慢性腎臓病を呈した脳卒中患者に対して上肢機能練習に加え適切な栄養管理を実施した一例

Nutritional management and arm function training for a stroke patient with chronic kidney disease: A case study

要旨：【はじめに】慢性腎臓病を併発した脳卒中患者は低栄養状態に陥りやすい．【方法】慢性腎臓病を呈している脳卒中患者にリスク管理や栄養管理に注意しながら入院・外来リハビリにて複合的な上肢機能練習を実施した．【結果】入院期間中は麻痺手の瞬発的な筋出力は改善したが，持久力を伴う生活場面の使用には支障をきたしていた．退院後，新たに栄養状態を改善するために処方された腎不全患者用の配合薬を摂取しながら運動を行った．結果，持久力の向上が得られ，日常生活で右手の使用頻度に改善が得られた．【結論】腎臓病を併発した脳卒中患者に対しても，適切な運動負荷に加え栄養指導を行うことで長期的な上肢機能の改善が得られる可能性がある．

　Background:Stroke patients with chronic kidney disfunction are prone to malnutrition. Method:Stroke patients with chronic kidney disfunction treated with intensive rehabilitation approaches have high reliability with managing risk factors and nutrition. Results:In in-patient settings, our approaches failed to improve prolonged muscle output, but we were able to improve temporary muscle output. In the outpatient setting, to improve nutrition, the patient received intensive approaches with newly prescribed medications for renal chronic kidney disfunction. Consequently, improved endurance muscle output resulted in the real-world use of the affected arm use in activities daily living. Conclusions:In stroke patients with chronic kidney disfunction, the long-term functional improvement of the affected arm might be improved by both appropriate nutrition guidance and intensive training.