{"@context":{"@vocab":"https://cir.nii.ac.jp/schema/1.0/","rdfs":"http://www.w3.org/2000/01/rdf-schema#","dc":"http://purl.org/dc/elements/1.1/","dcterms":"http://purl.org/dc/terms/","foaf":"http://xmlns.com/foaf/0.1/","prism":"http://prismstandard.org/namespaces/basic/2.0/","cinii":"http://ci.nii.ac.jp/ns/1.0/","datacite":"https://schema.datacite.org/meta/kernel-4/","ndl":"http://ndl.go.jp/dcndl/terms/","jpcoar":"https://github.com/JPCOAR/schema/blob/master/2.0/"},"@id":"https://cir.nii.ac.jp/crid/1390001205571902080.json","@type":"Article","productIdentifier":[{"identifier":{"@type":"DOI","@value":"10.14900/cjpt.2009.0.d4p1191.0"}},{"identifier":{"@type":"NAID","@value":"130004582643"}}],"dc:title":[{"@language":"ja","@value":"flow volume loopを用いた呼吸介助中の呼気流量と肺気量位変化の検討"}],"dc:language":"ja","description":[{"type":"abstract","notation":[{"@language":"ja","@value":"【目的】呼吸介助手技は、深く呼気を行うことにより肺・胸郭の弾性拡張力を高め、その後の吸気を促すことが可能とされている。しかし、より深く呼気を行えば、末梢気道が閉塞しやすい低肺気量位で呼気を行うことになり、生理的に呼出可能な最大の呼気流量は限りなく少なくなる。このことは、呼吸介助手技中、術者により被術者の胸郭に過度な圧が加えられれば、容易に呼気流量制限が生じることを示す。呼気流量制限は息切れの原因の一つとされ、強い呼気流量制限は被術者に不快感を与えることも予測される。そのため、呼吸介助手技中に呼気流量制限が生じているのか、もし生じているのなら、どのような場合に生じ易いのかなどを明らかにすることは、この手技の技術的な習熟において重要と考える。本研究の目的は、呼吸理学療法の臨床経験が22年のある理学療法士を術者とし、呼吸介助手技中に呼気流量制限が生じているかどうか、もし生じていればどの程度生じているのかを明らかにすることである。<BR><BR>【方法】呼理学療法経験22年の理学療法士1名（年齢44歳）を術者、健常成人男性7 名（年齢30.0±5.9歳）を被術者とした。測定は、背臥位で2分間の安静呼吸を行った後、上部胸郭に対し5分間の呼吸介助手技を実施した。その後、同肢位にて最大吸気・呼気の測定を行った。肺気量、流量の変化を呼気ガス分析器（ミナト医科学社製AE300s）にて測定し、サンプリング周波数100HzにてA/D変換後パーソナルコンピューターに取り込んだ。得られた肺気量、流量の変化から、安静呼吸中及び呼吸介助中のflow volume loop (FVL)を、最大吸気・呼気のFVL（MFVL）の中に描いた。呼気流量制限は、(1)同肺気量位での呼吸介助中FVLがMFVLと同じ、または高い場合、(2)呼吸介助中FVLはMFVLよりわずかに低いが、ほぼ平行に推移していると視覚的に判断される場合に制限があると判断し、流量制限のある肺気量を一回換気量で除し、その程度を評価した。終末吸気肺気量位(EILV)と終末呼気肺気量位(EELV)は各被術者の肺活量に対する比で表わした。<BR><BR>【説明と同意】全対象者に対し、本研究の目的と方法を説明し、書面による同意を得た。<BR><BR>【結果】安静呼吸と比べて、呼吸介助中は一回換気量（安静時522.4±80.9ml、呼吸介助時1025.3±130.4ml、p<0.05）、分時換気量（安静時7.0±2.1L/min、吸介助時11.0±2.6L/min、p<0.05）は有意に増加した。呼吸数（安静時13.3±2.9 breaths/min、呼吸介助時10.9±2.6 breaths/min、p=0.063）は呼吸介助中減少傾向にあったものの有意な変化はなかった。EILVは、安静時33.4±8.1％、呼吸介助時34.4±7.6％であり、有意な差は認めなかった。EELVは安静時21.4±9.0％から呼吸介助時10.5±5.4％へと有意(p<0.05)に低下した。呼気流量制限は、呼吸介助中は5例で呼気流量制限を認め、その程度は平均52.6±25.1％であった。また、呼気流量制限を認めた肺気量位は低く、21.1±2.7％から9.6±5.5％に見られた。<BR><BR>【考察】今回の結果から、呼吸介助手技中には、高い頻度で呼気流量制限が生じており、中には一回換気量の90％と呼気中の広い肺気量位で流量制限が生じていることがわかった。また、呼気流量制限が生じる肺気量位は21.1±2.7％以下の低い肺気量位であった。呼吸介助手技は臥位で行われることが多い。今回測定肢位とした背臥位では、腹腔内臓器による横隔膜の挙上や、静脈還流量の増加から肺内血流が増加し、肺容量を減少させるため、機能的残気量(FRC)が0.5～1L程度低下するとされている。そのため、背臥位での安静時呼吸中の肺気量位は低くなり、今回の結果でも、EILVが33.4±8.1％、EELVが21.4±9.0％と低い肺気量で呼吸が行われていた。呼吸介助手技は、この低い肺気量位から、さらに呼気を促進する。この肺気量位では、健常人でも末梢気道は閉塞しやすく生理的に呼出可能な呼気流量は非常に少なく、呼気流量制限を生じやすくしていると考えられた。<BR><BR>【理学療法学研究としての意義】呼吸理学療法を行う際にしばしば適用される呼吸介助手技が、肺気量位や呼気流量などの呼吸パターンにどのような影響を及ぼすのかを明らかにし、臨床に応用していくことが重要であると考える。"}],"abstractLicenseFlag":"disallow"}],"creator":[{"@id":"https://cir.nii.ac.jp/crid/1410001205571902083","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000258363219"}],"foaf:name":[{"@language":"ja","@value":"荻野 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