看護診断「足の皮膚統合性障害リスク状態」の同定に関する研究―糖尿病患者を対象とした危険因子の検討

The Identification of the Risk Factors of the Nursing Diagnosis: Risk for Impaired Foot Skin Integrity in Diabetic Patients

　本研究は，糖尿病性足潰瘍を有する糖尿病患者の臨床的特徴を明らかにすることで，「足の皮膚統合性障害リスク状態」の同定を試み，この診断における危険因子を検討することを目的としている．糖尿病患者148名を対象に調査した結果，18名に現在または過去に足潰瘍の既往がみられた．足潰瘍の既往患者は男性が多く，またインスリン治療を受けている者が多く，網膜症や腎症の合併症が進行していた．そして，神経機能として，圧覚閾値や振動覚閾値の上昇，アキレス腱反射の消失，神経障害に関する自覚症状が多く出現しており，末梢循環機能として足関節上腕血圧比の低下がみられた．さらに，足潰瘍既往患者18名すべてに，胼胝または白癬，変形のいずれかの症状が存在していた．このことより，糖尿病性足潰瘍を対象とする「足の皮膚統合性障害リスク状態」の危険因子として，神経障害，末梢循環障害，皮膚や爪の非潰瘍性病変，足の変形といった項目が示唆された．

　The purpose of this study was to determine the risk factors for the nursing diagnosis“Risk for Impaired Skin Integrity”with foot and to identify the clinical characteristics in diabetic patients with foot ulcer. One hundred forty eight diabetic patients (137 type 2 diabetes mellitus, 92 men, mean age 62.7±8.8 years, diabetes duration 15.6±9.5 years) were examined. There were 18 patients who had an existing foot ulcer or a history of foot ulceration. Patients who had a foot ulcer were more frequently men, had an insulin injection treatment, had retinopathy or nephropathy, had an elevated pressure and vibration perception threshold, had lost or reduced achilles tendon reflex, had 1 or more subjective symptoms of neuropathy, and had a declined ankle brachial pressure index. In addition, all of patients with foot ulceration had any calluses, fungal infections or foot deformities. These findings suggest that neuropathy, peripheral vascular disease, skin disease or foot deformity are significantly associated with the presence of foot ulcer and are risk factors of the nursing diagnosis“Risk for Impaired Skin Integrity: Foot Ulcer”.