治癒過程に注目した高齢者の褥創の形態と看護ケアとの関係

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Author: 真田, 弘美ほか

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Publication date: 2003-09-16

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Note (General)：: 金沢大学医学部目的:高齢者における発生時の褥瘡の形態と褥瘡発生要因との関係、難治性褥瘡の形態的分類とその特徴から見た看護ケアとの関連を明らかにすることを目的とした。対象:褥瘡部の写真を撮る許可を得られ、発生直後から創部を観察できた115名(男性37名、女性78名)で平均年齢±SDは81.4±7.0歳...

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Material Type: 文書・図像類
Title: 治癒過程に注目した高齢者の褥創の形態と看護ケアとの関係
Author/Editor: 真田, 弘美
Sanada, Hiromi
Author Heading: 真田, 弘美
Sanada, Hiromi
Publication Date: 2003-09-16
Publication Date (W3CDTF): 2003-09-16
Alternative Title: Relationship between typical wound healing process based on morphology in elderly and nursing management
Periodical title: 平成13(2001)年度科学研究費補助金基盤研究(C) 研究概要 = 2001 Research Project Summary
No. or year of volume/issue: 1998 – 2000
Volume: 1998 – 2000
Pages: 2p.-
Text Language Code: jpn
Subject Heading: 治癒仮定
高齢者
褥創
形態
看護
wound healing
elderly
pressure ulcer
morphology
nursing
Target Audience: 一般
Note (General): 金沢大学医学部
目的:高齢者における発生時の褥瘡の形態と褥瘡発生要因との関係、難治性褥瘡の形態的分類とその特徴から見た看護ケアとの関連を明らかにすることを目的とした。対象:褥瘡部の写真を撮る許可を得られ、発生直後から創部を観察できた115名(男性37名、女性78名)で平均年齢±SDは81.4±7.0歳の入院患者である。主な疾患は脳血管障害であった。方法:1.正常治癒過程を辿った褥瘡の実態と形態的に分類、2.難治性の治癒過程を辿った褥瘡の実態と形態的に分類、3.褥瘡の治癒過程と看護ケアの関連から調査した。深度分類にはNPUAP分類を用いた。なお、ここでいう難治性褥瘡とは、1年以上経過していても治癒に至らない褥瘡とした。結果:1.正常治癒過程を辿った褥瘡では、発生部位は仙骨が44部位と最も多かった。深度別では、治癒期間はStageI〜1Vの順に長期間要した。ポケット形成はStageIIIとIVに認め、全周に形成したのはStageIVのみであった。形態的治癒過程をみると、StageIは発赤の色調によって3つに、StageIIは壊死組織の有無によって2つに、StageIIIはポケットの有無によって2つに、StageIV壊死組織の付着方法とポケットの形状によって5つにパターン化された。2.難治性の治癒過程を辿った褥瘡15部位の実態と形態的に分類では、発生部位は仙骨、尾骨、大転子部、坐骨結節であった。治癒遅延の状態として、肉芽の増殖が遅延や、創縁の肥厚・角化・浸軟・緊張があった。形態的には、表皮化、ポケットの治癒、肉芽の増殖から6つにパターン化された。3.褥瘡の治癒過程と看護ケアの関連から分析では、圧、ずれ、清潔、体位変換のケアを介入することで停滞していた治癒が促進し、仙骨部では拘縮があることによって治癒期間が長期化する傾向があった。以上の結果から、創治癒パターン化したことで、新たな褥瘡の治癒分類が導き出され、これを使用することで治癒を予測でき、効果的なケア介入が可能となる。
Purpose: We analyzed the morphology of pressure ulcer and the factor influencing the development of pressure ulcer in elderly patients, to clarify the relationship between morphological stage of incurable pressure ulcer and the care management.Objects: Objects were 115 patients (male 37, female 78) who admitted, mainly by cardiovascular diseases in hospital. Mean age and SD was 81.4± 7.0 tear and the informed consent for photographic examination was taken from all patients.Methods: 1. The pressure ulcered cured in standard, course were classified by the region, the stages of ulcer, and morphology. 2. The pressure ulcers which were incurable for more than one year were classified as same manner. 3. The relationship between the curable course of the pressure ulcer and the care management was analyzed. Staging of depth of pressure ulcers was classified by NPIJAP classification. Result: 1 Main region seen in the pressure ulcers that were normally cured in standard course was sacral region (44 patients). Duration for cure was increased with stage of depth. Formation of the pocket was detected in stage II and IV and the pocket surrounding all margins was only found in stage IV. Stage I was categorized into two subgroup by the degree of redness, stage II into two by the presence of necrotic tissue, stage II into three by the presence of pocket formation, and stage IV into five by the condition of attachment of the necrotic tissue and morphology of pocket.The 13 pressure ulcers incurable within one year were found at sacrum, coccyx, major trochanter, and ischial tuberosities. The etiology of prolonged for cure was estimated to be an in sufficient proliferation of granuloma, thickness, maceration, hyperketoratosis and tension at ulcer margin. The ulcer was morphologically categorized into six subgroups by the epithelization, the cure stage of pocket, and the proliferation of granuloma.3. From the analysis of the relationship between curable course of the pressure ulcer and care management, the introduction of care management with improvement of pressure, slipping, cleanness, and the change of position accelerated the cure of pressure ulcer. The curative period of pressure ulcer at sacrum with contraction was tendency to be long.From these results, a new classification in stage of curative pressure ulcer was found by the categorization of pressure ulcer in the curative stage. Using this method, it will be possible to achieve the estimation of cure and the effective care management.
研究課題/領域番号:10672236, 研究期間(年度):1998 – 2000
出典：「治癒過程に注目した高齢者の褥創の形態と看護ケアとの関係」研究成果報告書　課題番号10672236（KAKEN：科学研究費助成事業データベース（国立情報学研究所））（ https://kaken.nii.ac.jp/ja/grant/KAKENHI-PROJECT-10672236/ ）を加工して作成
DOI: 10.24517/00064002
Access Restrictions: 限定公開
Related Material: https://kaken.nii.ac.jp/ja/search/?kw=50143920
https://kaken.nii.ac.jp/ja/grant/KAKENHI-PROJECT-10672236/
Data Provider (Database): 国立情報学研究所 : 学術機関リポジトリデータベース（IRDB）（機関リポジトリ）
https://irdb.nii.ac.jp
Original Data Provider (Database): 金沢大学 : 金沢大学学術情報リポジトリKURA