80歳以上高齢者の清潔間欠導尿法による排尿管理の長期成績とその継続に必要な看護支援の検討

Current Status of Clean Intermittent Urethral Catheterization in Elderly Patients Over 80 Years Old and Review of Nursing Support

抄録

　本研究は，80歳以上の高齢者の清潔間欠導尿（以下，CIC）の長期成績と継続に必要な看護支援について検討することを目的とした．長期成績は，東京都内のA病院で2002年4月から2010年10月までに，CICを導入した80歳以上の58人（男性35人，女性23人，平均83.21±4.2歳）を分析対象とし，患者背景および導尿継続期間，合併症を診療録からデータ収集した．継続に必要な看護支援は，CICを1年以上継続している患者，家族20例（男性13人，女性7人，平均85.2±3.0歳）を対象に半構成的面接を行った．その結果，58人中CICの自己中断は1人，他の排尿方法への変更は4人，CICの離脱ケースは11人，合併症として尿路感染症を3人に認めたが，いずれも抗菌薬投与で改善していた．また，CICの継続要因として抽出されたカテゴリーは，【排尿に関する自覚症状の改善】【日常生活の質の改善】【介護負担の軽減】の3つであった．必要な看護支援として抽出されたカテゴリーは，【患者や介護者の能力に応じた技術指導】【日常生活に即した導尿プログラム構築】【タイムリーな個別的ニーズへの対応】の3つであった．

　In this study, we examined the long-term results of intermittent urethral catheterization in elderly patients over 80 years old and the nursing support required for the continuation of catheterization, with the aim of investigating challenges facing the elderly during long-term catheterization. To investigate the long-term results, 58 patients (35 men and 23 women, an average of 83.21±4.2 years old) aged 80 years or older who had started intermittent catheterization at a hospital in Tokyo between April 2002 and October 2010 were selected for analysis. Their medical records were reviewed to collect data on background factors, the duration of catheterization, and complications. To assess the nursing support needed for continuation of catheterization, semi-structured interviews were conducted with 20 patients (13 men, seven women, an average of 85.2±3.0 years old) and their families who had been performing intermittent urethral catheterization for more than one year. The results showed that for the self-interruption of CIC in 58, as for one person, the change to other urination methods ; for four people, the secession case of CIC ; contracted urinary tract infection in three people while 11 people had complications, which were improved by antimicrobial dosage both. The factors that were identified as contributing to the continuation of catheterization were as follows: (1) improvement of symptoms related to urination, (2) improvement of the quality of life, and (3) a reduced burden of care. The categories selected as necessary for nursing support were as follows: (1) technical guidance set according to the levels of performance of the patients and their caregivers, (2) an intermittent catheterization program that suited the patient's daily life, and (3) timely responses tailored to each patient's needs.