褥瘡に対する栄養介入のランダム化比較試験

褥瘡に対する栄養介入のランダム化比較試験の論文を紹介します。

Takehiko Ohura, Toshio Nakajo, Shingo Okada, Kenji Omura, Kayoko Adachi. Evaluation of effects of nutrition intervention on healing of pressure ulcers and nutritional states (randomized controlled trial). Wound Repair and Regeneration Volume 19, Issue 3, pages 330–336, May/June 2011

日本発の実に素晴らしい臨床研究です。

Ⅲ、Ⅳ度の褥瘡を有する経管栄養患者に対して、介入群はBEE × 1.1 × 1.3 to 1.5のエネルギー量を投与、対照群は研究前と同等のエネルギー量を投与しています。結果的に対照群は29.1±4.9kcal/kg/day、介入群は37.9±6.5kcal/kg/dayとなっています。

結果ですが、介入群で褥瘡のサイズが8週間以降で有意に改善しています。栄養状態では介入群で体重とプレアルブミンで有意に改善していますが、12週間で介入群の体重が37.36→38.79kg、プレアルブミンが19.55→20.83ということです。体重は臨床的に有意ですが、プレアルブミンは臨床的には微妙な差です。

介入群で脱落者が9人（対照群で1人）と多いのが気にはなりますが、Ⅲ、Ⅳ度の褥瘡に対して積極的な栄養介入を行うことで褥瘡が改善したという素晴らしい結果です。この論文はぜひ多くの医療人に知ってほしいですし、このような論文を発信できる方が増えると嬉しいですね。私も頑張らないといけませんが。

ABSTRACT
The objective of this study was to evaluate the effects of nutrition intervention on nutritional states and healing of pressure ulcers by standardizing or unified factors including nursing, care and treatment in a multicenter open randomized trial. Tube-fed patients with Stage III–IV pressure ulcers were selected. The control group (30 patients) received the same nutrition management as before participating in this trial, whereas the intervention group (30 patients) was given calories in the range of Basal Energy Expenditure (BEE) × 1.1 × 1.3 to 1.5. The intervention period was 12 weeks. The efficacy and safety were evaluated based on the nutritional states and the sizes of ulcers (length × width), and on the incidence of adverse events related to the study, respectively. The calories administered to the control and intervention groups were 29.1±4.9 and 37.9±6.5 kcal/kg/day, respectively. Significant interactions between the presence or absence of the intervention and the intervention period were noted for nutritional states (p<0.001 for body weight, p<0.05 for prealbumin). Similarly, the size of ulcers differed significantly between subjects in the intervention group and in the control group (p<0.001). The results suggest that nutrition intervention could directly enhance the healing process in pressure ulcer patients.