膠原病外来患者におけるステロイドの副作用体験とノンコンプライアンスとの関連—服薬自己管理指導のために

Relationship Between the Experiences of Steroids Side Effects and Noncompliance with Oral Steroids Treatment in Collagen Diseases Patients

はじめに

　膠原病患者の薬物治療において糖質コルチコイド（ステロイド）療法は大きな比重を占めており，ステロイド剤の服薬が正しく行なわれるか否かは予後に大きな影響を与えると考えられる。特に外来通院中の膠原病患者では，ステロイドを正しく服用するという服薬の自己管理が重要な課題となる。ステロイドの長期服用上の最も大きな問題点はその副作用であり，実際上はその有効性と副作用のバランスを考慮して治療がなされている^1,2）。そのため患者が副作用を体験したりあるいは副作用の出現を恐れて，故意に服薬を加減または中断する危険性がある。その結果，原疾患の増悪やステロイド離脱症候群が出現する可能性があり，看護職者にとって膠原病患者のquality of lifeの面からも患者に対するステロイドの自己管理指導は大切である。

　ステロイドの服薬のコンプライアンス向上をはかるために，当院膠原病外来に通院中のステロイド服用患者を対象に，ステロイドによる副作用体験状況とステロイドのノンコンプライアンスの実態を調査し，両者の関連を分析した。

　Purpose : To analyze the relationship between the experience of side effect and the compliance with oral steroids drug treatment of the patients in Collagen Disease Clinic.

　Methods : A questionnaire survey through interview was conducted on 165 outpatients with various collagen disease at Saga Medical School Hospital.

　Results : 94 patients (57%) had a history of noncompliance to the steroids drug. 49 patients (52.1%) adventitiously had forgotten to take the steroids as ordered and 45 patients (47.9%) intentionally had regulated their steroids dose or had discontinued the steroids drug treatment. Over 80% of the patients had experienced side effects of the steroids. The patients who experienced one or more of the following side effects, osteoporosis, bone fractures, menstrual disorders, moon face, central obesity, alopecia, acnelike eruption, manic-depressive state, and insomnia, intentionally regulated, or discontinued the steroids therapy. In addition, the patients who was not made cognizance about side effects of the steroids by their physicians and nurse tended to noncompliance group.

　Conclusion : To increase the compliance rate with oral steroids drug treatment, we must make conscious efforts to inform the patients on the condition of their medical statas, the efficacy of the prescribed drugs, and the side effects and risk concerning discontinuation of the steroids. It is Also necessary to establish “Drug information and counseling day” in outpatient Department.