開腹術後のイレウス発症と生活行動に関する研究

Relationship between postoperative lifestyle and onset of ileus following laparotomy

要旨

　開腹術退院後のイレウス発症予防に資する目的で，胃癌，大腸癌による開腹術退院後のイレウス発症32例，延べ57件を対象に，1）初回と2回目以降，2）1回のみの例と，再発例の初回，それぞれについて発症関連要因を検討した．

　その結果，1．初回発症には，「イレウスの知識不足」「食品の知識不足」「イベント」「回復感」が影響していた．2．「イレウスの知識不足」は，サブイレウス状態から発症を招く可能性があった．3．「要注意食品の摂取」は「食品の知識不足」「過食」と関連があった．4．「イベント」は「疲労」「要注意食品の摂取」「過食」を伴い，発症につながる可能性が高いと考えられた．5．胃癌術後例では，「回復感」を契機に術前の生活行動に近づき，発症に至った可能性が考えられた．6．知識習得後の再発例の背景には，切除臓器の相違の影響が考えられた．以上から，看護支援として，サプイレウス時の対処法や要注意食品の食べ方を含めた生活行動に関して，適切な時期を考慮した継続指導の必要性が示唆された．

Abstract

　The present study examines the factors related to the onset of ileus in patients who underwent laparotomy and then discharged. Thirty-two patients experienced a total of 57 episodes of ileus following laparotomy for gastric or colon cancer. In these patients, we investigated factors related to onset of ileus with respect to: 1) differences between the first and subsequent episodes, and 2) differences between the onset in patients who only experienced one episode and the first episode of recurrent patients.

　The results were as follows: 1) the first onset correlated with a "lack of knowledge about ileus","lack of knowledge about food","events" and "sense of recovery". 2)"lack of knowledge about ileus" was related to the change from a sub-ileac condition to ileus. 3) "intake of foods that should be avoided" correlated with "lack of knowledge about food" and "over-eating". 4) When combined with "fatigue intake of foods that should be avoided" or "over-eating"."events" was most closely related to ileus. 5) Patients who underwent gastric surgery resumed their preoperative life-style once they felt a "sense of recovery", thus leading to the onset of ileus, and 6) When patients were educated about the ileus, recurrence was most strongly related to the surgically treated organ rather than postoperative lifestyle.

　These findings suggest that recurrence of ileus can be prevented by educating patients about the appropriate behavior, including food preparation and activities that can affect their subileac condition, in a timely manner following laparotomy.