山形大学紀要(医学) 第35巻 第2号(2017)49-60

回復期脳卒中患者の蓄尿症状の実態と日常生活動作、うつ状態との関連

阿部桃子,佐藤和佳子


【背景】回復期脳卒中患者の3〜5割は、脳損傷による排尿抑制の遮断から、橋排尿中枢の排尿反射が生 じやすくなる。Tibaek Sらは、蓄尿症状を有する脳卒中患者は、急に起きる抑えきれない尿意や頻尿に よる心理的負荷から歩行能力の改善が妨げられる可能性を指摘した。しかし、蓄尿症状が病的状態であ ることをふまえ、回復期脳卒中患者を支援してきたとは言い難い現状から、蓄尿症状の主訴と排尿機能 と動作、排尿に対する患者の心理反応を定量評価し、ケアチームで支援することが重要だと考えた。そ こで今回は、回復期脳卒中患者の排尿に対する心理反応尺度の開発に向けた基礎調査として、回復期脳 卒中患者の蓄尿症状の実態と日常生活動作の自立度、心理反応はうつ状態に注目し、蓄尿症状との関連 を明らかにすることにした。
【方法】回復期リハビリテーション病棟の脳卒中患者120名の基本属性、蓄尿症状、日常生活動作自立度、 うつ状態を調査した。蓄尿症状と基本属性、日常生活動作自立度、うつ状態との関連は、Spearmanの順 位相関係数で検討した。
【結果】対象集団の92.5%が蓄尿症状を有していた。蓄尿症状と年齢、罹患期間、特異症状、日常生活動 作の自立度、うつ状態との間に有意な相関を認めた。なかでも、尿意切迫感、切迫性尿失禁の度合が重 度であるほど、排尿に関連する更衣、トイレ動作と移乗、排尿管理の自立度は有意に低下した。うつ状 態とも、中程度の相関関係を認めた( p<0.01)。頻尿と日常生活動作自立度、うつ状態は、一部を除き、 統計学的に有意な関係はなかった。
【結論】多くの回復期脳卒中患者は蓄尿症状を有し、尿意切迫感、切迫性尿失禁と日常生活動作の自立度、 うつ状態との間に有意な相関関係を認めた。看護職者は、ケアチームの一員として、脳卒中による排尿 機能、日常生活動作、心理反応の変化を速やかにとらえ、支援することが求められる。

キーワード:蓄尿症状、過活動膀胱、脳卒中、日常生活動作、うつ状態


Relation between the actual conditions of storage symptoms, activities of daily living and the state of depression on stroke patients in the recovery phase

Momoko Abe, Wakako Sato

Background: Urinary reflex of pontine micturition center from interruption of urinary control by brain damage tends to occur to 30〜50% of stroke patients in the recovery phase. An acute and strong desire to urinate which cannot be kept down and incontinence immediately after that affect improvement of stroke patients’ mobility capability. However, it is difficult for both patients and nurses to notice that it is pathological condition by stroke. The current condition is that it is difficult for both parties to even have discussion due to unnecessary guilty feeling and feeling of difficulty in care. Therefore, we have decided to create psychological scale for urination as the medium to connect the stroke patients and nurses. As the basic investigation for scale development, relation between actual condition of storage symptoms, activities of daily living and state of depression of stroke patients in the recovery phase was examined this time.
Methods: Investigation was conducted on the basic attribution, storage symptoms (OABSS), self-reliance of activities of daily living (FIM) and state of depression (JSS-D) of 120 stroke patients in the recovery phase rehabilitation ward. The relation between storage symptoms (OABSS), basic attribution, self-reliance of activities of daily living and state of depression was examined by using Spearman’s rank correlation coefficient.
Results: Storage symptoms were observed in 92.5% of the subject group, and 37.5% had more than moderate disease. Significant negative correlation could be observed in storage symptoms, basic attribution and self-reliance of activities of daily life. Among those, the stronger an urgent desire to urinate or degree of urgent incontinence was, the lower gowning related to urination, toilet activities and transfer or self-reliance of urination control became. In addition, the stronger an urgent desire to urinate or degree of urgent incontinence became, the stronger the state of depression became (p<0.01). Frequent urination and state of depression did not statistically showed significant correlation.
Conclusion: Storage symptoms, and urgent desire to urinate and urgent incontinence were observed in 90% of stroke patients in the recovery phase, and activities of daily living and state of depression had strong correlation. Therefore, it was suggested to be important to understand and utilize urinary functions and urinary activities as well as psychological reaction in support for independent excretion.


Key words : storage symptoms, overactive bladder: OAB, stroke, activities of daily living : ADL, poststroke depression : PSD



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