学会誌

健康成人を対象にした点滴静脈内注射の血管外漏出モデルにおけるサーモグラフィー画像の分析

著者

松井優子¹ 村山陵子² 田邊秀憲^2,3 大江真琴² 福田守良¹ 元雄良治⁴ 我妻孝則⁵ 木下幸子¹ 坂井恵子¹ 紺家千津子¹ 須釜淳子⁶ 真田弘美⁷

所属

1. 金沢医科大学看護学部
2. 東京大学大学院医学系研究科社会連携講座アドバンストナーシングテクノロジー
3. テルモ株式会社
4. 金沢医科大学医学部腫瘍内科学
5. 金沢医科大学病院看護部
6. 金沢大学医薬保健研究域附属健康増進科学センター
7. 東京大学大学院医学系研究科健康科学・看護学専攻老年看護学/創傷看護学分野

要旨

点滴静脈内注射の血管外漏出は皮膚に炎症や潰瘍を引き起こすことがあるため，早期発見が重要である．しかし，臨床の看護師による血管外漏出の鑑別方法は客観性に乏しい．本研究は，血管外漏出の有無の客観的評価指標の開発を目的に，健常者6名を対象にサーモグラフィーを用いて血管外漏出を鑑別できることを検証した．漏出モデルとして，前腕の皮下組織に留置針を刺入し生理食塩水を1.7ml/分で滴下した．対照群として，反対側の前腕の静脈内に留置針を刺入し，同様に滴下した．漏出の確認として，超音波診断装置を用いて留置針先端の位置と，滴下前後の皮下組織の厚さを観察した．滴下後10秒ごとにサーモグラフィーで針先周囲を撮影したところ，漏出モデルでは6名全員に滴下開始2分以内に針先を中心に広がる円形の低温域が出現した．サーモグラフィーにより，非接触的かつ迅速に点滴静脈内注射の血管外漏出が鑑別できる可能性が示唆された．

キーワード

血管外漏出，点滴静脈内注射，サーモグラフィー

Analysis of thermographic images in an extravasation model of intravenous infusion in healthy adults

Author(s)

Yuko Matui, RN, PhD¹ Ryouko Murayama, RN, PhD² Hidenori Tanabe, MS^2,3 Makoto Oe, RN, PhD² Moriyoshi Fukuda, RN, MSN¹ Yoshiharu Motoo, MD, PhD⁴ Takanori Wagatsuma, RN, MSN⁵ Sachiko Kinosita, RN, PhD¹ Keiko Sakai, RN, PhD¹ Chizuko Konya, RN, PhD¹ Junko Sugama, RN, PhD⁶ Hiromi Sanada, RN, PhD⁷

Affiliation

1. School of Nursing, Kanazawa Medical University
2. Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo
3. Terumo Corporation
4. Department of Medical Oncology, Kanazawa Medical University
5. Kanazawa Medical University Hospital
6. Wellness Promotion Science Center, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University
7. Department of Gerontological Nursing/Wound Care Management, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo

Abstract

Early detection of extravasation in intravenous drip infusions is important because it causes inflammation and ulcers on the skin. However, in clinical situations, nurses determine extravasation using low-objectivity methods. The purpose of this study was thus to develop objective indicators for identifying extravasation. Subjects comprised six healthy men and women who underwent observation for extravasation using thermography. As a model of extravasation, saline was drip-infused at 1.7 ml/min through a catheter inserted into the subcutaneous tissue of the forearm. As a control group, saline was drip-infused through a catheter placed in a vein in the contralateral forearm at the same rate. To confirm that saline was leaking into the subcutaneous tissue, we observed the position of the catheter and the thickness of the subcutaneous tissue both before and after infusion using ultrasonography. Thermographic imaging around the tip of the catheter was performed every 10s from the start of infusion. In all subjects, thermography showed a low-temperature region appearing at the catheter tip within 2 min of starting infusion. These results suggest that thermography can be used to identify extravasation in a fast and non-invasive manner.

Keyword

extravasation，infiltration，intravenous infusion，thermography

画像処理を利用したＢモード超音波検査法による誤嚥の検出方法の開発

著者

三浦由佳^1,2 仲上豪二朗¹ 藪中幸一^1,3 戸原　玄⁴ 村山陵子⁵ 野口博史⁶ 森　武俊⁶ 真田弘美¹

所属

1. 東京大学大学院医学系研究科健康科学・看護学専攻老年看護学/創傷看護学分野
2. 日本学術振興会特別研究員DC1
3. 医療法人大植会葛城病院超音波室
4. 東京医科歯科大学大学院医歯学総合研究科老化制御学系専攻口腔老化制御学講座高齢者歯科学分野
5. 東京大学大学院医学系研究科社会連携講座アドバンストナーシングテクノロジー
6. 東京大学大学院医学系研究科ライフサポート技術開発学（モルテン）寄附講座

キーワード

誤嚥性肺炎，画像解析，嚥下，感度特異度，超音波

Method for detecting aspiration based on image processing-assisted B-mode video ultrasonography

Author(s)

Yuka Miura, RN, MHS^1,2 Gojiro Nakagami, RN, PhD¹ Koichi Yabunaka, RT, PhD^1,3 Haruka Tohara, DDS, PhD⁴ Ryoko Murayama, RN, RMW, PhD⁵ Hiroshi Noguchi, PhD⁶ Taketoshi Mori, PhD⁶ Hiromi Sanada, RN, WOCN, PhD¹

Affiliation

1. Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo
2. Japan Society for the Promotion of Science
3. Department of Ultrasound, Katsuragi Hospital
4. Gerodontology and Oral Rehabilitation, Department of Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
5. Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo
6. Department of Life Support Technology (Molten), Graduate School of Medicine, The University of Tokyo

Abstract

We developed a computer-aided image processing technique to assist in the detection of aspirated boluses by clinicians using B-mode video ultrasonography (BV-US) movies. This study used 42 ultrasonography movies from a previous study that investigated the performance of aspirated bolus detection. This image processing technique aimed to assist clinicians in detecting aspirated boluses and the anterior tracheal walls from BV-US movies in which aspirated bolus appearances were emphasized. We combined a method that focused on the region of interest and the correlation coefficient between current and previous images to emphasize the characteristics of aspirated boluses from brightness-adjusted BV-US images. The sensitivity and specificity of this image processing-assisted method were 0.91 and 0.94, respectively, when we used simultaneously collected videofluoroscopy or videoendoscopy results as references. For four silent aspiration movies for which detection did not occur without assistance of image processing, detection was achieved with image processing assistance. Aspirated boluses detected only with image processing assistance had significantly smaller areas, shorter minor axes, longer major axes, and higher average brightness levels than those detected without image processing. This method will contribute to help clinicians provide modification of food viscosity and posture at an early stage for patients with dysphagia.

Keyword

aspiration pneumonia，computer-assisted image analysis，deglutition，sensitivity and specificity，ultrasound

中心静脈穿刺支援ロボットシステムにおける静脈の逃げと潰れを抑制する穿刺速度の解析

著者

築根まり子¹ 小池卓慎¹ 山崎　望² 張博^3,4 小林　洋^3,5 橋爪　誠⁶ 藤江正克⁵

所属

1. 早稲田大学大学院創造理工学研究科
2. 早稲田大学大学院先進理工学研究科
3. 早稲田大学理工学研究所
4. 株式会社菊池製作所
5. 早稲田大学理工学術院
6. 九州大学医学研究院先端医療医学講座

要旨

本研究では，中心静脈カテーテル手技を対象に，精確かつ迅速に静脈内へ針を留置することを支援するロボットシステムを開発している．穿刺成功率を低下させる要因として，穿刺した際に静脈が針先端位置から逃げること，および，静脈が潰れることがあげられる．この問題を解決するために，本研究では，静脈が粘弾性体であることを利用して，静脈の逃げと潰れを抑制する穿刺速度を導出し，穿刺速度を制御することで穿刺成功率を向上させる手法を提案する．本論文では，穿刺速度を変化させた際の静脈の逃げと潰れの関係を，摘出ブタ静脈に対する穿刺実験および有限要素解析により導出し，穿刺速度の制御により静脈の逃げと潰れを制御可能であるかを考察した．実験の結果，静脈の潰れ量は穿刺速度により制御できる可能性があり，一方，静脈の逃げ量は穿刺速度に対しばらつきが大きく，逃げ量を穿刺速度のみで制御することはむずかしいことが示唆された．

キーワード

中心静脈穿刺，穿刺支援ロボット，有限要素解析

Analysis of velocity of needle insertion to prevent translational displacement and deformation of vein in robotic needle insertion system for assisting central venous catheterization

Author(s)

Mariko Tsukune, PhD student/Research Associate¹ Takuma Koike, Master’s student¹ Nozomu Yamazaki, PhD student² Bo Zang, Dr/Adjunct Researcher^3,4 Yo Kobayashi, Dr/Associate Professor^3,5 Makoto Hashizume, Professor⁶ Masakatsu G. Fujie, Professor⁵

Affiliation

1. Graduate School of Creative Science and Engineering, Waseda University
2. Graduate School of Advanced Science and Engineering, Waseda University
3. Research Institute for Science and Engineering, Waseda University
4. Kikuchiseisakusho Co., Ltd.
5. Faculty of Science and Engineering, Waseda University
6. Department of Advanced Medical Initiatives, Faculty of Medical Sciences, Kyushu University

Abstract

We are developing a robotic needle insertion system for assisting central venous catheterization that relieves the difficulties of the manual procedure and reduces complications. If translational displacement and deformation of vein appear during needle insertion, the insertion success rate decreases. Therefore, we propose a method to control the translational displacement and deformation of vein and to improve the success rate of needle insertion by needle velocity, using the viscoelastic character of body tissues. In this study, we assessed the relationships of translational displacement and deformation of vein to needle velocity by an in vitro experiment using pig cervical vein and by finite element analysis. As a result, it was suggested that needle velocity can control the deformation of vein, but cannot control its translational displacement because of the large deviation of the translational displacement.

Keyword

central venous catheterization，robotic needle insertion，finite element analysis

下着のサポート力による膀胱頸部拳上作用のメカニズムの検討

著者

二宮早苗¹ 岡山久代² 遠藤善裕² 内藤紀代子³ 齋藤いずみ⁴ 森川茂廣²

所属

1. 京都光華女子大学健康科学部看護学科
2. 滋賀医科大学医学部看護学科
3. びわこ学院大学教育福祉学部子ども学科
4. 神戸大学大学院保健学研究科

要旨

われわれはこれまでに，下着のサポート力による膀胱頸部の挙上効果と腹圧性尿失禁の改善効果を報告している．今回，下着のサポート力による膀胱頸部拳上作用のメカニズムを解明することを目的に，形状，着圧，サポート部位の異なるサンプル下着を用いて，30～40歳台の女性10名を対象に着用による膀胱頸部の拳上量および骨盤内の解剖学的構造の変化を核磁気共鳴画像により比較検討した．結果，膀胱頸部の拳上には，殿部から大腿上部までサポートする形状，全面的に締め付け感のある着圧，恥骨から尾骨後方に向けた吊橋状のサポート部位が有用であることが示された．また，膀胱頸部拳上作用の強い下着の着用時には，挙筋板付近の筋組織が前上方に移動するとともに，会陰体付近の筋組織も上方に移動することが明らかとなった．膀胱頸部の挙上には，会陰体付近を支持し，後下方から後上方に吊り上げるようなサポートが有用であることが示唆された

キーワード

骨盤底弛緩，腹圧性尿失禁，サポート下着，核磁気共鳴画像

Examination of the mechanism to elevate bladder neck position by supportive underwear

Author(s)

Sanae Ninomiya, RN, PhD¹ Hisayo Okayama, RN, NM, PhD² Yoshihiro Endo, MD, PhD² Kiyoko Naito, RN, NM³ Izumi Saito, RN, NM, PhD⁴ Shigehiro Morikawa, MD, PhD²

Affiliation

1. Department of Nursing, Faculty of Health Science, Kyoto Koka Women’s University
2. Department of Nursing, Shiga University of Medical Science
3. Department of Childhood Care, Faculty of Education Welfare, Biwako Gakuin University
4. Kobe University Graduate School of Health Science

Abstract

A previous study reported the effectiveness of supportive underwear for elevating the bladder neck and reducing symptoms of stress urinary incontinence in women. This study investigated the mechanism by which bladder neck elevation occurs by using supportive underwear. The positions of the bladder neck and anatomical structures of the pelvis with and without underwear of different forms, strengths, and supportive regions were compared in 10 parous women using magnetic resonance imaging. The underwear that supported from the femur to the buttock, with high strength, or that supported from the pubis to the coccyx was effective to elevate the position of the bladder neck. The levator plate was lifted forwards and upwards by the underwear in elevating the bladder neck. In addition, the perineal body was also lifted upwards. The support to the perineal body and the support from the pubis to the coccyx might be effective to elevate the bladder neck.

Keyword

pelvic relaxation，stress urinary incontinence，supportive underwear，magnetic resonance imaging

看護のためのイヤホン型心拍モニタ装置のプロトタイプ開発

著者

山下紘正¹ 北角権太郎^1,2 長村伸一^1,2 佐藤智夫¹ 田山　愛³ 土岐　彰³ 千葉敏雄^1,4

所属

1. 国立成育医療研究センター研究所医療機器開発部
2. 株式会社ControlAD
3. 昭和大学医学部小児外科
4. 東京大学大学院情報理工学系研究科

要旨

現在の医療現場では心電図，血圧計，体温計，血中酸素飽和度計などが欠かせないものになっている．患者の生体情報を適切に収集するため，患者の体に電極などを貼り付け，交換し，値を確認して記録する，こういった作業に看護師たちは多くの時間を費やしている．そこでわれわれは，１）電極などを貼り付けることなく簡便に生体情報を収集できること，２）無線でその情報を送信できること，３）携帯端末でもその情報をリアルタイムに確認できること，を目標に，看護の大幅な効率化・省力化に寄与する“イヤホン型バイタルサインモニタ装置”の開発を進めている．これまでに心拍の検出ができるイヤホン型の単一トランスデューサを試作し，既存のモニタ装置との比較を行ったところ，有意に正の相関が得られた．今後は被験者数を増やしながらほかの生体情報の検出についても評価を行い，長時間の装着にも耐えうる形状や材質での試作を進めていく．

キーワード

単一トランスデューサ，イヤホン，バイタルサイン，心拍数

A prototype of the earphone-type heart rate monitoring device for clinical nursing

Author(s)

Hiromasa Yamashita¹ Gontaro Kitazumi^1,2 Shin-ichi Nagamura^1,2 Tomoo Sato¹ Ai Tayama³ Akira Toki³ Toshio Chiba^1,4

Affiliation

1. Division of Medical Device, National Center for Child Health and Development
2. Control AD Corporation
3. Department of Pediatric Surgery, Showa University School of Medicine
4. Graduate School of Information and Technology, The University of Tokyo

Abstract

In current medical practice, it is necessary to have equipment to monitor vital signs such as electrocardiograms, sphygmomanometers, thermometers, and pulse oximeters. However, nurses consequently have to spend a lot of time checking patients’ vital signs appropriately by attaching and replacing electrodes, as well as reading and recording values. To alleviate this burden, we are developing“an earphone-type vital signs-monitoring device”in order to：1）check patients’ vital signs easily without having to attach electrodes, 2）transmit data wirelessly, and 3）allow the medical staff to monitor the data on portable terminals in real time. So far, we have made a prototype earphone-type single transducer to detect the heart rate. In its performance evaluation, our new device displayed marked positive correlations with the measurement by a conventional monitoring device. In the future, we will evaluate the performance to detect other vital signs with a greater number of subjects, and develop prototypes with shapes and materials to withstand prolonged use.

Keyword

single transducer，earphone，vital sign，heart rate