救急科入院重症疾患患者におけるリハビリテーションの早期介入効果

フォーマット:

学位論文

責任表示:

山下, 康次

言語:

日本語

出版情報:

2017-03-23

著者名:

山下, 康次  

バージョン:

ETD

概要:

The purpose of this thesis is to verify the effect of early intervention of rehabilitation for hospitalized patients in the emergency department who received mechanical ventilation. Chapter 1: Investigation and explanation: The vicissitude … and current state of rehabilitation for critically ill patients who needed mechanical ventilation. In order to verify the rehabilitation for critically ill patients who needed mechanical ventilation, research and discussion were made from the precedence research of the historical background and the vicissitude of early mobilization rehabilitation.Chapter 2: “Quality improvement of rehabilitation” project for critically ill patients.We inspected the effect on period until rehabilitation request and order were made, length of stay in emergency ward, length of staying in hospital and the condition of mobilization when out of emergency ward when we induced the “quality improvement of rehabilitation” project on critically ill patients who needed mechanical ventilation. After the project induced, the period until rehabilitation request and order were made was significantly shorten(p<0.05) and the condition were able to be mobilize more frequently.Chapter 3: Effectiveness of new sedation and rehabilitation methods for critically ill patients receiving mechanical ventilation. [Purpose] The purpose of this study was to investigate the effects of new sedation management methods and cooperation between nurses and physical therapists on the duration of mechanical ventilation and hospitalization. [Subjects and Methods] Patients who had been treated at the study hospital 2 years before and after the implementation of the new methods were analyzed retrospectively and classified into a “control group” and an “intervention group”, respectively. Both groups were analyzed and subsequently compared regarding the effects of the new sedation and cooperative rehabilitation.[Results] A total of 70 patients met the inclusion criteria and were divided evenly into the two groups. No significant differences were found between the groups in age, APACHE II score, or duration of stay in hospital. On the other hand, significant decreases were seen in the duration of sedation and intubation, mechanical ventilation, and stay in the emergency ward, as well as time until standing(p<0.05). In addition, after intervention, three patients undergoing ventilator treatment were able to be ambulated. [Conclusion] These results suggest that the new sedation and cooperative rehabilitation methods for critically ill patients were effective in the early stage of treatment and shortened the duration of stay in the ward.Chapter ４ Early mobilization for intubated and mechanically ventilated patients ～verification of early mobilization safety~ From the point of view of hemodynamics and respiratory condition awareness, we verify the safety from the frequency and condition of adverse event when intubated and mechanically ventilated patients were mobilized. A total of 60 mobilization were conducted for 14 case. All cases were not under sedation when mobilization conducted. 13(21.7%) adverse events were observed; respiratory (53.8%), hemodynamics (38.5%) and agitation (7.7%). However additional treatment was not needed for either of the adverse event. Under detailed assessment of breathing, circulation and awareness, early mobilization for intubated and mechanically ventilated patients will be able to conduct without adverse event who needed treatment. 続きを見る

URL:

http://hdl.handle.net/10129/6121