須釜 淳子

The purpose of the present study was to examine the validity of the KINOTEX sensor via comparison with an existing sensor and to determine the sensing areas for a new alternating-air mattress that incorporates an interface pressure-sensing system. The study design was an evaluation study to validate and determine the sensing area of the KINOTEX sensor in comparison with another sensor. Study participants were fifty-one healthy volunteers over eighteen years of age, and the two sensors were placed between participants and an alternating-air mattress. We measured the contact area, full weight load, and maximum pressure in the calcaneal region using two sensors and obtained a graphic pressure distribution of >40 mmHg in the lateral and supine positions. Correlation coefficients between sensors were r = 0.88 (p < 0.001) for the contact area, r = 0.89 (p < 0.001) for full weight load, and r = 0.72 (p < 0.001) at maximum pressure in the calcaneal region. Ninety-one percent of the pressure distribution was recorded in the central 50 cm of the bed, and 94.6% was recorded within an area 160 cm in length need the foot of the bed. We investigated the correlation between the KINOTEX sensor and an existing sensor and determined the necessary sensing area. Results suggested the feasibility of developing a new alternating-air mattress incorporating an interface pressure-sensing system to help prevent pressure ulcers.

脊髄損傷者の褥瘡の深さと健康行動との関係を明らかにすることを目的に、脊髄損傷者23名(うち、褥瘡を有する者18名)を対象に半構成的面接を実施し、自己効力感の理論的状況として説明されている健康行動理論であるHAPA(Health Action Process Approach)を用いて分析した。その結果、深い褥瘡を有する脊髄損傷者の健康行動は浅い褥瘡を有する者に比べて、「褥瘡は気持ち悪い」「治らなくても仕方がない」「予期せずできた」と捉えており、褥瘡悪化への危険性の認知ができず、「そのうち治る」「手術で治る」という結果期待感から感染予防や創部の治癒を促進するための健康行動をとっていないことが明らかになった。

The effect of vibration on skin microcirculation was studied to investigate the possibility of clinical use of vibration to prevent and treat pressure ulcers. Vibrations at a vibrational intensity of 600, 800, or 1,000 mVpp with a fixed frequency of 47 Hz were applied horizontally to the ear of male hairless mice (n = 6 for each group) under inhalation anesthesia. The control group (n = 6) received no vibrations. Venular blood flow was measured by an intravital videomicroscope at the baseline and at 0, 5, and 15 min after the application of vibrations. A significant increase was observed in the 600 mVpp group 5 and 15 min after vibration in comparison to the control group (P = 0.002 and P = 0.046, respectively). We also detected increased blood flow in the 800 mVpp group (P = 0.028) and the 1,000 mVpp group (P = 0.012) 5 min after vibration; however, these increases attenuated after 15 min. These results indicate that direct skin vibration at a frequency of 47 Hz improves skin blood flow. The present study gives further support to the role of vibration on a short-term increase in skin blood flow.

Square skin wounds can heal to form a stellar scar with four protrusions at the four angles, whereas circular wounds can heal to form an ellipsoid scar. It is not clear why these differences occur and the aim of the present study was to clarify this phenomenon. Two square or circular full-thickness skin wounds were made on the dorsum of mice, and covered with hydrocolloid dressing. They were observed from day 0 to 15 after wounding, and used to prepare paraffin sections stained with anti-alpha-smooth muscle actin antibody to detect myofibroblasts. The square wound was transiently enlarged by edema and skin tension on day 3, at which time the angles became round, and thus the square form became more circular. Thereafter, the wound contracted rapidly and the circular form was maintained until day 11. On day 11 distinct angles appeared where the scar formation had progressed further, and there were fewer myofibroblasts than in any other section. A stellar scar with protrusions from the four angles was formed on day 15, when myofibroblasts almost disappeared in the protrusions. This indicates that due to the earlier disappearance of myofibroblasts and earlier scarring in the angles of the square wound, the scar angle cannot be pulled into the center of the wound but residual myofibroblasts on the side can pull the side into the center due to myofibroblastic contraction and consequently a stellar scar is formed. Thus, the earlier disappearance of myofibroblasts in the angles is very important for the formation of stellar scars.

The purpose of this study was to identify risk factors associated with the presence of pressure ulcer development in adult patients at an intensive care unit hospital in Indonesia. The prospective cohort design was conducted in this study. A total of 105 patients participated and a pressure ulcer developed in 35 patients. The initial analysis identified several variables as significant risk factors for pressure ulcer development (interface pressure, fecal incontinence, skin moisture, diastolic blood pressure, smoking and body temperature). However, when entered into a final multivariate analysis, four factors, interface pressure [odds ratio (OR) 17.6, 95% confidence interval (CI) 4.1, 74.3], skin moisture (OR 8.2, 95% CI 2.2, 30.9), smoking (12.7, 95% CI 2.8, 56.7) and body temperature (OR 102.0, 95% CI 7.7, 98.8) were found to be significant. The results suggest that interface pressure measured using a multipad pressure evaluator, skin moisture measured by a moisture checker, thermometer for body temperature and smoking status are adequate instruments for the prediction of pressure ulcer development. © 2007 Blackwell Publishing Ltd and Medicalhelplines.com Inc.

Aims and objectives. A reduction of pressure ulcer wound area is one of the most important indicators of wound healing. A wound measurement system (VISITRAK (TM)), which calculates the area based on simple tracings of wounds, has been developed as a practical tool for assessing wound area at the bedside. However, its accuracy has remained to be clarified in a clinical setting. This study aimed to clarify the clinical accuracy of the VISITRAK system. Design. A descriptive correlational study. Methods. Intra- and inter-rater reliability of wound measuring techniques were calculated using an intraclass correlation coefficient (ICC) from 10 pressure ulcers. Concurrent validity was assessed, using 30 pressure ulcers, by comparing VISITRAK and digital planimetry. Assessment times for VISITRAK and digital planimetry were also compared for clinical practicality. Results. The VISITRAK reliability results showed high (0 center dot 99) ICC values. For validity, a correlation coefficient between VISITRAK and digital planimetry was 0 center dot 99. The median time to take a measurement with VISITRAK was significantly shorter than that required for digital planimetry. Conclusions. Based on our results, VISITRAK was found to have high intra- and inter-rater reliability and high validity. Relevance to clinical practice. The short measurement time with the VISITRAK system, and the ability to use it at the bedside, make it a useful, convenient device for clinical use.

褥瘡に対する創傷計測キットの信頼性、妥当性、効率性について検討した。その結果、1)看護師4名が測定した創面積の評定者内変動係数の中央値は創傷計測キット0.4%、画像解析ソフト3.4%で、創傷計測キットの評定者内頼性が有意に高かった。評定者間変動係数の中央値は創傷計測キット2.9%、画像解析ソフト3.8%で有意差がなかった。また創傷計測キットは創の形状に関係なく高い評定者内信頼性が得られた。2)創傷計測キットで測定した創面積と画像解析ソフトで測定した創面積との相関係数はr=0.99と高かった。また、創辺縁整形、創辺縁不整形、凸面の創、平面の創いずれも相関係数が高く、創傷計測キットは画像解析ソフトとの併存妥当性が示された。3)測定時間の中央値は創傷測定キット54秒、画像解析ソフト126秒と、創傷測定キットの測定時間が有意に短かった。

The prognosis of stage I pressure ulcers cannot be predicted; therefore, nursing interventions for preventing their deterioration have not been clearly established. This study describes the clinical course of stage I pressure ulcers and prospectively investigates the factors related to their deterioration. Thirty-one stage I pressure ulcers in 30 patients in a long-term care facility were studied, and morphological changes were assessed every day until the ulcers healed or deteriorated. The physiological changes were assessed by ultrasonography and thermography. Twenty ulcers healed, and 11 deteriorated. The characteristics of deterioration were as follows: (1) double erythema; (2) non blanchable erythema across the whole area determined by glass plate compression; (3) erythema away from the tip of the bony prominence; and (4) expanding erythema on the following day. We analysed the sensitivity, specificity, positive predictive value, negative predictive value and positive likelihood ratio for the diagnostic utility of the indicators of deterioration double erythema and distance from the tip of bony prominence, which can be instantly assessed without the use of any special device. The values were 36.4%, 95.0%, 80.0%, 73.1% and 7.28, respectively. These results suggest that clinicians can predict the prognosis of stage I pressure ulcers by initial assessment and provide appropriate care based on the assessment.

褥瘡を有する入院患者9名(男性4名,女性5名・年齢中央値76歳)を対象に,二層式エアセルマット導入2週間前(対照期)と導入後2週間(実験期)で比較した.1)創面積は実験期で有意に縮小し,DESIGN合計点では実験期で有意に創状態の改善を認めた.2)仙骨部体圧値は実験期で有意に減少したが,ブレーデンスケール,上腕囲,上腕筋部皮下脂肪厚,上腕筋囲では対照期と有意差はなかった.3)褥瘡ケアの直接費用は,エアマットレス代が実験期で有意に高かったが,人的資源・物的資源の全費用では両期で有意差を認めなかった.4)創面積費用対効果は対照期-2298.1円と創拡大に費用を要し,実験期241.3円であった.DESIGN費用対効果は対照期32939.0円,実験期5577.9円と約6倍の効果を認めた

近年,寝たきり高齢者の褥瘡予防と介護負担軽減のため,自動体位変換機能(以下ローリング)が活用されている.しかし,在宅においてエアマットレスに付加されたローリングの体圧分散効果,介護者負担への効果は検討されていない.今回,研究に同意が得られた在宅寝たきり高齢者とその介護者5組を対象に,ローリングの有効性を評価した.ローリングを付加した縦エアセルマットレスを用い,1か月間の追跡観察を家庭訪問にて行った.ローリングあり2週間・なし2週間の使用において,いずれの対象も順瘡発生はなく,1名を除きローリング1周期において高体圧面積および最高体圧部位が移動し,同一部位の圧迫解除ができていた.介護負担では,2時間ごとの体位変換介助をしていた2名の介護者の精神的負担はローリングあり時に軽減した.以上よりローリングは在宅において体圧分散に有効であり,介護者の定期的な体位変換における精神的負担を軽減する可能性が示唆された.

Tissue hypoxia in a pressure-induced ischemic wound has been shown to facilitate bacterial proliferation and tissue destruction. However, no adequate animal models of pressure-induced ischemic wounding have been developed, and the effects of bacteria on the healing process of such wounds have yet to be clarified. Therefore, this study aimed to develop a pressure-induced ischemic wound model and to clarify the effects of bacteria on wound healing. Two incisions that extended to the peritoneal cavity were created in the flank region of rats, and a metal plate was passed through 1 incision under the peritoneum and then exited from the other. From the exterior surface, 8 kg of pressure were applied for 6 hours to the flank skin and abdominal muscle to create an ischemic wound. The wound was observed for 2 weeks, and histological tissue sections were prepared on Days 1, 3, 7, and 14. Wound healing was compared between 2 groups: a bacterial-inoculation group (5.3 x 10(7)/mL of Staphylococcus oureus was inoculated into the epidermis, subcutaneous tissue, and abdominal muscle before and after preparing the ischemic wound) and a control group (only pressure was applied to prepare an ischemic wound). In the bacterial-inoculation group, epidermal loss and, dermal, 'subcutaneous, and muscular tissue necrosis were seen; further, an abscess covered by a U-shaped membrane was formed and persisted to Day 14, appearing to extrude from the wound. In the control group, ischemia caused partial loss of epidermis and partial necrosis of the subcutaneous tissue and abdominal muscle; however, by Day 14, the epidermis had regenerated, granulation tissue formed, and the structure and alignment of collagen fibers in the dermal layer were normal. These findings may suggest that when a pressure-induced ischemic wound is complicated by bacterial infection, the collagen fibers in the dermal layer, which resist ischemia, become necrotic from bacterial proliferation and neutrophilic infiltration, thus delaying wound healing.

Many clinicians use the same solution, most often normal saline, to cleanse the periwound skin and the wound bed itself However, skin debris such as water-insoluble proteins and lipids are not efficiently removed by normal saline solutions. To analyze the skin debris and micro-organisms found on the periwound skin of pressure ulcers and to evaluate the effect of periwound cleansing on the microbial flora, a descriptive study was conducted among 17 long-term care residents with Stage III and IV pressure ulcers. Skin debris from both the periwound area and normal skin was collected from all 17 residents. In addition, micro-organisms from the wound bed, periwound, and normal skin of five residents were collected before, immediately after, and 6 hours and 24 hours after periwound cleansing using a skin cleanser All microbial species were identified by cultivation. Cholesterol and nitrogen-containing substances were found in greater quantity on the periwound than on normal skin (P = 0.0027 and P = 0.0054, respectively) and the number of isolated micro-organisms from the periwound area was larger than that from normal skin. Protein showed the highest correlation to the microbial count present on the periwound (r = 0.71, P = 0.0014). The microbial counts of all isolated micro-organisms decreased immediately after cleansing but the number of isolates with high microbial counts increased over time. In the wound bed, the number of isolates with decreasing microbial counts was larger than the number of isolates with increasing microbial counts. Both numbers returned to pre-cleansing values after 24 hours, suggesting that periwound cleansing only (without directly cleansing the wound bed) is effective at reducing the microbial counts in the wound bed for up to 24 hours. Further research is needed to evaluate the effects of periwound cleansing on healing time.

Background/Purpose. The prognosis of patients with pancreatic cancer is said to have not been improved markedly by any procedures in the past 20 years. Since 1973, we have gradually extended the area of dissection when performing curative resection for pancreatic cancer to improve the resection rate and prognosis. Nineteen patients have survived for 3 years or more, and the 5-year survival rates of patients with cancer of the head of the pancreas were 23.9% for macroscopically curative resection and 34.3% for histologically curative resection. Methods. We histologically observed surgical specimens, cut into 3- to 5-mm sections and compared the histologic characteristics of the 19 patients who survived for 3 years or more with those of 41 patients who died of cancer within 3 years (excluding 6 operative and hospital deaths), in order to find the conditions required for long-term survival. Results. The following conditions were associated with long-term survival: (1) tumor diameter 3 cm or less; (2) either absence of lymph node metastasis or metastasis limited to the n(1) group; (3) degree of invasion of the anterior pancreatic capsule of zero (s0); and (4) either no retropancreatic invasion (rp0) or exposed retropancreatic invasion (rpe) with no cancer invasion of dissected peripancreatic tissue ew(-). Conclusions. At present, because the rpe rate is more than 70%, resection of the pancreas, including the superior mesenteric vein and the retropancreatic fusion fascia, is essential for a curative resection, because the retropancreatic tissue between the back of the pancreas and this fascia is anatomically considered to be in the position of the subserosal tissue in the gallbladder or stomach. Combined resection of the superior mesenteric artery may further improve the results of resection for pancreatic cancer, from the anatomical viewpoint.

「褥瘡発生に関連する介護力評価スケール」を作成し,信頼性を検討した.スケールを作成する方法として,文献レビューによる先行研究における「介護力」の抽出,自験例の在宅で褥瘡を発生した症例の介護力を分析し,褥瘡発生に関連する介護力を明らかにしスケールにするという手順で行った.信頼性は,訪問看護師24人との総合点の一致度は75%,各項目では90〜100%であり,信頼性の高いスケールであることが示唆された