口腔がん手術患者の食機能維持に向けた看護栄養支援プログラム作成に関する研究

Development of a Nutritional Nursing Support Program to Maintain Oral Feeding in Oral Cancer Patients

要旨

　口腔がん手術患者に対する栄養管理の取り組みと，それに伴う患者の体験を含む栄養管理の実態を明らかにし，それを踏まえた口腔がん手術患者の食機能維持に向けた看護栄養支援プログラムを作成することを目的とした．

　首都圏の大学病院の口腔外科で口腔がんとの診断で腫瘍切除術を受けた過去3年間の全患者207名の入院診療録を対象に診療録調査を行い，また同病院で口腔がんとの診断で腫瘍切除術を受ける患者20名を対象とし，半構造化面接を行った．そして，双方の調査結果を並行的入れ子混合研究法デザインで統合し，栄養管理の実態を構造化した．さらに，その結果から看護栄養支援プログラムを作成した．分析の結果，口腔がん手術患者の受ける栄養管理の実態は，手術侵襲に伴う栄養状態の著しい低下だけでなく，継続的な栄養状態低下に陥っていた．その中で食に伴う苦痛や満足感の低下が生じ，食事が進まない体験をしていた．それに対し，周囲のサポートや食事摂取量増加への自身の取り組みが行われ，退院が近づくと退院後の食事に対して不安を抱えていた．

　看護栄養支援プログラムにより，治療法が多岐にわたる口腔がん手術患者に対し，介入時期や要件，その内容が明確となった．今後の導入により，看護師中心の医療チームによる栄養支援につながることが期待される．

Abstract

　In order to develop a nutritional nursing support program to maintain oral feeding in patients undergoing surgery for oral cancer, we introduced nutritional management for such patients and evaluated their experience and nutritional outcomes. Clinical records were examined for all 207 patients who underwent oral cancer resection at the Department of Oral Surgery, University Hospital A in the Tokyo metropolitan area during the last 3 years. In addition, 20 other patients diagnosed with oral cancer who were scheduled for surgical removal at out department participated in semi-structured interviews regarding eating was later examined. Data from the two groups of patients were integrated in a concurrent nested mixed methods design, analyzed comparatively, and systematized to understand the outcome of nutritional management. The results indicated that the patients' nutritional state declined significantly following invasive surgery. Malnutrition and poor appetite continued because oral feeding was painful and unpleasant due to the symptoms, including pain. Although food intake increased with support from others and by the patients' own initiative, as the day of discharge approached, the patients became anxious about eating after discharge. From the results of our nutritional management approach, we successfully identified the timing, requirements, and contents of intervention for oral cancer patients who generally can be treated with a wide range of treatments. Once these results are incorporated into our nutritional nursing support program, the program is expected to assist medical teams, centered around nurses, in the nutritional management of oral cancer patients.