@article{oai:opcnr.repo.nii.ac.jp:00000009,
 author = {石川, りみ子 and Ishikawa, Rimiko and ミヤジマ, 厚子 and Miyajima, Atsuko},
 issue = {1},
 journal = {沖縄県立看護大学紀要, Journal of Okinawa Prefectural College of Nursing},
 month = {Feb},
 note = {脳血管疾患は後遺症として麻痺、失語症、機能障害を残すことが多く、それらは痴呆やねたきりを招き、患者の生きがいや社会的活動にも影響を及ぼす要因となっている。 高齢化が進む中で、健やかな老後を送るためにも痴呆の予防は重要である。そこで、本研究は、後遺症を有する脳血管障害患者の退院・転院後を追跡し、痴呆の改善とその関連要因を明らかにすることを目的とした。対象者は脳血管障害のため平成5年8月1日から平成6年1月31日の間にO県内の3つの公立総合病院に緊急入院した患者のうち、麻痺を残さず退院した者、発症後6ケ月を過ぎた者、意思疎通のとれなかった重度の意識障害および拒否する者を除き96人を分析の対象とした。調査項目は、(1)性別、(2)年齢、(3)配偶者の有無、(4)同居者数、(5)診断名、(6)脳外科手術の有無、(7)脳血管障害の既往の有無、(8)麻痺側、(9)下肢麻痺の程度、(10)訓練意欲、(11)自発的意思表示、(12)視力、(13)退院先、(14)日常生活動作、(15)痴呆の15項目である。痴呆の指標は長谷川式簡易知能評価スケール（以下HDS-Rと略す）を、日常生活動作（以下ADLと略す）の指標をGraｎger改訂版Barthal Index（以下B.I.と略す）を用いた。痴呆と非痴呆の判定は、HDS-R の20点以下を痴呆、21点以上を非痴呆として分類した。データの解析は、SPSS統計パッケージを使用し、検定は、平均値はt検定、分布はX^2検定、重回帰分析はF検定を行った。分析の結果から以下の知見が得られた。 1) 年齢、同居者数、麻痺側、下肢麻痺の程度、訓練意欲、自発的意思表示、視力、退院時B.I.点の8変数を説明変数とする重回帰分析では、3ケ月後HDS-R点の重相関係数R=.787、寄与率R^2=.620となり、3ケ月後HDS-R点と8変数の関連が示唆された。また、ADLの中の尿失禁も同様に3ケ月後のHDS-R点に関連することが示唆された。2) 重回帰分析の結果、3ケ月後HDS-R点に有意に相関する変数は年齢、同居者数、下肢麻痺の程度、訓練意欲、自発的意思表示、退院時B.I.点の6変数であった。 3) 非痴呆と痴呆に判別して退院時と3ケ月後の分布の変化をみると、脳血管障害の後遺症を有して退院・転院した患者は、痴呆に悪化する者（14.0％）と、非痴呆に改善する者（30.0％）が出現し、身体的な改善の可能性のある時期に関連要因を踏まえた援助は痴呆の予防に有用であろうことが示唆された。以上の結果から、脳血管障害患者においては前述した関連要因をふまえ、患者および家族に対し、特に身体的な改善の可能性のある時期に痴呆の予防および改善に努めるよう援助することが重要である。, Cerebrovascular accident (CVA) often causes paralysis, aphasea, and functional impairment. Consequently, these sequelae result in a number of related problems such as dementia or becoming bed-ridden as well as influence patients' quality of life and activities in society. In an aging society, prevention of dementia is important for healthy living. The purpose of this study is to explore factors relating to dementia among patients with sequelae after cerebrovascular accident.The study subjects were 96 individuals who had been diagnosed as CVA and admitted to the hospital between August, 1993 and January 31, 1994. Excluded were those who had impairment of communication or no paralysis 6 months after onset as well as those who refused to participate in the study.Variables included the following factors: gender, age, spouse, the number of family members, diagnosis, neurosurgery, history of the post-CVA, side of paralysis, the degree of paralysis of lower extremities, motivation toward rehabilitation, expression of one's intentions, sight, direction after discharge, ADL and dementia. The researchers used the Revised Hasegawa Dementia Scale (HDS-R) to measure level of dementia and Barthal Index developed by Granger to evaluate ADL levels. The researchers categorized 21 points or above in HDS-R as non- dementia and 20 points or below as dementia based on HDS-R's criteria. SPSS was used to analyze the data, through the following statistical methods: t-test, chi-square, and multiple regression analysis.The findings were as follows:1. In the multiple regression analysis, the researcher used 8 independent variables including age, the number of family members, side of paralysis, the degree of paralysis of lower extremities, motivation, toward rehabilitation, expression of one's intentions, sight, and ADL score at discharge to analyze the simultaneous effects on HDS-R. The results showed R=0.787 and R=0.620 on the HDS-R score three months after discharge. A research finding also showed that incontinence, one of the ADL components, was related to the HDS-R score at three months after discharge.2. According to the multiple regression analysis 6 variables: age, number of family members, the degree of paralysis of lower extremities, motivation toward rehabilitation, expression of one's intentions, and B.I score at discharge were significantly correlated to the HDS-R score at three months after discharge. 3. 30% of dementia patients at the time of discharge improved their HDS-R and shifted to non-dementia, and 14% of non-dementia patients deteriorated to a dementia state 3 months after discharge. Conclusions: The findings of this study are analyzed considering dementia as one of the complications associated with cerebrovassular accident. With this in mind it is of utmost impostance that health care providers have knowledge of the factors relating dementia to CVA. The importance of early intervention to treat related factors while patients still have the potential to improve is paramount.},
 pages = {9--22},
 title = {後遺症をもつ脳血管障害患者の退院・転院後の痴呆の改善とその関連要因},
 year = {2000},
 yomi = {イシカワ, リミコ and ミヤジマ, アツコ}
}