室岡 陽子

This study investigated changes in heel pressure and shear force during head-of-bed elevation and examined the effects of pressure and shear release at the foot using a three-axis tactile sensor. Twenty-six healthy adults aged ≥30 years participated (mean age, 45.1 ± 11.1 years; mean body mass index, 22.2 ± 3.2 kg/m²). Heel pressure and horizontal shear force were measured at different head-of-bed angles as participants moved from the supine position. Measurements were also obtained after pressure and shear forces were released from either the left or right foot and were compared with measurements obtained without release. Heel pressure and horizontal shear force increased as the head of the bed was elevated. The most marked increases occurred when the angle was raised from 0° to 30°. At 45° and 60°, pressure and shear force remained elevated, but no further significant increases were observed. Releasing pressure and shear force from the foot after head-of-bed elevation temporarily reduced both values to nearly zero. However, pressure and shear force tended to increase again with further elevation. No significant differences were found in the overall changes in heel pressure and shear force between conditions with and without foot release, although the intervention produced temporary reductions in both measures. These findings indicate that heel pressure and shear force increase substantially at a head-of-bed angle of 30°. Although releasing pressure and shear force at the foot did not result in statistically significant differences, it reduced the continuous mechanical load on the heel. Therefore, after elevating the head of the bed, nurses should assess not only the buttocks but also the heels and perform appropriate repositioning and pressure-relieving interventions to minimize pressure and shear forces and prevent pressure injuries.

リハビリテーションを目的に入院した脊髄損傷患者の入院時と退院時の排便管理状況を比較検討することを目的に、A施設の障害者病棟に入院・退院した当該患者20名(男性19名、女性1名。平均年齢54.5歳)を対象に、処置時の聞き取りとカルテをもとに調査した。その結果、排便管理を困難とする要因として、障害レベルのほか、下剤など排便に関する薬剤やその他の疾患に伴う薬剤による影響や、失禁に対する不安から食事摂取を制限し、それが排便管理をさらに困難にさせていることなどが分かった。