須釜 淳子

点滴静脈内注射の血管外漏出の早期発見のための客観的評価指標の開発を目的に、サーモグラフィーを用いた鑑別方法を開発し、その効果を、健常者6名を対象に、漏出モデルとして、前腕の皮下組織に留置針を刺入して生理食塩水を1.7ml/分で滴下し、対照群として、反対側の前腕の静脈内に留置針を刺入し、同様に滴下し、それぞれ滴下後10秒ごとにサーモグラフィーにより針先周囲を確認した。その結果、漏出モデルでは6名全員に滴下開始2分以内に針先を中心に広がる円形の低温域が出現し、サーモグラフィーにより非接触かつ迅速に点滴静脈内注射の血管外漏出が鑑別できる可能性が示唆された。

褥瘡は外力が一定時間持続することで組織が不可逆的な阻血性障害に陥り発生する．その予防には外力の減少と持続時間の短縮が必要となり，臨床では体圧分散寝具を使用する．体圧分散寝具は3 つの圧再分配機能，すなわち，沈める，包む，経時的な接触部分の変化によって褥瘡好発部位である骨突出部位にかかる圧力を減少させる．体圧分散寝具は数多く市場に出ているが，本邦の寝たきり高齢者にみられる特異的な褥瘡発生要因「骨突出」を有する者には，2 層式エアセルマットレスが予防に有効である．今後さらなる体圧分散寝具の質向上には，体圧分散寝具の圧再分配機能評価法の標準化，体圧分散寝具使用時の看護技術の開発が必要である．

Purpose: The aim of this study was to compare ultrasonographic assessment of fecal loading or colonic gas in adults with computed tomography.<br>Subjects and Methods: Transabdominal ultrasonography (US) was carried out on 39 adult patients with fecal loading or colonic gas seen in abdominal computed tomography (CT) images. Immediately after fecal loading or gas was identified in the colon by CT, US images were acquired with the patient in the identical position.<br>Results: Of 39 patients, 26 were imaged with fecal loading and 13 were imaged with colonic gas. In the 26 patients with fecal loading, it was detected by US in the acoustic shadow behind the high echoic signal in the boundary between colonic contents and bowel wall (boundary echo). In 6 of 26 patients (haustrations-visualized cases), fecal loading was detected in the crescent shaped acoustic shadow with haustrations behind the strong boundary echo. In 15 of 26 patients (haustrations-not-visualized cases), fecal loading was detected in the attenuating echo with multiple high echoic spots behind the mildly boundary echo. In 5 of 26 patients, fecal loading was detected in similar haustrations-visualized cases without haustrations in the colon. In the 13 patients with colonic gas, gas was detected by US in the invisible acoustic shadow behind the unclearly boundary echo. In 7 of 13 patients, colonic gas was detected in multiple reflections in the colon. In the remaining 6 cases, it could not be depicted in the reflection.<br>Conclusion: Transabdominal US can be used for qualitative assessment of fecal loading or gas in the colon. This new technique is simple and noninvasive and can be used concomitantly with physical examination to assess severity of constipation. Thus it may offer an improvement over current assessment techniques.

点滴療法などに使用している末梢静脈内カテーテル留置法は対象静脈が目視困難な場合、 穿刺の成否、合併症発生の頻度に影響を及ぼす。目視困難静脈とは駆血しても静脈の特徴 色が見えない、怒張しない静脈のことである。 そこで目視困難静脈を可視化する機器が必要である。静脈を可視化する機器はいくつか あるが現在臨床に普及するものはみあたらない。既存機器が普及しない原因として、臨床 使用における操作性と目視困難静脈を対象とした評価の検討が不十分であった。そこでこ れらの課題を解決する機器を開発することとした。本研究では、臨床の操作性に適応する 試作機器を作製し、目視困難静脈の可視化性能を評価した。 対象は、前腕部を走行する深さ 3 mmの目視困難静脈モデル（n=10）を用いた。各対象 静脈をデジタルカメラで撮像した画像と試作機器で撮像した透視画像を、静脈の可視性に ついて主観的、及び半定量的に比較した。主観的評価方法では可視化できなかったが、半 定量的評価方法では、デジタルカメラで撮像した画像が目視困難静脈の10%を可視化 （1/10）、試作機器で撮像した透視画像は目視困難静脈の80%を可視化し（8/10）、試作機器 による撮像が静脈を可視化する割合が高かった（2p=.0055）。 今後、臨床実用に向け、透視画像の画像処理技術などを検討することにより、さらに静 脈可視化率を向上させ、3 mmより深い目視困難静脈で可視化性能を評価する必要性が示 唆された。 Catheter placement in peripheral veins used in treatment such as infusion therapy influences the success or failure of the puncture and frequency of onset of complications when visual observation of the target vein is difficult. Difficult to observe veins include those in which the characteristic color is difficult to distinguish despite avascularization and veins that do not engorge. Therefore, a device for visualizing difficult to observe veins is required. Although a number of devices for visualizing veins exist, no such device is commonly used in current clinical practice. The reason for this lack of popularization of currently available devices may be that not enough investigations have been conducted regarding operability for clinical use and evaluation of difficult to observe veins. In light of this, I decided to develop a device to solve these issues. The present study involved the creation of a prototype device suitable for clinical operability and the evaluation of its visualization capability for difficult to observe veins. This study targeted difficult to observe vein models (n = 10) of 3 mm depth that ran through the antebrachial region. The visibility of images of each target vein taken with a digital camera and transparent images taken with the prototype device were subjectively and semi-quantitatively compared. Visualization was not possible with the subjective evaluation method. However, with the semi-quantitative method, digital camera images could visualize 10% of difficult to observe veins (1/10) while transparent images taken with the prototype device could visualize 80% of difficult to observe veins (8/10). Thus, a high ratio of images taken with the prototype device could visualize veins (2p = .0055). This study suggested the necessity of further improving the vein visualization rate and evaluating visualization capability with difficult to observe veins deeper than 3 mm through investigations involving topics such as transparent image processing technology.

Our objective was to clarify the sleep states of bedridden elderly patients with disturbances of consciousness. We studied a bedridden elderly in patient with disturbances of consciousness for 24 hours in March 2010. We recorded the electroencephalograms, electro-oculograms, and electromyograms of the study subject. We classified the electrograms thus obtained into sleep stages according to international standards and identified various sleep variables and the patients' sleep structures. A patient showed very high values for sleep efficiency (SE), 97.8%. The number of awakenings was 36, the percentage of SWS was 1.0%, and the percentage of REM sleep was 8.5%. It is inappropriate to use SE and SWS as indicators of good sleep quality in such patients. To improve their sleep quality, further study is needed to determine better indicators of good sleep and to investigate respiratory conditions as a potential factor in sleep quality in this subgroup.