nst 4 - marianna uigakukai.marianna-u.ac.jp/idaishi/www/353/06-35-03hiroyuki hayasi.pdf · vol. 35,...

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腃腄腂腀腁 腸腽腩膀腲膈膔膞臒臝 Vol. 35, pp. 151161, 2007 腌腑腐腅腂腀腁腄 NST 腇腎腒腊腆腎腉 4 腏腈腃腇腎腋腍 腗腞腌 腘腢 腟腆 12 腝腠 腞腛 腘腢 腟腆 2 腜腞 腌腒 腜腖腡 2 腑腃 腎腏 2 腅腣 腌腛 2 腊腣 腙腍 腑腖 12 腅腣 2 腘腢 腟腆 2 腗腛 2 腞腛 腝腔 腒腅 腘腔 2 腕腅 腋腣 腂腈 2 腎腏 腘腢腌 23 : 膇腇 19 5 1 腸腽腩膀腲膈膔膞膏腊膄膁膃膐1987 62 腘膚膋腌腏518 臲腙膬膤膲膋腔腁腤膋腚 2002 9 膷腡腣膌腫腷腀腱腮腀腺 nutrition sup- port team: NST腇膕腌腏臄腔腚腎腙腐腅腡腜膋腬腭腰腺膑腙膴膇腧膜腍腤 腕腕腠腘NST 腭腐腘臆腑腏膋膌臶膯腕腌腓臸膊腙膌腍腤膅臣膔腘腅腈腤膌膹臍臧臛腖腢膞腘腒腂腓臉腍腤腞腏 NST 腘膣腦腤膈 膡膾臘臏臘腽腳腴腽腰腀腬腻膀腙腭腪腾腩腯腶腅腡腜腽膚腆腘腒腂 腓臮腝腏膈腘腌膝臩膌腶腼膀腧臡腌腏腇NST 臰腌腏膌腶腼膀腧膌膝膋膌膛膡膛腓腇腩膘腘腧臹臟腱膙膹臍腘膆膤膈腙自腥臶 膯腧膘腌臅臑腌腏膓腄腓膄膠臨腧腇腨膛臯膶膢腗腖腙臥膠膱腘膆膤NST 膽腙膌腧腩腾腵腹膀腔膹腌腎腙膑腘腒腂腓臅臑腌腏腞腏膂腒腆腅腡腜膴臎膢膌臰腋腥腤NST 膽腙膌膝膋膌膑腘腒腂腓臮腝腏臄腙腇臋膽腙 NST 腘腅腈腤臦腙膆臠膿臵腘腇腣腥腌腗膌腧膝臸臩 腇膭臙腍 NST 腇膋腘腋腢腘臌腂腓腂腈腛腕臅腄腤腈腅腋腇 腫腷腀腱腮腀腺 NST腮腀腺膈腸腽腩膀腲膈膔膞膏腊膄膁膃膐1987 62 腘膚膋腌腏518 臲腙膬膤膲膋腔腁腤膋腚 2002 9 膷腡腣 腫腷腀腱腮腀腺 nutrition support team: 膃膐NST腇膕腌腏腎腙膽 NST 2003 9 膷腘膋腙臢腗臷腔腁腤臈膌臚膎臤腕腌腓至NST 腚膂腥腈腗膌膛膠膌腂腀腍腤 腮腀腺腔腲膎腷膀膒膥臃 Ver. 5 腔腚臛腊腕腘 NST 腍腞腽膚腆膦腋腥 1腞腏臨膥膣腔腁腤腲膎膛膠膌腂腀膮膨膗腙腻腗腗腖腧 自腈腙臦膙腘臞腍腤膋膥腽膚膄膒 腕腙膘腇臂腞腑腓腂腤腉腙腡腃腗膳腠腁腣NST 腍腞腋腥2007 2 膷膼臐 983 NST 腇膟腌腓腂腤NST 腲膎膛膠 膌腂腀膮膨膗腙腴腢腧自腈腋腢腗腤膈臇膺腇腞腥腤腉腕腕腗腑腏腎腉腔膼臐腞腔腙 NST 腧臬膵膘腌膋膛腘臡腍腉腕腘腡腣腤腉腕腘腗腤腕臅腄腢腥腏腞腏1 腸腽腩膀腲膈膔膞膏腊膄膁2 腸腽腩膀腲膈膔膞膏腊膄膁NST 3 腰腏膟膉臜膞膞膔 151 25

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Page 1: NST 4 - Marianna Uigakukai.marianna-u.ac.jp/idaishi/www/353/06-35-03Hiroyuki Hayasi.pdf · Vol. 35, pp. 151 161, 2007 NST 4 1 2 2 2 2 2 ˘ˇ ˘ 1 2 ˆ ˇ ˆ ˙ ˙ ˝ 2 ˛ ˝ ˚ 2

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� ����������� �!���"�#�� "�$� 1987��%! 62��&'"()�*" 518*+,#-.�"/01$ "$ 2002� 9�234$567897: �nutrition sup-port team: NST� ;<%()$ �=/$>+�3&?@2A"'BCD:E+FGHI(J1KKL&� NST <%)&�M) "4$N*OPK(Q� RS+4$&+J1TU,V� WX-�&@Y14$Z.[V�\/� 0]12/&^_Q3`J1$ a) NST &Zb1�c� dec� 4fc� N*4$g� �hi�D7Bj��+Ckl�mn@2A56#&^_Qop)$ q7�&+(Wr4$ns�H8t();� NST ;9u()4$ns�H4$N*:;� 4$<� 4$=�� >?@A� vw'B� 4$Z.[V&CD(� q7�+�ExOPHyF(z{()$ |}Qq7~�H;�� ��� G�N��+�~�&CD( NST �E�+4$�HH�l���I/[J(>+KE&^_Qz{()$ a)�L#@2AF�#��MN4$;9u�x1�� NST <%�+4$N*:;+KE&^_Qop)$ �=+��N[J;��+ NST �%&@Y1�+��� ��&�;3� �L/OP�4$N*HWRr;�Q/R�J NST �%;"'&��&��_Q_Y�Kz}1$

��4$567897: �NST�� 4$N*� 97:�-

���������� �!���"�#�� "�$� 1987 ��%! 62 ��&'"()�*" 518*+,#-.�"/01$ "$ 2002� 9�234$567897: �nutrition support team: #��NST�;<%()$ >+� NST$ 2003� 9�&�"+S��=�/01T�4$� ¡K(Q¢UH

V)$ NST $�L/OS�4$-;H9WJ197:/� ���-£XY¤£¥ Ver. 5 /$\Z¦K& NST Z[+56#;\§�x1�� a)]¨�£Z/01��4$-;9W©ª«+^_��H�Y� �-+�¬`&­J1�"£X&56��aK+*y;�aMQ_1$ ®+2¯�b°L03L±N& NST;Z[�x� 2007� 2�²³ 983\Z/ NST ;�c(Q_1$ " NST L��4$-;9W©ª«+U2H�Y� ���1�-´µ;dax1®KK�M)$ >®/� ²³a/+ NST �%H¶·yF("'�&tJ®K&23� ¸e+*y�©fHV1®K&�1Kz}�x)$ a)��

1 ���������� �!���" 4f�2 ���������� �!���" NST3 ¹g�º&h»i¼�� h»i¼�� 4$��

151

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Page 2: NST 4 - Marianna Uigakukai.marianna-u.ac.jp/idaishi/www/353/06-35-03Hiroyuki Hayasi.pdf · Vol. 35, pp. 151 161, 2007 NST 4 1 2 2 2 2 2 ˘ˇ ˘ 1 2 ˆ ˇ ˆ ˙ ˙ ˝ 2 ˛ ˝ ˚ 2

������� NST ��������� ��� �������� 2002 � 9 ����������� NST ����� ���������� �!"�

NST �����NST # 1970� �� �$%&'(��)��*

�� ����+� �total parenteral nutrition: ,-� TPN� �.+�/�����01� &2324�5���6789��:������+�/��;<� �!=�=�*��2�� ��"#>�$�?%+�&'(@#� A4BCD)�*E*+�?%�+�,��1� *+��-.��$�/,�F0�G1��H��I��2*�� ?% QOL,J�34K�E)�5��$�6>�+�/�L$�7��89*��3�� M�:0;N��O�(#NST <�=>��P�)��*��<�$� NST #�$�� 30 �Q�R?S��

.)R@$*��� $A( NST @$�B���TQ� +��C�DE��FG�RE0E� H��IU1J� JVWX��+��CYK� L�ZM0[J�N\JO�+]��T(^)�� �?S#P_RE4�� O�(# NST �E`J�QJ�R���34K�0M��FG�STa3b(���RE� ���UV(#STa3bQJ�W�c[+��C�DE�#89*�RE0E�d� XY�NST ef%82bQ�g"���^1� ?S#�hi1j32kZ[ �potluck party method:PPM� "0<h\H" ��� �Ql]m��hi1j32kQno"^p� NST q_`�a�r�bs� #tQuL�a3bQef"PPM ZCQ�g�� a3b��Qef"%82bQc1�v��Q2���

������ NST �����de0+�/�Qa3b��Rf"�#� +

�/��;<gR��s���Sh�Q>w"�� �� t�;6x� iyQJ����0� ��z��d�#R�0�a3b���j"�{�.|}~�A~����(^� NST �kl����1mn NST a�A�D(^o��A�_0�pq�zrst��N�uv�VWw�#R�0�iyQ�x��yQz��

�����������R�0�iyQ{� �pq,-� /�+�|�}�~�x� NST ����W1��)��NST #R���� 1 �(^� ��89���NST Q�A�s��J�"%82bQ�g���2002� 4� TPN����Z6��+����A�E0[Q��"�s�(^)� IVH&ED�s�Q��� NST ef�s������ �pq�s0� z��a�A�D(^l������P����s0����� �s qH��� q_`���L�����s��� �s��#��qR���NST �D}3Q�1� m�O� NST �D}3�0)��s#� J~ 26�� ��~ 23�� /�+�| 3�� }�~ 4�(^)�� NST ���Q Fig-ure 1 �2"� NST ��# NST ef�s��������Q�����"M�Q"�s�(W�d� NST �����c����� �!�� �H 0[����Q����� ��+��I"���u� ����Q ���� NST V¡�Q� 1�no"M����� M�c� NST ef�s�(#a3b���6¢�£�� +�¤ ?%Q¥L"+�8�¡3¢D£ZCQ�¦��c�� �/+�a¤3B�¥�<0[�§¦Q§¨"�¨����¢¤A4�c��©ª� ��+�©ªD�««�a0E¬}ª8�@$0[� +�/�Q­g�f"�d�®!6@$Q¬)��

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Society for Parenteral and Enteral Nutrition: ,-�JSPEN� � NST �¯°��9�\H� 2004� 3��#±­®Q{$� NST WX8�f� 2004� 8�� "V�� NST��8�f� 2006� 9��#/U+��C¯°x��� NST ��f8�Q{�� ��J~�+��j"²WX�����R JSPEN ��o" TNT �total nutrition ther-apy� ³¡�� 2002� 5�� 3�Q±´���##µd� z��(���²T"J~ 7�� TNT {³Q­��RE� M�c�V�³(�¶´#2007� 3�µ�(�·¶, 62¶� �·¸¹�º�>» 15¼� ªD¸¹¤33º�0)RE

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���� �������2001� 11����� NST ������ 1�������� ��!"���#����$%&� '(&� )&� ��*� +������,��-./01����2�� -./0134�5%& 44.5��164 �� 73 ��� '(& 80.5��405�� 326���6� 78$ 70.9�$9:� �����;<=56���>?��@� A���$5�10��50���A3��!"�� 80�AB��CDE�@�F��GH������ I�J���K���25L�MNE� ��OP��;QRST��UV��W�AXY@� A����5�Z[7!"��Y\W�� A3��� �����]^_`a��b c������d�A\W� � e!� ���f0g��%&�h:i�$�TPN jk"����2��lL� ���mj#�$5n�op��@� ���$5� ��q�%&5rsA� 3��� �-./015��tu01v0w �NST� A�Yx%�y���&�� ;'�NST ��z{�|(�}:�� -./01~^@�� ����� ����� ����)y��� �A5��$��� ������8��}��*5+,$9�� ����5%&�k��`��2z ���/0����d�A\W� �

���� ���� ���K����#����$� NST -�����,.�/����A8b�0�$�1�������� ��������������2A����A����-���.�j�.��q�9�5�� 3�-���.�5�;QR�45�6���$9�A�,�@�z ���6�� ��:���GH<=�7���D��;�-���.�058&@�9 A\W� �� 2001� 12�:;�;<=��;�-���.�Z@� �������0����� �Figure2�� -���.�0�5 54.9�� �.���0�551.9� $9��  A��;¡�¢£-v¤.��0� 79.4� �¥3:� �~^@��;:¦������§¨�2A��-���.�j�.��q$©W�A�:�5ª<$��d�A\W� � I-���.�0�5«�¬R�­�D� e=®¬ 83�� ¯�°'¬ 88�� �±'¬ 80� �6�;¡�� ²³®¬ 9�� >´k®¬17�� ��µ�«�¬?¶5 43�$9:������� �����8b�05��K��·@$9�� ¸AA�,¹@� BMI �body mass index�kgm2� �º�z �BMI � 25 �r3�A B��� C � 18.5 �¥3:lL5 �{� AD»z ��GH�D0z �� I8bE�5��$�¼:c�D»���2A��b Az �7�� ��K��_��b ��2$9�8b�0������D� NST ���� 2001� 11�� ¯�°'¬_`a®¬FG�;

Figure 1. The formation of the nutrition support team in St. Marianna University

School of Medicine, Yokohama City Seibu Hospital.

activity of nutrition support team 153

27

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����������������� ����������� ����������������� �� �������� �!"#$� �Table 1�� ���� �%� �&��� �'()*+,-� ������.)������%�/����0� 1���-����� 23�4��5 �6����7-89:��0� :���;<������%��=�>��:�� ������.) �� ���7-89��?@�A� NST BCD* E� F�G� �A��!*%/HIJKL�����*5����M�(NOP�QRS�T�"##9��

�� NST ������� NST ������ ���NST �U$%� �VW�X�%/�Y&;<Z

1�� NST Y&G� � �[-\�]��^_� ` �ab'�cd�4'�ef���g�� F�G� (h$�iPj()�� � )*Kk'+l

,m�9,\�NnoNKp-�X�.'q/()�!0r*�s����,#��( �'�Harris-Benedict t8��u�vw� Fx�yz{ �|}��10��� ~�23 NST ���P%����\��9���*+�:�;<4�M�(2�5K6�� 78 �%M�;� ()�9: �|}��0�� E������%� ;��(���+� NST i�o�jP�X���x� �NSTi�o�jP%�� TNT �CD��<W�-$���� � �[K23���P�/y���� �|}��1��� F�r*�G�=�7�10��� 9�x���-10�� �|}�5(�g����(�>?K2�()�����:�� 1�7��_@�9{A ;<� Y&;<B¡1*% 48 �¢£��CD���� 1 NSTi�o�jP%���¤E�(¥¦§P��F�GH� ��*+x¨�VW�©M�I#� NST -ª«J¬­��9� �KL^_G�®� � ]¯��°()�¬­M���� ¬­�!�-±?G� ²�³�´�µ¶�� NST Y&G� �

Figure 2. The ratio of inspected operations related to nutrition in each department.

Table 1. Investigation of Weight Measurements Before the NST Began Operations.

N ·� ¸¹º»¼ <154

28

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���� �� NST ����� NST ����� 3� ��������������� �� 1���� 3.29������ 48��� ������� �!"#$�%� 2� 2.39�� 3� 2.09��&'����()*%�+,-���������.%/$� 4 � 2.67 ��01�����&���%� NST ��2� �3&456��������7#,��(8�)*%�+,-�� �����������(�� 9:;<=�>?@A��B�CD-�%� E NST :�FG�H�IJ*K�@�.,�L�%�M� NST N��O�PQ�R.ST��

���� �������2002 9U#, NSTV�&WX�XY+�� �Z� V�[\�]^�QTS_`�� NST V�[\�� ���7 1��abc d 10�&���14d� �d#, 48�� NST V�%/$�� ��!��e"�efg���% 19��# 40���h@iT$%&&+�� e"�efg����V�[\�� P'��=(���2@ NST �Gjk���L�#,� l�<N�%m )'�*+8�L�� TSno%/$��CD-�� 2�p�V� �d��,b��+,-"T@��� -qrd� .' d�V�%/s�� J2�0��t1�i2\�34�5Zuv"w���x6K�78&yQz�%9��"$��

���� NST �������NST V�[\���]:�QTS� ��2 4

��{$|& Table 2 ��8� };~����<�=>�?�����@�����S BMI �bodymass index�, IBW �ideal body weight, 6A>��

$� TSF �triceps skin fold,KB���CZ�D��,AMC �arm muscle circumference,KB����QTS$|��� =>�?<� �TSF �� �AMC�T�-@ JARD �Japanese Anthropometric Ref-erence Data� 2001���+�� NST ��#, 4&'���2@V�[\�~����<�=>�?<���<&Z�$ST�� L�L�#, NST ��2@0��[\�,D,�m �E��� NSTN���F�S45G�H%���-��

���� NST �� ����������NST %V�H���������8"D�G�

"��I���� 6�A-&�J�����������x6KL� ��x6�G�"���M�"w%� V�H�w�NOWX�-,-ST�#� L���&{�� 6�� K� ��� 4¡¢�£"w�,¤PQ&WR�NST �����¢�£S¥%���S�T�� �Table 3��NST�M�����x6KL� ASPEN �Ameri-

can Society for Parenteral and Enteral Nutrition�¦§¨�§��©$�9�� 8"D�UxªV«Wz��'Ux��&M��� 'X�¬xx6% 6­�K�Y�x6�"$�®�� ¬Z[\&M���� ]^���Ux%ªV�M"Tz�� 2­�K%_A�-�®�� TPN, 2­� �`¯]^��&M���� L�5� NST V�[\�'X¬xz�%9°� ¬Z[\&�±8�²�:%9#$�� L-�'X¬x�a���³Y��� Xb´�µ¶� 5Z·c�d¸� ¹º\�»�"w#,�6e�R.�� �#��±�f8�V�H�¢�£S¥�g�NO�h6$�� L��B�[\ ��¼i�jn%k,-"#$�L�� 6�(ml�¬Z[\%W�-mW"w�6n�/$�� o�(ml�78�

Table 2. The Nutritional Circumstances of the Patients Requested by the NST

activity of nutrition support team 155

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����� �������� ������������������������ ���� �� �!"���#$%��& � �!��'(%����)� *������%� �!+,����-����� ���� �!�� .���/%� �"0123�!"#$��4�� 56%���%&78'()*#$9:4�56+,� �!2;���-����� (�-<./ �="012345�� GFO��>?@AB�6789:;C�DEF��2;� <=2 �(�>�%�?@�GH��� -H� ��A� evidence based nutrition

"IB+C�D�H�� �!"E�8J@KLEMN�O�� �F� � GAHHP�%�pharmaconutrients �2�QI�RJ��4� �!�SH��10�� NST TKL%�U�H"���<8%� ��"MV��%� �W"D�XNYO� NST ZPQRPHS 60� [%� \P"]��T^%_UT`a�� U�H"V�� �W"WX �bc"dY����,��e�-�� �!�W"S+C�fgU�"hZ-[%�i:������ ��� �j+�[�\klU�/NST "m]^$_n�2;� �!"`ao�-H�K�����+`�� �!� �b�c�2pde+qr-�

�� 2PT�fg"_�pde�sh+`�� sh� �!"ijt� .�E�� 0g"k� �!� ;ClE��a�c�2�u�vm���-��+� �!"� ng+o�2uwT`���px-����11�� U�H"qPH �!� r"shyz��%� NST T�>Dng{-

KL%�� |G� �">Dng{-�}~�s+t��2�� 2;" NST }~WPH"M#�`�� }~�s��%P�`u�>Dng�B���?T�� ���B�"vDwa����� U"�B�� NST To�"xlyz%�>Dng�{��g��8"_�yz�E9|�%���� (�.>�.�}!"� ng����#$%�� .�}!d�=��~e+qr%/��U�+px-������P12�� Q�T�./ �=".�}!l� ���G-��13�� D��.�}!"^�����!"0n.>�� .���+����C��(��~e+qr%/�l2��%�.�}!"� ng����U�+o�T`���px%���14�� U"D�H"�G�O�����!"��� >��]���%� ��?����O���.�7���J�%�./ ���+ 1� �!�-<8%�e���� ^�T��¡�2ng�-�� 0.1 g�kg�hr �!"� =¢KL%.>�.�}!"d�MV%�� U"�� -<./ ����" �e£=�� ng"�_����p"¤[2;�� �!"� ng���� NST "KL�� ¥PQR����g"��T`a�+� ZP 4 ��� 8 ¦§+�¨D�H���9����� �©S/ª«A��a��9��s�¬���%�9­�KL%�®�NT`�� 9­�"�¯+���°nH��yz�� � �±/�� ²±2;� �³yPH�s�¬4�yz�´Hµ� _­²±/�±�2;*��±���%���� _�8¶·¸n¹HP"�3��¬4Q� �9�s�¬4�_�z+���-��15�

Table 3. The Ratio of Order Reflections by the Doctors from the NST’s Recommendations

  º� ¡¢�»¼ H156

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�� ������������� ������ ������ NST �� �������������������� �� � �!��"#$% �& ��� 2003� 4'()��*����*� ���*� ���+*,-.(/012034567��8��� ����901���:������� �9�;3<= ��>? �&VF �Video Fluorography�, VE �Video Endscopy�@A� !� ����B��9C"D#���E�@$F��� ?G� %H���9I&�JK'L�':��;� ��B�012034567()�*+F���@A,-�./ �� 0�MNOP7�1Q�

R47S4T�2UVMNOP7�E�,-D#��W4<�X� #�YZMNOP7�3[\�4 205�X�]� NST ^!6�_7`8�ab�9�� � ��_7:;�<c�=�����>d�?#� e@� UVMNOP7�3[\�4 1.9 5 A�� _7fc�gB�C-�h16����D� EFiGjHkIl�mJno �pK �qLF�� mJMN,-B� O?�rs�no�PQ#� �RS �TtF��17�18�� �L�����@AuU�5VWX�YSF����]L� Zv�@AD#w&� �NST @Axy=��E�z<#{[�|}��� @A,-./�\#9Z�4 6~�]�}�� ���@A�_7`8^� O?L�RS�@A�X)� �B�NST ��F��_=`�X���0a,�b���c��^F�� JK'qd�(eQ�_7`8�f]�|��� ���� ������@AuU�eghi�-��j%WX�.�er�k�l����^� NST �m� 4�d����� NST �nb

��_7U�7�./�\�� 0a,�9Z�_7jo('�9Z����p�L�q��������� NST �n��,-� ��-� `8_7��r�-�E�����st L�n�F���Z�X)� n��\#,-�9Z�q�������4��m�-�.(/O? ��Y���c ����

���� NST ����������NST �mB� uvWX*()w��x��D#

�X}�� ���x�y� NST ^!B�_7z�

�� NST �{�� � 105d�^���4���|���� � }~� � }~���+��E�+*x�� �m`Il� ��D�x�� 4 ����� D#>� ^! 1 �B� ��>_7¡¢�NST �£���O?�~¤�1Q�� �Table4�� ���w�x� ¥ � NST D#L�^!��>�_7z��MNOP7�¦�@$�� �Ta-ble 5�� NST D#>��x� ���O?������W4<�u��]���� ��BNST �(_7O?�nb�E�()� D#B1 �B� NST ^!��>�_7�O?�§¨��� �� NST D#L������MNOP7��� � }~�|���q��� ���m`Il�|�p�L�iG�b��� e@� � }~�|�� _7����(}��O���_7qd�XMNOP7��iG��� NST^!fc� ADLj QOL, ��N�iG�E� F��y�qd��-�@$#O?�X� �b�� ����� ����B�©��X�

�� �������� ����������NST ��m6B� H�og�_7`8.ª�Figure 3�b#� TPNj��_7� �enteral nutri-tion: EN� }����_7`8�O?�|��kh��¦��]����� «�� NST �¬­F��%��U'� TPN ��S)®�X}������ NST ��m-� �� TPN `8�|��[{�¯���� Tt#���X19�� %H�� NST �mB� e�� TPN `8�|�[{�b���� °§��>/q��� �}�� ��?±��F���²�@$�O? ��� ��_7���_7�1Q��(��8'�X)� �m��E��³'¤����c�X)20�� F���´'�R��X� �p�L�F��21�� µo .(/�´ L�� ��¶S�h�|���`_7�|�� �_7`8�·���Z¡) TPN �er�()¸¹��� � NST �m����¢)��

� �

NST �mB�Mº=»��� £¤¼�X�¼�.�!H\d�A¥j!H¦S�¤��c�³§c�¨)�E�p�L �}�22�� e@� �

activity of nutrition support team 157

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������ 2001 ����� �� PPM�potluck party method������� NST��������� ������� !""#�� $%&%'()*+,� -./0+1�2�34567$8�9: !��;23�� <=� 2002� 9>� NST��?@A�� BCDE 200F?GH; NST IJKL�MNOP�QR2�S�� D�IJKL�TU

11V�=WEXYZ?@[�� MNOP�\]^� _`MNabcd�e�fg�hi� MNOP�V�j��fg�"��kl��?m2�S�� no�9:�� NST ���=W�MNOPpq�g��rfst?��ujv�"��� 4�w�px?yDH�z{���<=��|; NST ��}���?D1~;1�

Table 4. The Ratio of Energy Su$ciency of the Patients Requested by the NST

Table 5. The Changes of Objective Nutritional Indicators Classified by Diseases

Figure 3. The monthly transitions of TPN and EN controlled patients both before and after the

commencement of NST.

� �m ����� 158

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NST ���������������������� ������ NST ��� ����������������� NST �������������� �� NST ��! ���������� ��"��#$�%��� &�'��������(� � NST )�����*+,-���.�!��/� ���� "0�123��� 4�� 5������6��7���TPN 6����� �!8� 9�.! ���"#� NST )�'$�: $/� "�� "0�$%&$'3;�"<�� �=� NST �>(8)?>���5���@AB�C�D�*+���E,���F-6�"0�B@A*G@H�I.J"0K%� L5/ �M0� 5�F-��#1�23� N3456��M0� 78�M0"0�NST ��9�O=�'3;":P�;3���"�� Q�3�&�����R'� STU< .J �V���� �3�W=XY>5�=Z!� ?�X�5�@>��"#�;�AX�B["\C�D]!2�;� >#^E_����F�`G"0�NST a'$��6��b�H$�IJ ����Q���"@� /%��5�7c� NST ���=dKL�Me;3f=��� 9: NST �N�� ASPEN ghi�h�>$Oj3����24������"#��!�P�Q�k%�RS"bl� 8� ��Tm�\U�!���$�;� ���F�$%> �;V'"&��n� Q�WX>�����N��<���� �3� NST ��������\U>#��o���;�P�> 8 NST�N�YL�Vpq> �� NST rsN�Me��*+���E,��+�I�6�� Z[� Et\()s"0� ��uv�w�B"]^D]� x�;�_`"���Fab�!>P�"KL> �� 9�cd\(�ey�fPgh"0zi�� ��@AB�C�D� ��*G@H�I/�aj �����<��n� NST �q;Q��>�"�KL> �� ��k��l���P�=�{|����R/� mn�� 93:� JkB�}~i�hi�o�! ��;���@�~������@;3� 5������FV��� �^p�j��q���� r�N���s��rt�u��7�����r4�F�v�cd\(M0"0�w&;3 NST �7c�Ki� �� �5r�x�

TPN�y�z{7��|o j�4�6� �&�|o ��;3� ��-�}Z[! �~����1! ��o"0V<���13�� Q���"r��\���! 6�� NST �7��$P�> 8� ��j�Me�����f=3��� Q�3 4KL��;� �lU�x� B��B�����x� �d�� ���"0�n�KL� NST �b��Q���8x�� _`"���F��3������$��f=�� ���F�b���� �4��) ! ���� � �8_`"! 6�����������u���+> � NST ���=��nR'���f��7��$P��f=3���

� �

4��� NST ��7��� �N� rsN��%6���k� r�N� B��B�����x"0dx������8� 5����6��������U< � ����C�*+��p��"<��NST ��! �� � w��f=3������������ ��"#�/� �Q���8�! �!  ��F������$ �nE¡ �� R^�U<>� NST a�:P���=������'3;�>�";<�&$ �� ; ¢�£���� ��"0��6��¤�D���K�� � �5� NST ���a�h� ���Q�¥�¦���� §��7c� NST ��8� _�"��6��L5/ �#1�� ¨"0�b��Q���¡�:25�� �8����6��! QOL, PS �Performance Status� �©!�9�Eª=�$¢� �>5b£��<���> �x¤� �����«�8� x��_`"��6�dKL���>9¥ NST ��5���3�¬¦nQ�­<�§9"��

� �

®�=����8 NST ���¨¯�����©�°�o� °��ª<��«�B*�±�²�¢³¬­®x>5>5¯� I@´°±3�²«�B*�±�²�¢³¬­®x>5>5¯� �³´µ±3�©�¶ !29� 9�����@µ�"� NST ¶·¸A��¹%�·��º³¬­�­¸>5 »¼¹º±3»%d¼�²�±3�"3����x� rsx� B��B�����x� r

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������������� � NST ���� ���������������������������� !����"�#�$%&��'�����

����

1� (�)(*+,-.,/http:��jcqhc.or.jp�html�documents�pdf�jikohy-oukaV5�V5DATA�G.pdf

2� Blackburn GL, Bothe A, Lahey MA. Organi-zation and administration of a nutrition sup-

port service. Surg Clin North Am. 1981; 61:

709�7193� Sheridan, J. F. and Calvert, F. S The nutritionsupport team Results of a comprehensive hos-

pital survey. Ross Laboratories, Columbus,

Ohio, 1983

4� �012� 3 ��� 4��5� Potluckparty method��6�789 NST�:�;<=>� ?���)@A� 2000; 17: 407�412.

5� BCD� E�FG� H�IJ� �K��� �LM��NOPQRSTU� V�;�?� 1999;14: 21�26.

6� Charney P: Nutrition assessment in the 1990’s,where are we now?. Nutri clin prac 1995; 10:

131�139.7� W��X� Y�Z�� [�6 !�"#@ !\��$]^� !_` 2000; 6: 18�28�

8� Harris W, Benedict F. A biometric study ofbasal metabolism in man. Carnegie Institution

of Washington 1919; 40�44.9� Journal of Parenteral and Enteral Nutrition Aninternational journal of nutrition and meta-

bolic support 26 1 Supplement, JPEN 2002;

January-February: 10�11.10� Heyland DK, Novak F, Drover JW. Shouldimmunonutrition become routine in critically

ill patients? A systematic review of the evi-

dence. JAMA 2001; 286: 944�953.11� Wab� c%&d�Sefg-� nutritionsupport journal 2004; 14: 9�11.

12� Fischer GW, Hunter KW, Wilson SR, MeaseAD. Diminished Bacterial Defenses with In-

tralipid. The Lancet 1980; 2: 819�820.

13� 'hi� ()j�� IVH kil*@+�!�,m� -��n+�!opq 2000; 36: 37�41�

14� .rs�� tuv�wx�yz\@{/0��:|�}~� 1994; 168: 515�518�

15� ��1�2� ACE �v+@3��4�� -��n+�!opq 2000; 36: 75�78�

16� 5r�6� 7�����uvA��$�O?�M�@��� Rapid turnover protein�#���� t87�9d:�;<� 2004; 27: 204�209�

17� WY��� ��=i� +��>�uv� ?���)@A� 2005; 22: 143�145�

18� ?���� �)�@� A��� >��B 10C� 2278 D���OE�F��� -G:q1995; 54: 529�535�

19� �H�I�  )¡� rJK�� NST �?�¢£,U¤,-� &ICT �yz¥TU¦,§¤,-�¥¨©ª,«¬T�­> �4C��M��®¯� V�;�?� 2006; 21: 35�42�

20� Moore FA, Feliciano DV, Andrassy RJ,McArdle AH, Booth FV, Morgenstein-Wagner

TB, Kellum JM Jr, Welling RE, Moore EE.

Early enteral feeding, compared with par-

enteral, reduces postoperative septic complica-

tions. The results of a meta-analysis. Ann Surg

1992; 216: 172�183.21� Kotler DP, Fogleman L. Comparison of totalparenteral nutrition and an oral, semi elemen-

tal diet on body composition, physical func-

tion, and nutrition-related costs in patients

with malabsorption due to acquired immuno-

deficiency syndrome. JPEN 1998; 22: 120�126.22� Nehme AE. Nutrition support of the hospital-ized patient :the team concept. JAMA 1980; 16:

1906�1908.23� �012� NST °¦/±²U³´µ¨´T :¶+·L �¸ 2001: 70�82.

24� Journal of parenteral and enteral nutrition aninternational journal of nutrition and meta-

bolic support vol 26 No1 supplement, January-

February 2002.

25� Payne-James JJ: Cost-e#ectiveness of nutri-tional support teams. Are they necessary?� Nu-trition 1997; 13: 928�930.

' hi ¹ºr»¼ w160

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Abstract

Starting up a nutrition support team �NST� and its achievements duringthe first 4 years at St. Marianna University School of Medicine,

Yokohama City Seibu Hospital

Hiroyuki Hayashi1, 2, Hiroyuki Komoriyama2, Minoru Miyashita2, Suzumi Soh2,

Yukiko Kawashima2, Sonoko Sawafuji1, 2, Misako Kawase2, Hiroyuki Abe2,

Kumiko Hamada2, Takahito Yamamoto2, Akeo Nakazawa2, and Hiroshi Suzuki2, 3

St. Marianna University School of Medicine, Yokohama City Seibu Hospital, was established in 1987

admitting patients in their acute phase. This 518 bed hospital has operated a nutrition support team �NST�since September 2002. In this article, the origins of the NST and the details of the system inside the hospital

are described. An investigation of the sta#’s awareness, the ratio of inspected operations related to nutrition

in each department, and the ratio of weight measurements are reported as nutritional circumstances before

the NST began operating in this hospital. The necessity for improving the skills of the doctors, nurses,

pharmacists, registered dieticians, and rehabilitation department as a whole, is discussed. Each and every

nutritional plan requested by the doctors, and designed for the patients has been presented by the NST. In

this article, the nutritional plans presented were classified by nutritional management methods, nutritional

quantities, nutritional compositions, speed of administration, diet content, and inspected operations related

to nutrition. The results were then collated and analyzed. In addition, patients who were requested by the

doctors in charge were divided into various groups, such as cancer, trauma, cerebral vascular disease, etc.

and the changes of their nutritional status were noted after intervention by the NST, using albumin as a

nutritional indicator. In the worldwide recommendation of enteral nutrition, where costs and safety are

concerned, the changes in nutritional management methods are described by the NST. I believe that the

retrospective study of this article will help connect the maintenance and quality improvement of the NST

functions and also help ingrain the NST functions that each type of occupation deems safe and appropriate

nutritional management in this hospital.

1 Department of Pharmacy, Yokohama City Seibu Hospital, St. Marianna University School of Medicine2 Nutrition support team, Yokohama City Seibu Hospital, St. Marianna University School of Medicine3 Kanagawa University of Human Services, Faculty of Health & Social Work, School of Nutrition & Dietetics

activity of nutrition support team 161

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