後の摂食・嚥下カンファレンス介入効果

Effect of intervention with team conference for aerodigestive tract functions and nutrition in oral cancer treatment

　目的：摂食・嚥下カンファレンスは多職種で嚥下と栄養をサポートするために行うものであるが，A大学病院歯科口腔外科病棟での介入の実際をretrospectiveに解析した．対象および方法：手術や放射線療法を施行した口腔癌30名の入院患者に対して介入前後で藤島の摂食・嚥下能力グレード(嚥下グレード)，総エネルギー摂取量，body mass index(BMI)，血液検査結果を調査し改善率を調べた．結果：治療から介入までは平均25日であり，介入期間は平均45日であった．嚥下グレードは76.7％の患者で改善し，血中総蛋白濃度は6.1％，アルブミン濃度は7.5％上昇した(それぞれp＜0.05)．総エネルギー摂取量は2.4％増加したが，BMIは2.3％低下していた(p＜0.05)．結論：多職種がカンファレンスに介入し情報を共有し周知して，その場で方針の変更や決定を行った結果，摂食・嚥下機能や栄養状態の改善に効果があったと考えられる．そして，BMIの維持にはさらなる投与栄養量の増加が必要である．

　The objective of this research, which was conducted in the oral and maxillofacial surgery ward of a university hospital in Kobe, Japan, was to evaluate retrospectively the effect of intervention with team conference on swallowing and nutritional status. The target group contained thirty oral cancer patients who had received an operation or radiotherapy. The Fujishima grade, nutritional intake, body mass index (BMI), blood tests and improvement rate of the patients were analyzed. The results of the analysis showed that on average, the intervention was started 25 days after operation and continued for 45 days. The Fujishima grade improved in 76.7% of the cases, and, concentration of total protein and albumin level by 6.1% and 7.5%, respectively. Overall nutritional intake increased by 2.4% but BMI fell by 2.3%. It is therefore concluded that swallowing function and nutritional status were improved by the team intervention, but further nutritional intervention is required to improve BMI.