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				<ul class="property"><li class="disc">B5判・384頁・2色刷</li><li class="disc">ISBN&nbsp;978-4-8306-8153-0</li><li class="disc">2014年7月14日発行</li></ul>

				
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">若手医師が求める日常診療のエッセンスをよりすぐり、かつ一歩進んだ知識を提供するムックシリーズ第13弾．代謝を理解して行う栄養管理は，一体どこが違うのか？どうして患者に有益なのか？本書はこの問いに基づき，必要となる生化学・代謝のおさらいに始まり，管理の基本と，疾患・病態・時期別のマネジメントの実際を症例ベースでレクチャー．基礎から現場での応用まで，深く，わかりやすく解説した．慣習にならって「何となく」漠然と行なってしまいがちな栄養管理に，自信がつく一冊．<br>☆図版86点，表組94点，イラスト・線画20点<br><br><br>▽BEAM（Bunkodo Essential &amp; Advanced Mook）編集委員会<br>　宮地良樹（京都大学皮膚科教授）<br>　上田裕一（名古屋大学心臓血管外科教授）<br>　郡　義明（天理よろづ相談所病院総合診療部長）<br>　服部隆一（市立島田市民病院院長）</section><section class="preface">序文<br><br>　一般に，医学は自然科学に属すると考えられているように思われる．しかし，医学は疫学や生理学，病理学，内科学，外科学など雑多な学問の集合体であり，その目的は<i>Homo sapience</i>といったきわめて特殊な種の健康増進にある．そのため，医学はしばしば自然科学に必須である普遍性を欠くことになる．<br>　一方，医学の進歩が科学の進歩とともにあったことは事実である．内視鏡やCT，MRIといった診療機器，抗菌薬や分子標的薬は医師の診断能力と治療成績を格段に進歩させた．しかし，その進歩は工学や光学，薬理学，免疫学などの成果によってもたらされたもので，実は医師はそれらを利用させてもらったにすぎない．<br>　栄養学は，生化学を基礎に成り立っている．その生化学は，医学を構成する学問の中では数少ない生粋の自然科学である．また生化学の分野では，分子生物学と相まってさまざまな代謝の連関，臓器の代謝のつながりが分子レベルで明らかにされてきた．では，栄養学は生化学の進歩を取り入れて前に進んでいるのであろうか．そうは言えない状況にあるのではないだろうか．<br>　ヒトの身体は多数の臓器・器官の集まりである．そこで営まれる代謝を正確に理解することは，病態に応じた栄養管理計画の策定にきわめて役に立つ．また，摂食は生体の恒常性を維持するために最も大切な行為なので，集団として捉えた健常人の摂食行動は必要栄養量を反映する鏡であると考えられる．本書では，栄養管理に必要な生化学の知識に加え，燃料の臓器特異性と日本人の摂食行動にも言及した．EBM全盛の昨今，臨床医に求められる判断は経験と思考によるものから暗記された知識に基づくものへとシフトしつつあるようにも感じられる．そのようななか，栄養管理を行うにあたっては本書に記されていることを糧に存分に頭を使っていただきたい．<br>　また臨床栄養の分野では，古来行われてきたことが何の疑いももたれずに踏襲されている場面に遭遇する．栄養状態の維持・改善が重要である急性期病棟への短期間の入院に際し，診断病名に盲従した心臓食や脂質異常症食の処方が本当に有益なのであろうか．さらに，粥食の細分に意味があるのであろうか．今後の臨床栄養の進歩は，われわれ医師が慣習や言い伝えに疑問をもつことから始まるように思われる．<br>　編者の愚考を上手に汲み取られ，素晴らしい原稿を書き上げてくださった執筆者の方々に深甚なる敬意と謝意を表させていただく．そして，本書が読者の皆様のお役に立てることを心から祈念し，序文としたい．<br><br>平成26年6月吉日<br>上尾中央総合病院外科・腫瘍内科顧問<br>大村健二</section><section class="indexes">序　医療における栄養管理の重要性<br>　〜あちこちにある“ 落とし穴” に気をつけよう〜<br>Ⅰ 　栄養素代謝の基礎を知ると栄養管理が楽しくなる<br>　１. 糖はどのように利用されるのか～万能のエネルギー源ではないブドウ糖～<br>　２. アミノ酸の行方～蛋白質にもブドウ糖にも脂質にも代謝されるアミノ酸～<br>　３. 脂質は大切な熱源～貯蔵量は大きいが常に摂取すべき脂質～<br>　４. 臓器によって異なる燃料の種類<br>　５. グルコースを過剰投与した場合の罪～悪影響を回避する方策～<br>　トピックス 生体と臓器の要求を勘案した栄養投与量の決定法<br>　トピックス 微量栄養素の欠乏<br>II 　安静時と侵襲時の代謝の変化を知ろう<br>　１. 骨格筋のエネルギー代謝～安静時と運動時の違い～<br>　２. 飢餓と摂食で生じる代謝の変動<br>　ミニレクチャー refeeding 症候群とは？<br>　３. 侵襲に伴う体内環境の変化～手術や病気ではこんなことが起こっている～<br>　４. 侵襲後早期の代謝変動を勘案した栄養管理<br>III　栄養管理の実際<br>　１. 栄養スクリーニング<br>　２. 栄養アセスメント～医師に必要な最低限の知識～<br>　３. 栄養管理のプランニング<br>　４. 栄養の投与ルートとその設定<br>　５. 栄養管理のゴール<br>　６. 合併症<br>　　１）経腸栄養の合併症とその対策<br>　　　A 経腸栄養の機械的合併症<br>　　　B 経腸栄養の消化管合併症<br>　　　C 経腸栄養の代謝性合併症<br>　　２）静脈栄養の合併症とその対策<br>　　　A 静脈栄養の機械的合併症<br>　　　B 静脈栄養の代謝性・感染性合併症<br>　７. 栄養管理のモニタリング<br>　８. TPN 処方の組み立て方と処方，投与法<br>　９. PPN 処方の組み立て方と処方，投与法<br>　10. 経腸栄養剤の種類と投与方法<br>　11. 在宅栄養管理の実際<br>　12. PEG<br>IV　様々な疾患，病態，時期の栄養管理を身につけよう<br>　１. 高度侵襲手術周術期<br>　　１）胸部食道癌手術の周術期栄養管理<br>　　２）膵頭十二指腸切除術<br>　　３）縫合不全症例（食道胃管吻合部縫合不全例）<br>　　４）術後回復能力強化プログラムERASプロトコール<br>　　トピックス 術前の経口摂取，炭水化物負荷，経口補水に対するエビデンス<br>　　トピックス immune-modulating diet（IMD）とその有用性<br>　　トピックス 体蛋白の崩壊を抑える持続硬膜外鎮痛<br>　　トピックス 早期の栄養管理開始はこんなに良いこと〜腸を早く使いましょう〜<br>　２. 集中治療室における栄養管理<br>　３. 整形外科手術後の回復期リハビリテーション時<br>　４. 脳卒中の栄養管理<br>　５. 心不全<br>　６. 癌悪液質<br>　７. 血液透析中の慢性腎不全<br>　８. 糖尿病<br>　９. 劇症肝炎<br>　10. 肝硬変<br>　11. 急性膵炎<br>　12. 炎症性腸疾患<br>　13. 慢性閉塞性肺疾患<br>Ⅴ　ライフサイクルと代謝の変化<br>　１. 小児の栄養素代謝と栄養管理〜栄養管理でも子どもは小さな大人ではない〜<br>　２. 妊娠時の栄養管理〜健やかな胎児の成長のために〜<br>　３. 高齢者の栄養管理に必要な知識<br>　　１）加齢と消化吸収能〜健康な高齢者は消化吸収能は衰えない〜<br>　　２）加齢とエネルギー消費の変化<br>　　３）加齢と蛋白質代謝の変化<br>付録：Further Readings<br>索引<br><br><br>● M e m o<br>解糖系のATP産生速度は速い<br>癌細胞における糖代謝とFDG-PET<br>侵襲時にみられる生体の反応<br>トランス脂肪酸ってなに？<br>脂肪酸からグルコースは合成されない<br>PUFAと脂質メディエータ<br>autophagyと感染防御<br>解糖系は厳密に調整されている<br>脂肪は糖の炎で燃える<br>糖新生とグルコース6-ホスファターゼ<br>飢餓時のエネルギー源と飢餓の影響<br>BMI〔(body mass index) 体格指数〕と理想体重とは？<br>活動係数とストレス係数<br>NPC/N比の求め方<br>不可避窒素喪失量とは？<br>肝硬変と分岐鎖アミノ酸補充<br>ヒトの必須微量元素<br>代謝水と不感蒸泄<br>半固形化栄養剤の開発<br>バンパー埋没症候群<br>ボールバルブ症候群<br>経胃瘻的空腸瘻の呼称<br>半固形化栄養剤の利点<br><i>Clostridium difficile</i><br>高浸透圧性非ケトン性昏睡<br>橋中心髄鞘崩壊症<br>低ナトリウム血症でのスポット尿検査<br>SIADH（syndrome of inappropriate antidiuretic hormone secretion）<br>PICC<br>Trendelenburg体位<br>厳密な血糖管理<br>NPC/N<br>ビタミンB1欠乏による乳酸アシドーシス<br>CRBSI<br>bacterial translocation（BT）<br>フィルタについて<br>便の性状<br>Professor Stanley J.Dudrick<br>高カロリー輸液用基本液の組成<br>成分栄養剤の有用性と使い方<br>医療保険からみた使い方<br>医薬品経腸栄養剤の使い方<br>補食に有用な高濃度栄養剤<br>在宅成分栄養経管栄養法指導料<br>在宅中心静脈栄養管理指導管理料<br>長期留置用のBroviac-Hickmanカテーテルと皮下埋め込み式カテーテル（ポート）<br>PEG施行時は左側臥位で送気を<br>PEG施行時には長めのシャフト長を選択<br>食道癌手術後の乳び漏<br>食事開始日はいつ？<br>術前減黄法は本当に必要か？<br>食道癌手術と縫合不全<br>胃管血流の特殊性<br>経腸栄養と静脈栄養〜どういう病態において使い分けるか〜<br>創傷治癒と第XIII因子<br>ERASプロトコールはわが国で知名度が高い<br>集学的リハビリテーションプログラム<br>緩下薬の弊害と現在の使用方針<br>輸液は制限だけではなく，適正な輸液の時代へ<br>クリニカルパスや栄養サポートチームとの違いは？<br>ESSENSE projectとは？<br>術前飲料の選択指針<br>REDOXS試験<br>抗血栓療法との組み合わせはどうするか？<br>CCPGについて<br>サルコペニア，ダイナペニア，ミオペニア<br>サルコペニア肥満<br>機能訓練室での栄養剤摂取<br>サルコペニアとビタミンD<br>延命のための経腸栄養<br>グレリンとレプチンは食欲を調整するホルモンだ<br>MIAとは？<br>IDPNについて<br>食品交換表<br>炭水化物制限食<br>グリセミック・インデックス（glycemic index：GI）<br>カーボカウント<br>急性肝不全と劇症肝炎の違い<br>間接熱量計による評価<br>Fischer比の低下の原因<br>肝硬変患者のエネルギー低栄養状態の評価<br>シンバイオティクス<br>呼吸不全<br>水分必要量と電解質管理の考え方<br>牛乳蛋白は食物アレルギーのリスクあり<br>低出生体重児，極低出生体重児（1,500g未満），超低出生体重児（1,000g未満）へのアミノ酸の投与意義<br>必須脂肪酸は人体の成長発育および機能調節に必須である<br>栄養管理中の高トリグリセリド血症への対応<br>絶食，手術など侵襲時のエネルギー所要量<br>ライフスタイルの急激な変化〜遺伝子との乖離〜<br>出生時体重が毎年減少している<br>チーズと早産<br>栄養が与える消化管への影響<br>基礎代謝量と基礎代謝基準値<br>元気な高齢者はしっかり食べている<br>サルコペニアとは？<br>蛋白質摂取量と骨格筋萎縮</section></article>
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