【介護のギモン】胃ろうってなに?介護のポイントは?

みなさんは「胃ろう」という言葉を耳にしたことはありますか?胃ろうは、食事を摂る上で、口から摂るのが困難になってしまった場合等に、直接胃に栄養を運んでくれるお腹の口のことを言います。この記事では、胃ろうのための介護についてまとめています。

目次

胃ろうとはなにか

胃ろうは、胃に直接栄養を送り込むため、胃に穴を開け、チューブを通したものを指します。例え口から食事を摂取していても、口から食事を摂取できない場合があります。そんな時に胃ろうがあれば、栄養の補給するためのルートが増えます。

胃ろうは内視鏡を使用し、作られます。PEG(Percutaneous Endoscopic Gastrostomy=経皮内視鏡的胃瘻造設術)は胃ろうを造設するための手術のことを言います。PEGの内視鏡手術は平均的に30分程度で終わります。身体への負担も少ないものと言われいます。非常に入院期間も短く設けられていることが多く、手術をしてから、4日程度で入浴をしても問題ないと言われています。

 胃ろうは口から栄養を摂ることとは異なり、生きていくために必要最低限の栄養を胃に直接流し込むことになります。そのため、体重が減少してしまう場合も少なくありません。

例え胃ろうを作っても、喉にチューブを入れるわけではありませんから、可能な限り、口から食事をとるリハビリを行い、経口摂取を継続することも必要な場合があります。胃ろうに至るまでには、さまざまなケースがありますから、かかりつけ医等に相談しましょう。

胃ろうの種類について

胃ろうにはいくつかの種類があります。その大きな違いは、「チューブが体外に出ているか、いないか」という点にあります。また、カテーテルの内部構造が「バルーン型」か「バンパー型」かによっても異なってきます。

次の組み合わせによって、胃ろうは4種類に分類することができます。

チューブがついているのが、「チューブ型」で、チューブがついていないのが「ボタン型」と呼ばれています。

カテーテルが長いタイプの胃ろうである「チューブ型」と、カテーテルがついていないタイプの胃ろうである「ボタン型」です。

バンパー型:胃の内壁にしっかりと固定されるのが特徴で、ボタン型より抜けにくいのがメリットです。バンパー型胃ろうの交換頻度は、約半年に1回程度で、バルーン型に比べて期間は長いと言われています。一方デメリットとしては、交換時に痛みや圧迫感を感じやすいという点です。

バルーン型:挿入後にチューブバルーン内部に固定水(蒸留水)を注入して膨らませ、チューブを設置します。またカテーテルを交換する際には、バルーン内の固定水(蒸留水)を抜き、小さくすることで、痛みが感じにくいと言われています。他にも、交換が容易である点がメリットと言えます。しかし、バルーンが破裂してしまうリスクもあり、チューブを1〜2ヶ月に1回程度の間隔で、交換が必要になる点はデメリットでしょう。

ボタン型:ボタン型は、目立ちづらく、動作の邪魔にならず、お手入れについての負担軽いという点がメリットとして挙げられます。またボタン型には逆流防止弁も付いています。栄養剤を注入するチューブの接続に手間取ることもあり、時間がかかる点はデメリットです。

チューブ型:栄養剤を注入する際、チューブの接続がしやすく手間がかからないのがメリットです。デメリットは体外にチューブが出ているため、動作の邪魔になりやすく、自分で引き抜いてしまう恐れがあることとチューブの内側が汚れやすいことです。

胃ろうの対象者とは

極力体に負担をかけず、栄養を摂取することを一番の目的としているのが胃ろうです。

胃ろうの対象者は、次のような状態にある方です。

・認知症が重度な状態の方で、口から自力で食事を摂るのが困難な方
・食べ物・飲み物を摂取しようとすると、飲みこむ際にむせ、誤嚥性肺炎につながるリスクのある方

いずれも高齢者に多くみられる傾向にあります。誤嚥性リスクが高くなった場合や、本人や家族が望む予後にそって、医師から胃ろうについて勧められることがあります。

胃に穴をあける以外に、方法ってあるの?

胃に穴を開ける、胃ろうの造設方法ではなく、チューブを鼻から胃まで挿入する方法(胃管挿入)もあります。これは「経鼻型胃管」と呼ばれます。胃ろうと同じように、胃まで直接栄養を送り込むことができます。とはいっても、人によっては呼吸がしづらかったり、鼻に異物感があったりするため、体に負担がかかることがデメリットとして挙げられます。そのことから、長期的に(半永久的に)口以外からの栄養補給が必要な方については、体への負担が比較的少ない、胃ろうをすすめる場合もあります。

胃ろうの方の介護のポイント

体をしっかり起こす
胃ろうだけでなく一般的な食事においても、胃ろうを使用し、栄養剤を投与する際は、体を起こして姿勢を正しましょう。これは胃ろうでなく、経口摂取の際でも、大切なことです。不良姿勢をとることにより、摂取した食事を逆流させてしまう場合があります。本人が要介護状態のときは、介護者がしっかりと気をつける必要があります。注意点は、腰痛の既往がある方で、その場合、同一姿勢を続けることは困難な場合も。苦痛を与えないよう、クッション等を使用し、体位を整えます。

口腔ケアを念入りに行う
胃ろうを使い始めることで、経口摂取の機会が減少します。普段口からの食事摂取をしていれば、唾液が分泌され、自然に備わっている口腔内の自浄作用の役割を果たします。ところが、その機会が減ったり、なくなるわけですから、口腔ケアを意識し、念入りに行うようにしましょう。口腔内に雑菌が繁殖することで、誤嚥性肺炎の発症リスクがあがります。

胃ろう周りの観察
胃ろうはさまざまなメリットもありますが、体からしてみられば、異物が入っていることに変わりはありません。腹部に穴を開け、カテーテルを胃に差し込むという行為が胃ろうですから、トラブルが起きる場合もあります。よく起きるのは、皮膚のトラブルです。皮膚の一部が腫れあがったり、ただれるといった症状が起こります。胃ろうを必要とする方は、栄養状態が悪い場合もあり、いずれにしても、皮膚や消化に負担をかけやすいものです。

まとめ

胃ろうは口から栄養が摂取できない方が、胃に穴をあけチューブを通して、栄養を摂取できるようにするための処置です。

胃ろうには4つの種類があり、それぞれメリットとデメリットが存在するため、医師と相談しながら選択しましょう。

あなたや家族が、胃ろうの適応となる場合にも、極力経口での摂取もつづけていくことが望ましいと言われています。
また口腔ケアや胃ろう周りの観察など、胃ろうの方を介護する場合、誤嚥性肺炎などにならないために押さえておくべきポイントがあります。
訪問看護等を利用しながら、胃ろうを使用する家族がいらっしゃる場合、胃ろうに関する介護について、知識を覚えておくと役立ちます。

介護の相談窓口
  • 「今後の生活環境が変わる事への不安」や「介護を使って生活をどうデザインをしていったら良いか」など介護は協力体制で成り立っております。 ちょっとでも解決できる、ストレス軽減できる記事を目指し、一つの相談場所のメディアを目指しております。

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