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application/pdf, 本研究では、わが国における心肺蘇生指導に関する研究の動向を概観し、心疾患患者の家族を対象とした心肺蘇生指導の現状と課題を明らかにすることを目的に文献検討を行った。, 文献検索は、医学中央雑誌Web（Ver.5）を使用し、1980年〜2020年までに公表された国内の原著論文を対象とし、キーワードを「心臓マッサージ」「心停止」「胸骨圧迫」「心肺蘇生」に「家族」を掛け合わせて検索した。結果446文献が抽出され、重複文献や心肺蘇生指導に関連のないものを除外し、107文献を対象文献とし、研究内容別に分類した。さらに研究内容別に分類したなかで、看護師が心疾患患者の家族を対象とした心肺蘇生指導について報告している10文献を最終分析対象とし、現状と課題を整理した。その結果、心疾患患者の家族を対象とした心肺蘇生指導は、講習会形式で実施されていたものが多かった。受講前の患者の家族は不安を抱えていたが、受講後は急変時の対応について理解を深めることができていた。一方で、一度の講習では習得が困難なため再受講を希望する家族もいた。, 家族は心肺蘇生指導をうけることで不安の軽減につながっていた。今後の課題として、繰り返し受講できるシステムづくりが必要だということが示唆された。, We conducted a literature review to outline trends in research on cardiopulmonary resuscitation (CPR) guidance, and to clarify the current status and challenges of such guidance for families of patients with heart disease in Japan., We searched for original Japanese research studies that had been published between 1980 and 2020，and are available in the Ichushi Web (Ver. 5) database, using the following keywords: “cardiac massage”, “cardiac arrest”, “sternal compressions”, “cardiopulmonary resuscitation” and “family”. As a result, 446 studies were extracted and after excluding duplicate papers and those not related to CPR guidance, we classified 107 studies based on the topics. Furthermore, we finally adopted 10 studies that discuss CPR guidance for families of patients with heart disease provided to clarify the current status and challenges of such guidance. We found that the CPR guidance for families had been provided in a workshop style in many cases. The families had been anxious before participation, but the workshops deepened their understanding of measures to manage sudden changes., Families' anxiety was reduced by receiving CPR guidance. As a future challenge, the necessity of establishing a system that enables families to regularly participate in CPR workshops was suggested.

Epidemiological investigations have shown that consumption of soybeans or soy foods reduces the risk of the development of cardiovascular disease, cancer and osteoporosis. The aim of this study was to determine the associations between different soy foods and inflammatory markers, including high-sensitivity C-reactive protein (hs-CRP), interleukin (IL)-6, and IL-18, in Japanese workers. The cross-sectional study included 1,426 Japanese workers (1,053 men and 373 women) aged 20 to 64 years. Intake of 12 soy foods was estimated by a validated food frequency questionnaire. Associations of total soy foods, fermented soy food, non-fermented soy food, soy isoflavone with hs-CRP, IL-6, and IL-18 levels were examined by general linear model regression analysis. We found that total fermented soy food intake was inversely associated with multivariable-adjusted geometric concentration of IL-6 in men (Q1 : 1.03 pg/mL, Q5 : 0.94 pg/mL ; P for trend = 0.031). Furthermore, it was shown that IL-6 concentrations were inversely associated with miso intake (β= -0.068 ; p = 0.034) and soy sauce intake in men (β= -0.074 ; p = 0.018). This study suggests that intake of total fermented soy food, miso and soy sauce be associated with IL-6 concentrations in Japanese men.

Purpose : The aim of this study was to clarify the changes in medication-taking behavior and related factors over time in patients with initial mild cerebral infarction up to 12 months after onset. Methods : Thirtyone patients with initial mild cerebral infarction were surveyed a total of four times : on admission to hospital, 3 months after onset, 6 months after onset, and 12 months after onset. Patients were surveyed regarding medication compliance, awareness of taking medication, perceived behavioral control, lifestyle risk factors, and subjective norms. Results :Medication compliance improved over time from the time of admission, but no changes were seen in awareness of taking medication. A cluster analysis based on changes in medication compliance over time revealed a “Persistently high compliance group” and a “Persistently low compliance group” for medication compliance. The health locus of control in the “Persistently high compliance group” was perceived as the result of chance and fate. Conclusions : Assessing the current state of medication compliance and the health locus of control during hospitalization permitted an understanding of patient characteristics, and indicated a need for recurrence prevention education and medication guidance tailored to each patient’s cognitive and behavioral characteristics.

The present study investigated the factors contributing to the loss of upper and lower extremity muscle mass in three elderly stroke patients with right hemiplegia in whom our rehabilitation program could not be performed at １‐２ weeks after onset. The results revealed common factors such as prolonged accurate microinjection of hypotensive agents, severe hemiplegia（Brunnstrom stage I or Ⅱ）, diarrhea and delayed initiation of tube feeding at ３ to ８ days after onset. With regard to individual differences, while all patients were recovering in bed, the degree of decrease in muscle mass varied among patients because they moved their extremities differently.

The present study measured lower extremity muscle mass using DXA （Dual energy X-ray Absorptiometry） in order to verify the effectiveness of intervention with a series of movements, including lying hip raise exercise with bent knees pointing upwards, among bedridden patients with post-stroke hemiplegia in the acute post-stroke period. Subjects in the intervention group were required to perform １０ repetitions of a series of back-lying exercises once a day with researchers, in addition to the exercises performed by those in a control group. The first measurement of muscle mass was conducted at three to five days after onset, and the second measurement was conducted seven days after the first. Muscle mass in the lower extremities was reduced by approximately ６００g （decrease rate ： ９％）on the paralyzed side and by ２８０g on the non-paralyzed side（decrease rate： ５％）in one week in the Brunnstrom stage ≤ II subgroup（site of measurement : lower extremities） （n＝８） of the control group （n＝２３）. The decrease in muscle mass in the Brunnstrom stage ≤ II subgroup （n＝４） of the intervention group （n＝１５） was approximately ２６０g on the paralyzed side （decrease rate ： ５％） and approximately ２８０g （decrease rate ： ５％）on the non-paralyzed side. Thus, muscle mass decreased on both sides, and this occurred regardless of degree of paralysis. Comparison of the Brunnstrom stage ≥ III subgroups between the control and intervention groups also confirmed that the decease in muscle mass was smaller in the latter group. Thus, it was confirmed that back-lying exercises combining lower extremity movements, including hip raises with bent knees pointing upwards, prevented the decrease in lower extremity muscle mass on the paralyzed side in post-stroke patients. The present study also suggests that these exercise movements can be applied to preventive care for bedridden patients with other severe diseases.

The present study analyzed１６patients who were bedridden for one week immediately after onset of post-stroke hemiplegia. We used DXA（dual energy X-ray absorptiometry）to determine changes in muscle mass in the lower extremities on both paralyzed and non-paralyzed sides. The first measurement was conducted ３ to ５ days after the onset, and the second measurement was conducted ７ days after the first. Muscle mass in the lower extremities was reduced by approximately ６００g （９％） on the paralyzed side with and by ２００g on the non-paralyzed side （３％） in the Brunnstrom stage≤II group （n＝５）. Although the decrease of muscle mass in the Brunnstrom stage≥III group（n＝１１, relatively slight degree of functional motion impairment）was not significant, a decrease of approximately ３００g （decrease rate ： ５％）was observed on the paralyzed side and approximately １００g （decrease rate ： １．５％）was seen on the non-paralyzed side. Hence, muscle mass declined on both sides, and this occurred regardless of degree of paralysis. The findings suggested that conventional range of motion exercises, functional position maintenance, and postural changes are inadequate to prevent disuse muscle atrophy in post-stroke patients ; thus, it is necessary to develop a new rehabilitation program which adopts different exercises such as trunk motion, even for patients in the acute stage after stoke onset.

In order to verify the accuracy of the thickness of the rectus femoris muscle and overlying subcutaneous fat as assessed by ultrasound, experiments were conducted on １０ healthy subjects aged over ３０ years to assess the following： １） concordance of measurements made by two different observers； ２） concordance of repeated measurements made by the same observer ; and ３） concordance of repeated measurements made by the same observer with and without an imaging aid（ultrasound gel block）. Between two observers with varying experience in ultrasound, no significant difference in measured muscle thickness was observed ; however, there was a significant difference in subcutaneous fat thickness. When measurements were made by the same observer on two separate days, a significant positive correlation was evident for muscle and subcutaneous fat thickness between the first and second tests. While use of the imaging aid was associated with higher concordance of measurements between the first and second tests, the measurements themselves were affected. Although ultrasonic measurement of tissue thickness requires further investigation to minimize intra-observer error and examine correlations with other imaging techniques, the accuracy of the measurements in the present study suggests that clinical application may be possible.

In order to establish an objective and convenient technique to assess postoperative recovery following laparotomy, in particular activities of daily living, we measured the thickness of muscle tissues by ultrasound sonography. In the present study, the following four muscular compartments were selected: rectus femoris, biceps femoris, extensor digitorum longus, and soleus. These account for a large portion of the systemic skeletal musculature and are important for locomotion. Subjects were 28 patients who underwent moderately invasive surgery for stomach or colon cancer. The results showed that muscle thickness decreased significantly in all four compartments. Rectus femoris exhibited the greatest reduction in thickness and was most affected by short-term or long-term recumbency. Furthermore, for soleus, the tendency was that the longer the recumbency, the greater the wasting. These findings suggest that, of the four areas of the lower limb, rectus femoris is most affected by short-term recumbency and is most suited for objectively assessing postoperative recovery. The results of the present study suggest that it would be effective to design a recovery program focused on maintaining the femoral extensor muscles, which are most affected by short-term recumbency following laparotomy., 広島保健学学会 特別講演

術後の健康回復の促進に向けた看護ケアの基礎的資料を得るため,超音波診断装置(周波数は7.5MHz)を用いて,開腹による胃あるいは大腸手術を受けた患者を対象に,手術経過に伴う下肢の筋組織厚および皮下脂肪厚の変化を明らかにした.術前,術後離床日,術後10日目,術後20日目の合計4回,下肢の大腿直筋上,大腿二頭筋上,長指伸筋上,ヒラメ筋上にプローブを当て,組織厚を測定した.開腹による胃または大腸手術を行なった患者のうち,合計4回の測定結果が得られた16名を分析対象とした.4箇所の測定部位の筋組織厚および皮下脂肪厚をそれぞれ合計し,筋組織厚総和および皮下脂肪厚総和を算出し,術前値との比較を行なった.その結果,下肢の筋組織厚総和は,術後離床日,術後10日目,術後20日目に有意な減少を認めた.一方,下肢の皮下脂肪厚総和は,術後には有意な減少を認めず,ほとんど変化しないことが明らかになった.胃手術群と大腸手術群の比較においては,胃手術群は,術後10日目から術後20日目にさらに減少し,回復の傾向を示さなかったが,大腸手術群は,術後10日目から術後20日目に下肢の筋組織厚が回復の傾向を示した.よって,開腹術後患者,特に胃手術患者に対して,より細やかな看護観察と栄養評価,および食事摂取量を増やす看護介入の必要性が示唆された., In order to obtain basic data for use in postoperative nursing care intended to promote the recovery of patients after surgery, the authors examined postoperative changes in lower limb muscular tissue thickness and subcutaneous fat thickness by ultrasonography (7.5 MHz) in patients who underwent open surgery of the stomach or large intestine. The ultrasound probe was placed on the skin above the following muscles: quadriceps femoris, biceps femoris muscle, extensor digitorum longus, and soleus. Measurements were taken on 4 occasions: before surgery, and on the 1st, 10th and 20th day after postoperative mobilization. Of all patients who underwent open surgery of the stomach or large intestine, 16 patients were selected for analysis and ultrasonic measurements. Muscular tissue and subcutaneous fat thicknesses at each of the four sites of measurement were totaled to yield measures of total muscular tissue and total subcutaneous fat. Postoperative and preoperative parameters were then compared. The total lower limb muscular tissue thickness at each of the 4 postoperative measurement points was significantly less than the preoperative thickness, whereas the total lower limb subcutaneous fat thickness showed no significant decrease after surgery and remained almost unchanged from the preoperative value. Comparing patients undergoing different types of surgery, leg muscular tissue thickness showed a tendency to recover on the 10th and 20th day after surgery in the colorectal surgery group, while the gastric surgery group showed further decreases in this parameter on the 10th and 20th day, with no trend towards recovery evident over the timeframe investigated. These results suggest the necessity of active nursing intervention for patients after open gastric surgery.G2