山梨大学看護学会誌　第6巻2号　005-009(2008)

＜原　著＞
消化器術後患者の意識状態と身体状態の変動
―術後患者の安全管理のために―

山田　章子，中村美知子

消化器疾患患者の術前から術後の意識状態と身体状態の変動を経時的に調査し，術後患者の安全管理のための看護のあり方を検討した。意識状態は，Schuurmansらの作成したDelirium Observation Screening Scale（以下，DOS，2003年）を使用し，身体状態は，血圧，脈拍，などについて調査した。術前と術後の意識状態を比較したところ，DOS スケールの『精神運動活動』『睡眠/ 覚醒サイクル』『気分』の3 つの下位尺度で術直後から術翌日夜まで有意に上昇した。また身体状態において脈拍が術当日夜から，体温・疼痛は術直後から術翌日夜まで有意に上昇した。意識状態と身体状態の関連をみると，疼痛（r＝0.199 p＝0.00）に正の相関がみられた。術後患者は，せん妄状態をおこす可能性もあり，早期に変動を把握する必要がある。そのためには，疼痛コントロールを行い，意識状態の悪化を防ぎ安全を確保する必要がある。

術後患者，意識状態，身体状態，DOS スケール，痛み



Changes of the Mental and Physical Status in Patients Following Gastrointestinal Surgery : Ensuring the Safety of Postoperative Patients

YAMADA Shoko , NAKAMURA Michiko

In the present study, temporal changes in the mental status and physical status of patients with digestive disorders before and after surgery were investigated. In addition, nursing methods for ensuring the safety of patients following surgery were examined. Mental status was evaluated using the Delirium Observation Screening (DOS) scale developed by Schuurmans et al, while physical status measurements included blood pressure and pulse. Comparison of preoperative and postoperative mental status revealed significant increases from immediately after surgery to the night of the day following surgery in the following three subscales on the DOS scale: “Psychomotor activity”, “Sleep-wake cycle”, and “Mood”. As for physical status, pulse significantly increased from the night of the surgery to the night of the day following surgery, while body temperature and pain significantly increased from immediately after surgery to the night of the day following surgery. Analysis of relationships between mental status and physical status showed a positive correlation for pain (r=0.199 p=0.00). Due to the risk of delirium among postoperative patients, early detection of changes in condition is ecessary. Therefore, safety must be ensured by providing pain control and carefully monitoring the mental status of patients.

Postoperative Patient, Mental Status, Physical Status, Delirium Observation Screening Scale, Pain


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