早産児の気管内吸引に伴う看護に関する研究

A Study on Nursing Care of Preterm Infants in Association with Endotracheal Suction

要旨

　本研究の目的は，気管内吸引に伴って行われる看護ケアを観察し，特に気管内吸引後に行われた看護ケアに対する早産児の生理学的および行動状態における反応を明らかにすることである．

　対象は，呼吸管理を受けている4名の早産児であり，観察時点の受胎後週齢は26週から35週，平均体重は792.5ｇであった．

　気管内吸引に伴って行われた看護ケア，心拍数，酸素飽和度，ストレスサイン，睡眠覚醒状態を，気管内吸引開始5分前から吸引終了後20分まで，2分毎に構成的に観察した．

　気管内吸引後には，腹臥位，屈曲姿勢の支持，触覚刺激の提供など，複数のケアが認められた．様式の異なる複数のケアが行われていた45場面を複数ケア群，腹臥位または側臥位の70場面を単一ケア群として反応を分析した．

　複数ケア群は単一ケア群に比べて，ストレスサインが速やかに減少し，静的睡眠が増大し，静的睡眠に入るまでの時間が有意に短かった．

　結果から，気管内吸引という侵襲的な刺激の後に行われた複数のケアは，早産児の運動や状態の組織化に有効な看護方法であることが示唆された．

Abstract

　The purpose of this study was to monitor nursing care provided in association with endotracheal suction, and particularly to identify the physiological and behavioral responses of preterm infants to nursing care provided after endotracheal suction.

　The subjects were four preterm infants undergoing respiratory management. Their post conceptional age at the time of observation was 26 to 35 weeks, and their mean body weight was 792.5g.

　Nursing care provided in association with endotracheal suction and the infants' heart rate, oxygen saturation, stress signs, and sleep-wakefulness state were systematically monitored every 2 minutes from 5 minutes before the start of endotracheal suction until 20 minutes after its completion.

　Multiple kinds of care, including maintenance in the prone position and flexed posture, and provision of tactile stimulation were provided after endotracheal suction. A total of 45 settings in which several different kinds of care were provided were classified as the“multiple care group”, and 70 settings in which the infants adopted the prone or side lying position as the“single care group”, and the infants' responses were analyzed accordingly.

　Stress signs decreased more rapidly, the duration of quiet sleep was longer, and the latency until the start of quiet sleep was significantly shorter in the multiple care group in comparison with the single care group.

　These results suggest that the use of multiple kinds of care after invasive stimulation in the form of endotracheal suction is an effective nursing method for organizing the motor and state of preterm infants.