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Title: 代替療法による浮腫ならびに合併症状の改善効果の検討 : 健康成人の生理的浮腫に対する効果 (研究ノート)
Other Titles: The Study of Alternative Treatments for Edema and its Complication : The Assessment of Physiological Edema in Healthy Subjects (Notes)
Authors: 北脇, 愛野
Keywords: 浮腫
lymphatic drainage
acupuncture stimulation
alternative treatment
Issue Date: 31-Mar-2009
Publisher: 滋賀県立大学人間看護学部
Abstract: 背景 慢性疾患では浮腫を主訴とする患者が多く、我が国では浮腫を抱える患者は12万人以上とされており、浮腫に対する具体的な対応は十分とは言えない。現在、浮腫の治療法は保存的療法が主流となっているが、各研究者が独自に考案し、限局した部位に施行して効果の確認を行っている段階であり、治療方法の確立には至っていない。 目的 将来的に慢性疾患による浮腫を有する患者の症状改善方法の一つとして、浮腫を有する健康成人に対して新しい方法での全身リンパドレナージを実施し、浮腫に対する改善効果の判定を、また、浮腫に合併する様々な症状の改善のために経穴刺激を行いその症状改善の検討ならびに、副作用の有無の確認を行う。 方法 新しいリンパドレナージ法や経穴刺激の効果判定のために、特定の疾患を有さないが浮腫を生じやすい医療スタッフ26名を対象とした。期間は2007年8月から9月の2ヶ月間で行った。手技は約40分間の四肢や体幹を軽くさする方法(軽擦法)によるリンパドレナージ、ならびに両上肢と下肢の6種の経穴刺激であり、看護師1名が8時間以上の勤務が終了した直後の対象者全員に実施した。その施術前後に体温、血圧、脈拍、呼吸数の測定、両側の手関節と足関節の周囲径の計測、身体組成分析装置(MLT-50セキスイメディカル電子株式会社)を用いた細胞内・細胞外液量測定、医用サーモグラフィー装置(28BZ5007富士システム株式会社)を用いた手掌の温度測定を実施した。また、Visual Analog Scale(VAS)を用いて「痛さ」「だるさ」「動かしにくさ」「眠たさ」「温かさ」「食欲」「複痛」「吐き気」「胸やけ」「腹部の張り感」の10項目のVAS値を測定した。分析はSPSS.V. 15.0 Familyを使用し、有意水準は5%とした。また、本研究はA総合病院の倫理委員会の承認を得た。 結果 対象群の施術後の手関節、足関節の周囲径、細胞外液量が有意に減少し、細胞内液量ならびにI/E比が増加し浮腫が軽減した。また、手掌温度が有意に上昇した。さらに、施術前後の脈拍、呼吸数は有意に減少し、血圧では有意差はなかったが数値が減少した。さらに、VASにおいて、痛さ、だるさ、動かしにくさ、腹部の張り感に有意な軽減を、温かさ、食欲などが有意に上昇し、インタビューにて睡眠の改善や、体の爽快感の増加を認めた。 結論 施術によって対象者の浮腫ならびに諸症状に改善が認められたことにより、患者に負担をかけること無くQOL向上に寄与する可能性が示された。
Background It is speculated that more than 120,000 people may have a systemic or local edema in Japan, however, those subject are not administrated a appropriate treatment so far. Objectives Manual lymphatic drainage was performed on subjects having edema refractory to treatment with diuretics only, and improvements in their edema were evaluated, while acupuncture stimulation was also preformed to improve the various symptoms accompanying their edema, and those symptom improvements also investigated. Methods In order to evaluate the efficacy of new manual lymphatic drainage methods and acupuncture stimulation, 26 otherwise healthy nursing personnel at S Medical Center having lower leg edema were selected. The lymphatic drainage procedure involved light rubbing of the four extremities and torso (effleurage), as well as 6 types of acupuncture stimulation to both the upper and lower extremities, once for a total, as administered to all subjects by one nursing pers onnel. Body temperature, blood pressure, pulse and respiration rates were measured both before and after these procedures were performed, while the circumference of both wrists and ankles were also measured , and intra- and extra-cellular water volume measurements taken with a bioimpedance device (Sekisui Medical Inc. MLT-50), and palm temperatures taken with a medical thermography device (Infra-Eye, Fuji Systems Inc. ). The subjects' feelings of heaviness, sleepiness, warmth and appetite were also evaluated via four visual analog scales (VAS). And, the subjects' food intake, excretion volumes and sleep durations were recorded during interviews.Analysis was done with Statistical Package for the Social Sciences (SPSS) v. 15. 0 software, the significance level set to 5 %. This study was also approved by the Shiga Medical Center for Adults Ethics Committee. Results Wrist and ankle circumferences were red uced, and extra-cellular water volumes and I/E rateo were lowered in the control. A significant rise was also seen in palm temperatures. Furthermore, post-procedure pulse rates and respiration rates were significantly lowered , while blood pressure were also reduced, although not significantly. Additionally, control group feelings of pain and heaviness VAS were significantly reduced, while energy, warmth and appetite rose significantly, with significant increases in sleep duration being observed. Conclusion Improvements in control edema and its accompanying symptoms were observed, which contributed to amelioration of patients' QOL.
NII JaLC DOI: info:doi/10.24795/nk007_053-062
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