6．嚥下・栄養 - neurology-jp.org

1 6 . Clinical Question 6-1 6 .. B .. C1 .. C1 .. ALS activities of daily living ADL .. body mass index BMI 1 3 . b .. 1 .. ADL 4 .. b . BMI . 10 1 3 .. 1, 2 .. CQ 6 2 6 4 .. 5 .. 6 .. CQ 6 5 .. 104. 6 . 2 .. 3 .. 6 .. NST .. 1 Dupuis L, Pradat PF, Ludolph AC, et al. Energy metabolism in amyotrophic lateral sclerosis. Lancet Neu- rol. 2011; 10: 75 82. 2 Marin B, Desport JC, Kajeu P, et al. Alteration of nutritional status at diagnosis is a prognostic factor for survival of amyotrophic lateral sclerosis patients. J Neurol Neurosurg Psychiatry. 2011; 82: 628 634. 3 Shimizu T, Nagaoka U, Nakayama Y, et al. Reduction rate of body mass index predicts prognosis for sur- vival in amyotrophic lateral sclerosis: a multicenter study in Japan.

2 Amyotroph Lateral Scler. 2012; 13: 363 366. 4 Bouteloup C, Desport JC, Clavelou P, et al. Hypermetabolism in ALS patients: an early and persistent phe- nomenon. J Neurol. 2009: 256: 1236 1242. 5 Pradat PF, Bruneteau G, Gordon PH, et al. Impaired glucose tolerance in patients with amyotrophic lateral sclerosis. Amyotroph Lateral Scler. 2010; 11: 166 171. 6 Andersen PM, Abrahams S, Borasio GD, et al; EFNS Task Force on Diagnosis and Management of Amy- otrophic Lateral Sclerosis. EFNS guidelines on the clinical management of amyotrophic lateral sclerosis (MALS): revised report of an EFNS task force. Eur J Neurol. 2012; 19: 360 375.. PubMed 2012 10 11 . ("Amyotrophic Lateral Sclerosis"[MAJR] AND ("Energy Metabolism"[MH] OR "Digestive System and Oral Phys- iological Phenomena"[MH] OR "Nutrition Disorders"[MH] OR "Nutritional Support"[MH])) AND (Humans [MH].)

3 AND (eng[LA] OR jpn[LA]) AND 2000: 2012[DP]). 164 . Cochrane Library JMEDPlus . 1 3 . 105. Clinical Question 6-2 6 .. C1 .. C1 .. ALS .. 1 .. 1 . 1 .. 2 . 2 .. 2 ALSFRS R swallowing part FRSsw .. 1, 3, 4 . FRSsw 4 .. FRSsw 3 .. 1 .. FRSsw 2 .. 4 . FRSsw 1 . CQ 6 4 6 5 . 106. 6 . FRSsw 0 . CQ 6 3 . 3 .. QOL 5 .. b .. 1 Palovcak M, Mancinelli JM, Elman LB, et al. Diagnostic and therapeutic methods in the management of dysphagia in the ALS population: issues in efficacy for the out-patient setting. NeuroRehabilitation. 2007;. 22: 417 423. 2 .. 2003; 43: 77 83. 3 Kuhnlein P, Gdynia HJ, Sperfeld AD, et al. Diagnosis and treatment of bulbar symptomsinamyotrophiclat- erasclerosis. Nat Clin Pract Neurol. 2008; 4: 366 374.

4 4 Miller RG, Jackson CE, Kasarskis EJ, et al. Practice parameter update : the care of the patient with amy- otrophic lateral sclerosis: drug, nutritional, and respiratory therapies (an evidence-based review): reportof the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2009; 73: 1218 . 1226. 5 ALS- ALS / .. 2007; 59: 1149 1154.. PubMed 2012 2 17 . ((("Amyotrophic Lateral Sclerosis"[MH] OR "Amyotrophic Lateral Sclerosis"[TIAB]) AND ("Deglutition Disor- ders/complications"[MH] OR "Deglutition Disorders/diagnosis"[MH] OR "Deglutition Disorders/pathology". [MH] OR "Deglutition Disorders/physiology"[MH] OR "Deglutition Disorders/therapy"[MH])) OR (("Amy- otrophic Lateral Sclerosis/complications"[MH] OR "Amyotrophic Lateral Sclerosis/diagnosis"[MH] OR "Amy- otrophic Lateral Sclerosis/pathology"[MH] OR "Amyotrophic Lateral Sclerosis/physiology"[MH] OR "Amy- otrophic Lateral Sclerosis/therapy"[MH] ) AND ("Deglutition Disorders"[MH] OR "Deglutition Disorders".)))

5 [TIAB] OR dysphagia[TIAB])) OR (("Amyotrophic Lateral Sclerosis"[MH] OR "Amyotrophic Lateral Sclerosis". [TIAB]) AND ("Deglutition Disorders"[MH] OR "Deglutition Disorders"[TIAB] OR dysphagia[TIAB]) AND. (nutrition[TIAB] OR "food texture"[TIAB] OR "quality of life"[TIAB]))) AND (Humans[MH] AND (eng[LA] OR. jpn[LA]) AND 2000: 2012[DP]). 100 . JMEDPlus . 6 . 107. Clinical Question 6-3 6 .. C1 .. body mass index BMI .. 1 .. 2, 3 .. b .. 1 .. CQ 6 5 .. 2 .. 3 .. 4 . 108. 6 .. 4 .. 5 .. 1 Radunovic A, Mitsumoto H, Leigh PN. Clinical care of patients with amyotrophic lateral sclerosis. Lancet Neurol. 2007; 6: 913 925. 2 Andersen PM, Abrahams S, Borasio GD, et al; EFNS Task Force on Diagnosis and Management of Amy- otrophic Lateral Sclerosis.

6 EFNS guidelines on the clinical management of amyotrophic lateral sclerosis (MALS): revised report of an EFNS task force. Eur J Neurol. 2012; 19: 360 375. 3 Kuhnlein P, Gdynia HJ, Sperfeld AD, et al. Diagnosis and treatment of bulbar symptoms in amyotrophic lateral sclerosis. Nat Clin Pract Neurol. 2008; 4: 366 374. 4 .. 2004; 60: 543 548.. PubMed 2012 10 12 . ("Amyotrophic Lateral Sclerosis"[MH] OR "Amyotrophic Lateral Sclerosis"[TIAB]) AND (Eating[MH] OR "Ener- gy Intake"[MH] OR "Enteral Nutrition"[MH] OR "Deglutition Disorders/therapy"[MH] OR ingestion[TIAB] OR. "nutrient intake"[TIAB]) AND (Humans[MH] AND (eng[LA] OR jpn[LA]) AND 2000: 2012[DP]). 73 . 2012 2 14 . /TH and ( /TH or /AL or /AL or /TH or /AL) and and (DT=2000: 2012 and PT= and CK= ).

7 142 . JMEDPlus . 2 . 4 . 109. Clinical Question 6-4 6 .. C1 .. ALS Harris Benedict .. QOL . 1 .. 1 .. b . 900 kcal 2 .. 3 . 4 .. 2 .. 1 .. b . 5 .. 110. 6 .. 3 .. 1 Miller RG, Jackson CE, Kasarskis EJ, et al. Practice parameter update : the care of the patient with amy- otrophic lateral sclerosis: drug, nutritional, and respiratory therapies (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2009; 73: 1218 . 1226. 2 Ichihara N, Kamada Y, Fujii S, et al. Energy requirement assessed by doubly labeled water method in patients with advanced amyotrophic lateral sclerosis managed by tracheotomy positive pressure ventila- tion. Amyotroph Lateral Scler.

8 2012; 6: 544 549. 3 Magnuson B, Peppard A, Auer Flomenhoft D. Hypocaloric considerations in patients with potentially hypometabolic disease States. Nutr Clin Pract. 2011; 26: 253 260. 4 Shimizu T, Honda M, Ohashi T, et al. Hyperosmolar hyperglycemic state in advanced amyotrophic lateral sclerosis. Amyotroph Lateral Scler. 2011; 12: 379 381. 5 E 6 .. 2003; 57: 461 467.. PubMed 2012 11 18 . (("Amyotrophic Lateral Sclerosis"[MH] OR "Amyotrophic Lateral Sclerosis"[TIAB]) AND ("Enteral Nutrition". [MH] OR "Energy Intake"[MH] OR "Gastric Fistula"[MH] OR "nutrient intake"[TIAB] OR "gastric fistula"[TIAB]. OR ingestion[TIAB] OR "tube feeding"[TIAB] OR gavage [TIAB])) AND (Humans[MH] AND (eng[LA] OR. jpn[LA]) AND 2000: 2012[DP]).

9 59 . JMEDPlus . 3 . 5 . 111. Clinical Question 6-5 6 .. FVC 50 30 50 . 30 . C1 .. 1 . C1 .. 10 1 .. 1 . body mass index BMI . 1 b . QOL . 2 . FVC. b . 50 SNIP 40 mmHg 2 .. 3 . NPPV MAC mechanically assisted coughing . b . 3, 4 . TPPV . 4 . 1 2 .. 112. 6 .. FVC 50 SNP 40 .. 5 .. 5 .. 6 .. 1 Bedlack RS. Amyotrophic lateral sclerosis: current practice and future treatments. Curr Opin Neurol. 2010;. 23: 524 529. 2 Miller RG, Jackson CE, Kasarskis EJ, et al. Practice parameter update : the care of the patient with amy- otrophic lateral sclerosis: drug, nutritional, and respiratory therapies (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2009; 73: 1218.

10 1226. 3 Sancho J, Servera E, Chiner E, et al. Noninvasive respiratory muscle aids during PEG placement in ALS. patients with severe ventilatory impairment. J Neurol Sci. 2010; 297: 55 59. 4 Bach JR, Gonzalez M, Sharma A, et al. Open gastrostomy for noninvasive ventilation users with neuro- muscular disease. Am J Phys Med Rehabil. 2010; 89: 1 6. 5 Radunovic A, Mitsumoto H, Leigh PN. Clinical care of patients with amyotrophic lateral sclerosis. Lancet Neurol. 2007; 6: 913 925.. PubMed 2012 2 7 . (("Amyotrophic Lateral Sclerosis"[MH] OR "Amyotrophic Lateral Sclerosis"[TIAB]) AND (Gastrostomy[MH] OR. gastrostomy[TIAB] OR "Gastric Fistula"[MH] OR "gastric fistula"[TIAB])) AND (Humans[MH] AND (eng[LA]. OR jpn[LA]) AND 2000: 2012[DP]).