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Fontaine分類II度の閉塞性動脈硬化症(ASO)患者(61歳,男性)についての治療経験を報告する.患者は,間欠性跛行の出現以来3年間にわたり鍼灸治療を受けていた.鍼灸治療により下肢痛の軽減がみられるも,再燃することを繰り返していた.今回,症状の悪化と足関節上腕血圧比(API)が低値であったため本学附属病院血管外科に精査を依頼したところASOとの診断を受けた.その後も患者は鍼灸治療の効果を信頼し,鍼灸治療のみを希望した.そのためASO診断後も鍼灸治療を継続し,西洋医学的には経過観察となった.鍼灸治療開始時は随証治療に基づき行い,経過の中で鍼通電を追加した.しかし,喫煙回数の増加や症状が悪化したため薬物治療を勧め,鍼灸治療と薬物との併用治療を行った.その結果,歩行距離がさらに延長し,ASOによる下肢症状が改善された.一方,APIの推移は特に変化は認められなかった.しかし,鍼灸治療の直前直後における患側肢APIを比較すると有意に増加したことより,鍼灸治療の効果が認められた.以上より,鍼灸治療に薬物治療を併用することで,より高い治療効果が得られたことが示された.(著者抄録)

Pain relief is the most important care for cancer patients, because they have a right to receive palliative care and to be free from pain. It is necessary for nurses to have knowledge and skill of palliative care and pain relief with opioids which are the most potent and proper drugs for pain relief of cancer patients. In this study, the nursing students of College of Medical Technology and the registered nurses at Kyoto University Hospital were surveyed by questionnaires regarding pain relief of cancer patients and opioids, and following results were obtained. 1. The ratio of the nursing students who have a positive opinion to use opioids was significantly lower than that of the nurses. 2. Reasons for negative opinion against opioids were a fierce impression and dependency. 3. The ratio of the nursing students who think pain relief is completely possible was significantly higher than that of the nurses, while the ratio of the nurses who think pain relief is impossible was significantly higher than that of the nursing students. 4. More than 70% of the nursing students who have a positive opinion to opioids put value on medical care including drugs in palliative care for cancer patients, while less than 30% of the nursing students who have a negative opinion against opioids put value on medical care. 5. The ratio of the nurses who want complete pain relief if they have cancer pain was significantly higher than that of the nursing students. These results suggest that the nursing students have gradually had a good knowledge about relief and opioids. Education to nursing students and nurses is important to rid of the unnecessary fear for opioids and to obtain proper knowledge and skill of palliative care including pain relief.

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