術後老人患者の早期離床促進看護プログラム作成のための基礎的研究―術後下肢筋断面積減少と重回帰分析による減少影響因子の検討

Basic Research on Nursing Program of Early Ambulation for Post-operative Elderly Patient : Study of the Decrease of Femoral Muscle Cross-Sectional Area and the Factors Influencing the Decrease by Multiple Regression Analysis

要旨

　術後の下肢筋力低下とその影響因子を知るために，消化器疾患手術患者72例を対象として，大腿周径および皮下脂肪厚より算出した筋断面積を生理学的筋力の指標として，その術前術後の変化を継続的に調べ，変化に関わる因子について重回帰分析を行なって，以下の結果を得た．

1．術後の下肢筋断面積減少は術後早期ほど顕著で，術後7日目までの減少率は8.4％，それ以降は減少が緩徐となり，日々約0.2％の減少が認められた．

2．下肢筋断面積減少は主として出血量と離床日との影響を受け，離床の影響は術後病日が遅くなるほど大きかった．

3．年齢，術前％標準体重，術前Alb.も下肢筋断面積減少に対する説明変数として採択された．

4．離床日は他の因子と異なり，看護援助によって左右されることから，早期離床に向けての看護援助の重要性が裏付けられた．

Abstract

　The purpose of this study was to investigate the deterioration of femoral muscle strength and the factors influensing deterioration. Subjects were 72 surgical patients with gastrointestinal diseases aged above 40 years. As indicators of muscle strength, we chose a crosssectional area (CSA) of muscle, which reflected physiological muscle strength and was estimated from femoral circumference and skinfold. Changes in the CSA were inquired during pre-and post-operative periods, and the factors influensing the decrease were computerized by multiple regression analysis program.

　Findings were as follows:

1. Femoral muscle CSA decreased markedly greater as earlier as in post-operative period. At the 7th post-operative day, the CSA decreased 8.4%, and after that time about 0.2% per day.

2. Dominant factors influensing decrease of the CSA were quantity of operative bleeding and ambulation, especially the latter.

3. Other variables correlated with decrease of the CSA were age, pre-operative body weight, and pre-operative serum albumin.

4. Ambulation is facilitated by nursing intervention and differs from other factors in that aspect, therefore the result from this study dose support importance of the nursing intervention in terms of postoperative early ambulation.