うつむき姿勢保持に対する温罨法およびマッサージによる苦痛緩和効果―60歳以上の健常な高齢者による検討

　本研究は, 硝子体手術後のうつむき姿勢を想定した体位の保持に伴う苦痛に対する温罨法およびマッサージの効果を検証することを目的とした.
　対象者は健常高齢者とし, 温罨法群 (12名 ; 67.3±3.3歳), マッサージ群 (12名 ; 66.5±4.0歳) のそれぞれで検討した. 温罨法群では, うつむき姿勢のみ, うつむき姿勢に加え温罨法実施の2条件, マッサージ群では, うつむき姿勢のみ, うつむき姿勢に加えマッサージ実施の2条件を実施した. うつむき姿勢は90分間とし, 温罨法は開始45分後から肩部に42℃前後のホットパックを30分間, マッサージは開始45分後から肩～背部へかけ10分間実施した. 測定項目は気分評価, 主観的疼痛, 心拍数, 自律神経活動指標, 皮膚温等とした.
　温罨法およびマッサージは, うつむき姿勢保持による主観的疼痛を一時的に軽減する効果が示唆された. さらに, 温罨法はうつむき姿勢保持に伴う心拍数および血圧の上昇を防ぎ, マッサージは一時的に低下させる効果が示唆された. うつむき姿勢保持に伴う皮膚温の低下に対しては, 温罨法は直接作用する肩部の皮膚温を上昇させる効果が認められたが, マッサージでは効果は認められなかった.
　また, 対象者の主観的な感覚や身体的反応には個人差が大きく, 高齢者において硝子体術後にうつむき姿勢の保持が必要な場合には, 本人の疼痛の訴えに頼らず身体への負担を予測した援助が必要であることが示唆された.

　The purpose of this study was to investigate the effect of hot pack and massage for pain in face-down posture, which is the assumed posture following vitrectomy.
　This experiment was conducted on two groups : hot pack group (12 healthy adult volunteers, 67.3±3.3 years old) and the massage group (12 healthy adult volunteers, 66.5±4.0 years old). The hot pack group had two conditions : only face-down posture and face-down posture plus hot pack. The massage group had two conditions : only face-down posture and face-down posture plus massage. The subjects maintained a face-down posture for 90 minutes. A hot pack with a temperature of about 42 degrees centigrade was applied for 30 minutes beginning 45 minutes after the start of the posture. The massage was performed from the shoulders to the lower back for 10 minutes beginning 45 minutes after start of the posture. Evaluation included a profile of mood states, subjective pain, heart rate, autonomic nerve activity index, and skin temperature.
　This study suggests that hot pack and massage reduced temporary subjective pain in maintenance of face-down posture. Furthermore, hot pack prevented increase of heart rate and blood pressure. Massage also had the effect of reducing heart rate and blood pressure. Hot pack significantly raised the temperature of the shoulder region, which was observed to decrease in maintenance of face-down posture. However, massage did not show an effect similar to that of the hot pack.
　Moreover, this study has shown that the subjective sense and physical response of subjects is highly individual. Therefore, it was suggested that nurses are required to care for the anticipated physical burden of elderly patients in face-down posture following vitrectomy in any case.