慢性肺気腫患者の呼吸困難と心因的問題

The relationship between a patient's dyspnoea and chronic pulmonary emphysema along with a psychogenic problem

要旨：心因的問題が呼吸困難に関与していると考えられた慢性肺気腫患者一症例の「不安」に焦点を当て，不安が呼吸困難に与える影響，呼吸リハにおける作業療法の役割に関して検討を行った．体動や不安感から呼吸困難を生じ更にはパニックを引き起こしていた症例に対して，状態不安，呼吸困難度，動脈血酸素飽和度，訓練環境，その日のエピソードやコメント，に関する評価を行った．結果，状態不安が強い時に呼吸困難も強くなる傾向，訓練環境が好ましくない時に状態不安が高く維持される傾向にあった．今後は身体機能に対する訓練に加えて，心身両面の機能や，身体自覚症状への対処，心理的ストレスへ対応する環境整備が重要であると考えられた．

　In this study, we focused on the fear and insecurity of a patient with chronic pulmonary emphysema. The patient felt fear and insecurity with regard to difficulty of breathing, and it exacerbated dyspnea. We studied how the fear and insecurity influenced the dyspnoea, and the role of occupational therapists in respiratory rehabilitation.

　Furthermore, we evaluated the anxiety state, the extent of dyspnoea, the oxygen saturation of arterial blood, the environment of occupational therapy, and an episode and a comment on the day of exercise.

　The results were as follows : 1) as the insecurity state of the patient became stronger, dyspnea symptoms become worse. 2) In an undesirable therapy environment, the anxiety state of the patient was worsening.

　It was concluded that, not only the therapy for respiratory functioning was important for the patient, but also environmental considerations with regard to physical and mental function and psychological stress.