周手術期実習中の看護援助における学生のストレス認知と生理的反応との関連 : 唾液中クロモグラニンA(CgA)、コルチゾールによる検討 (研究ノート)

Abstract

背景 これ迄、周手術期実習中の学生のストレス要因に関して、認知的評価理論に依拠した質問調査を行ってきた。今回、精神的ストレス指標としての唾液中Chromogranin A (CgA)に着目し、術後ケア前後の生理的ストレスレベルの把握に試用した。目的 周手術期実習中の学生のストレスレベルを生理的側面から把握し、心理・生理的反応の関連性を裏付ける基礎データを得る。また、CgAのストレス指標としての有効性の検討を行う。方法 対象:倫理的手続き後同意書の得られた短期大学3年生女子12名。分析対象は10名であった。時期:H16年5月～7月の成人看護学急性期実習中。調査内容:「手術後状態観察」、「手術後清拭」、「ガーゼ交換介助」の3ケア前、終了後、終了30分後の3時期に、「日本語版STAI(State-Trait Anxiety Inventory)」、「緊張、不安度調査(7件法)」および唾液中CgA、コルチゾールの採取・測定。分析:(1)3時期反復測定値変動に対するFriedman検定(2)認知的評価と生理的指標間に対するSpeamanのρ 結果 対象者年齢は20～24歳、平均21.4(±1.4)歳。実習2週前のCgAベースライン値は上昇したが、3ケアのCgAは、共に開始前には0.8から0.9pmol/mlと、一定レベルであった。ケア後は、変動がバラつき下降しなかったが有意差は認められなかった。コルチゾールは、開始時0.1から0.2μg/dlとベースラインレベルと差は無く、その後も有意な経時的変化を示さなかった。質問紙結果は、3ケア共開始前は、状態不安59から66、緊張、不安度5から6と高不安状態を示した。その後は有意な経時的低下を示した。CgA、コルチゾールと、緊張、不安度との相関分析の結果、有意な生理的・認知的相関は認められなかた。結論 1.実習開始2週間前のベースライン値のCgA上昇は、実習を目前にした心理的ストレスの反映と判断され、CgAの精神的指標としての可能性が示唆された。2.術後ケア時の認知的反応はケアの直前高く、その後経時的に低下する傾向が見られた。3.唾液CgAとコルチゾールは、顕著な上昇を示さず、ケア前をピークにその後の低下にばらつきが見られ、術後の3ケアはマイルドな身体的ストレスであると判断された。4.CgAと質問紙の相関分析の結果、心身相関の裏付けは得られなかった。

Background We have investigated the aspects for an initial appraisal of stress of nursing students in the clinical training of perioperative nursing. This time, we directed our attention to cromogranin A(CgA) currently used as humoral marker of mental stress and tried to use it as physiological indicator of mental stresses of students. Objectives The purpose of this study is to assess the time serial change in salivary CgA, cortisol and self-perceived stress of nursing students and the association with salivary CgA, cortisol and initial appraisal stress, before and after three nursing cares; observation, bed-bath and dressing assist for the patients after operation. Another purpose is to confirm the salivary CgA as humoral marker of mental stress. Methods Twelve third-year nursing students consented to join in the study as a subject after the explanation about contents of the study. They indicated how stressed they felt on a 7-point rating scale just prior to, immediately after and half after every care. And two-minute unstimulated whole saliva samples were collected at those times to measure salivary CgA and cortisol. Human CgA is determined by a simple and sensitive enzyme immunoassay (EIA). In analysis Friedman test was used to evaluate the time serial changes of salivary CgA, cortisol and self-perceived stress. Spearman correlation coefficients were used as parameter association with CgA and other variables. Results Tow students were excluded from analyses because of the deficit and the edge of data. Mean age of ten students were 21.4 (±1.4) years, range were 20-24 years. The results were as following. 1. In self-perceived stress students rated significantly higher scores before compared to after the cares (p<.01) and scores declined after with high levels in bed-bath and dressing assist. 2. Baseline level of Salivary CgA in 2 weeks ago went up at 1.4pmol/ml. We supposed it to reflect student's mental stress. 3. Salivary CgA and cortisol levels were observed no significant change before and after the cares. 4. A correlation was not seen between self-perceived stress score and CgA and cortisol with stress levels. We couldn't confirm mental-physical interrelation in human response to stress. Conclusions 1. It was supposed reflection of student's mental stress that baseline level of Salivary CgA went up. 2. Students perceived significantly high levels of stress before the cares and downed after, but the salivary CgA and cortisol didn't indicate significant raising. 3. The salivary CgA and cortisol didn't prove to associate with cognitive of stress of students.