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1日目離床による下肢筋断面積減少抑制効果の検討

Basic Research on Nursing Program of Early Ambulation for Postoperative Elderly Patient: Study of the Effect of Ambulation on the 1st Postoperative Day upon Sectional Area of Femoral Muscle

要旨

　術後1日目よりの離床が特に老人患者の下肢筋力に及ぼす影響を知るために，消化器疾患手術患者を対象として，1日目離床群（40～59歳；9例，60歳以上；12例）と対照群（40～59歳；8例，離床日3.1±0.8日，60歳以上；11例，離床日4.4±1.7日）について，生理学的筋力をあらわす筋断面積を筋力の指標として，大腿周径および皮下脂肪厚より筋断面積を算出し，その術前術後の変化を継続的に調べて以下の結果を得た．

1．1日目離床群の術後の下肢筋断面積減少率は，40～59歳および60歳以上の両年齢グループとも，対照群に比べて少なかった．

2．1日目離床群の40～59歳と60歳以上とは，術後の下肢筋断面積減少率は同様の推移を示したが，対照群では，60歳以上の方が40～59歳に比べて減少率が大きかった．

3．60歳以上の対照群では離床日の遅いものほど筋断面積減少率が大きかった．

　以上より，術後1日目よりの臨床は下肢筋力低下を抑制し，特に60歳以上に効果が大きいといえる．

Abstract

　The purpose of this study was to inquire the effect of ambulation on the 1st postoperative day upon femoral muscle strength in elderly patients. Subjects were surgical patients with gastro-intestinal diseases aged 40-59 and over 60 years. The number of subjects were 1) ambulatory group who began to walk on the 1st postoperative day: 40-59 years old; 9, over 60 years old; 12, and 2) control group: 8 and 11 patients respectively. As indicator of femoral muscle strength, we chose a sectional area of muscle, which reflected physiological muscle strength and was estimated from femoral circumference and skinfold. Changes in the sectional area was investigated during pre- and postoperative periods, and rates of decrease were compared between ambulatory group and control group on the one hand, and between those aged 40-59 and over 60 years on the other.

　Findings were as follows:

1. The ambulatory group showed less decrease of the sectional area in both patients aged 40-59 and over 60 years.

2. In the ambulatory group, both classes of patients aged 40-59 and over 60 years showed similar decrease curves of sectional area, but in the control group, the decrease of the sectional area for patients of over 60 years old was greater than that for those of 40-59 years old.

3. In the control group of patients of over 60 years old, the later they began to walk, the greater was the decrease in the sectional area of muscle.