| 特集名 | 透析患者の中枢神経系障害 | |
|---|---|---|
| 題名 | 透析患者の中枢神経系障害と介護 (2) 脳卒中後遺症とその看護と介護 | |
| 発刊年月 | 2013年 09月 | |
| 著者 | 林田 征俊 | 衆和会長崎腎病院血液浄化センター |
| 著者 | 岩本 まゆみ | 衆和会長崎腎病院看護部 |
| 著者 | 丸山 祐子 | 衆和会長崎腎病院看護部 |
| 著者 | 舩越 哲 | 衆和会長崎腎病院血液浄化センター |
| 【 要旨 】 | 脳卒中急性期を経て退院し，在宅・在所復帰を成し遂げた外来透析患者に焦点を当て，retrospectiveにその傾向を分析し，患者・家族の望む社会復帰の生活像に近づけるためわれわれが提供すべき事項を検討した．介護保険利用可能者は，全患者に比べて脳卒中既往患者において有意に高く，介護保険利用状況では要介護2・3が有意に高かった．また，2010年に発症直後のKDQOLを評価し，現在再評価しえた症例で検討したところ，包括的尺度で下降する傾向であったにもかかわらず，「日常役割（身体）」と「日常役割機能（精神）」は有意に上昇していた．これはリハビリなどにより身体機能が改善した結果，活動時間が増加した効果と考察する． よって，われわれが留意すべき事項は，(1) 早期からの十分な介護保険の利用，(2) 要介護2・3取得を念頭におき主治医意見書作成，(3) 通常より患者家族との信頼関係を構築する，と考える． |
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| Theme | Disorder of central nerve system in dialysis patients | |
|---|---|---|
| Title | Nursing-care for hemodialysis (HD) patients with cerebrovascular disorder (CVD) | |
| Author | Masatoshi Hayashida | Blood Purification Center, Nagasaki Renal Center |
| Author | Mayumi Iwamoto | Department of Nursing, Nagasaki Renal Center |
| Author | Yuko Maruyama | Department of Nursing, Nagasaki Renal Center |
| Author | Satoshi Funakoshi | Blood Purification Center, Nagasaki Renal Center |
| [ Summary ] | The risk of cerebrovascular disorders (CVD) in hemodialysis (HD) patients is much higher than in healthy subjects. We examine the utilization profile of nursing-care insurance (NCI) and other factors affecting HD patients who have successfully returned to normal social activities after CVD, and investigate the keys for their rehabilitation. The utilization rate of NCI is significantly higher for those who experience CVD. Interestingly, HD patients with a history of CVD require NCI at level 2 or 3, not 1 or > 4, suggesting those levels match their social rehabilitation. Measurements conducted using the KDQOL-SFTM version 1.3, provided scores of "role physical" and "role emotional". These scores well being immediately after CVD episodes significantly improved from 2010 to 2012. At the present time, there are indications of improved duration of physical activity for these patients, presumably due to rehabilitative training programs. In conclusion, we need to offer ; (1) earlier applications of NCI, (2) NCI level 2 and 3 recommended. (3) building trusting relationships with HD patients and their families who have experienced CVD. |
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