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研究代表者 紺家千津子
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Asano, Kimi ; Nakajima, Yukari ; Mukai, Kanae ; Urai, Tamae ; Okuwa, Mayumi ; Sugama, Junko ; Konya, Chizuko ; Nakatani, Toshio ; 浅野, きみ ; 中島, 由加里 ; 向井, 加奈恵 ; 浦井, 珠恵 ; 大桑, 麻由美 ; 須釜, 淳子 ; 紺家, 千津子 ; 中谷, 壽男
概要:
金沢大学医薬保健研究域保健学系<br />Background Previously, we showed that lymphatic vessels (LVs) formed detours after lymphatic obstru
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ction, contributing to preventing lymphedema. In this study, we developed detours using lymphatic ligation in mice and we identified the detours histologically. Methods and results Under anesthesia, both hindlimbs in mice were subcutaneously injected with Evans blue dye to detect LVs. We tied the right collecting LV on the abdomen that passes through the inguinal lymph node (LN) at two points. The right and left sides comprised the operation and sham operation sides, respectively. Lymphography was performed to investigate the lymph flow after lymphatic ligation until day 30, using a near-infrared fluorescence imaging system. Anti-podoplanin antibody and 5-ethynyl-2’-deoxyuridine (EdU) were used to detect LVs and lymphangiogenesis. Within 30 days, detours had developed in 62.5% of the mice. Detours observed between two ligation sites were enlarged and irregular in shape. Podoplanin+ LVs, which were located in the subcutaneous tissue of the upper panniculus carnosus muscle, connected to collecting LVs at the upper portion from the cranial ligation site and at the lower portion from the caudal ligation site. EdU+ cells were not observed in these detours. The sham operation side showed normal lymph flow and did not show enlarged pre-collecting LVs until day 30. Conclusions Detours after lymphatic ligation were formed not by lymphangiogenesis but through an enlargement of pre-collecting LVs that functioned as collecting LVs after lymphatic ligation. Further studies are required to explore the developmental mechanism of the lymphatic detour for treatment and effective care of lymphedema in humans. © 2020 Asano et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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木森, 佳子 ; 須釜, 淳子 ; 中谷, 壽男 ; 福田, 汐里 ; 宮地, 利明 ; 紺家, 千津子 ; 大桑, 麻由美 ; 真田, 弘美 ; Kimori, Keiko ; Sugama, Junko ; Nakatani, Toshio ; Fukuda, Shiori ; Miyati, Toshiaki ; Konya, Chizuko ; Okuwa, Mayumi ; Sanada, Hiromi
概要:
金沢大学医薬保健研究域保健学系<br />末梢静脈内カテーテル留置法では，対象静脈が目視困難な場合，確実な穿刺，合併症の発生に影響を及ぼす．本研究の目的は目視困難静脈の穿刺技術向上に向け，目視の可否による血管径 ・ 深さ，動脈との位置関係を
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超音波診断装置で，皮膚色を色差計で計測し違いを明らかにすることである．研究デザインは実態調査型研究である．対象者は健常若年女性 20名，計測静脈は 58本，計測動脈は 18本であった．その結果，目視の可否に有意差があったのは深さのみで，血管径，動脈との位置関係，皮膚色は同等であることが明らかになった．静脈の深さの平均 (SD) は，目視可能静脈が2.7 (0.7) mm，目視困難静脈が4.6 (1.8) mmであった (p=.0001)．目視の可否の分離値は 3.0mm (AUC=0.919，95％CI 0.84－0.99)で，深さ3mm以上の留置カテーテル用末梢静脈は目視困難になることが明らかとなった．したがって，目視困難な静脈は深さ3mm以上の穿刺技術が，動脈穿刺の防止は，目視の可否に関わらない穿刺技術の必要性が示唆された．<br />During catheter placement, peripheral intravenous access is affected by the visibility of the vein, such that the risk of peripheral nerve injuries and arterial punctures, increases as the visibility decreases. This study examined the relation between vein visibility and (a) vein width, (b) vein depth, (c) position of the artery relative to the vein, and (d) skin color. This was an observational study with prospective data collection. A total of 20 healthy young women (58 veins and 18 arteries) were examined. As a result, vein visibility demonstrated significant differences in relation to vein depth, but not in relation to the other three factors. The mean depth (SD) was 2.7 (0.7) mm for visible veins and 4.6 (1.8) mm for invisible veins (p=0.0001). The cut off point was 3.0 mm (AUC=0.919 95％ CI-0.84 to 0.99), indicating that peripheral veins for catheter placement are more likely to be invisible when the depth is 3.0 mm or more. These findings highlight the need for two kinds of venipuncture skills : those for invisible veins with a depth of 3.0 mm or more, and those that will prevent arterial puncture regardless of vein visibility.
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黄, 芳 ; 中谷, 壽男 ; 真田, 弘美 ; 紺家, 千津子 ; 鈴木, 定 ; 佐藤, 文 ; 間脇, 彩奈 ; Huang, Fang ; Nakatani, Toshio ; Sanada, Hiromi ; Konya, Chizuko ; Suzuki, Sadamu ; Sato, Aya ; Mawaki, Ayana
概要:
金沢大学医薬保健研究域保健学系<br />ポケットを有する褥瘡が治癒しがたいことを被蓋部の組織像から検討した. 外科治療の目的で切除されたポケットを有する褥瘡のポケット被蓋部13組織を, 肉眼的, 組織学的方法で研究した. 肉眼的所見：皮膚
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はポケット開口部で白く浸軟し, 表皮が開口部より内表面の一部を覆い停止していた. 断面では, 線維化した白い結合組織がみられた. 組織学的所見：表皮は基部から開口部に向かって厚さを増し, 表皮索または突起と真皮乳頭は互いに咬み合い, 伸展が停止した表皮は棍棒状または舌状形態を呈していた. 表皮下では, 正常な膠原線維束はみられず, 線維性瘢痕を呈し, 炎症細胞が少数みられた. 内表面は炎症細胞を含むさまざまな厚さのフィブリン様膜に覆われていた. 3組織の開口部にのみ炎症性肉芽組織が観察された. これらの結果は, ポケット被蓋部内表面を覆うフィブリン様膜と瘢痕組織が表皮の再生と肉芽組織の増殖を阻害し, 被蓋部と創底部の接着を妨げている可能性を示唆している.<br />This study macroscopically and microscopically examined the wound roof from thirteen pressure ulcers that were surgically excised. Based on these findings, we discussed the cause of intractability of pressure ulcers with undermining. The skin covering the wound roof was white and macerated at the wound orifice area. The epidermis covered part of the inner surface of the wound roof. White fibrosis was observed under the epidermis at the cutting plane of the roof. The epidermis became increasingly thicker from the base area of the roof to the wound orifice area, and interdigitated with the dermis. The edge of the extending epidermis showed a club-like or tongue-like shape. Under the epidermis, there was no normal collagen bundle, but there was collagenous scar tissue. Moreover, a few inflammatory cells and blood vessels were present in the scar. The inner surface of the wound roof was lined with various thicknesses of fibrinoid tissue including inflammatory cells. Inflammatory granulation tissue was observed in the wound orifice area in only 3 of 13 tissue specimens, indicaing that fibrinoid tissue over the inner surface of the roof and scar of the roof could impede the development of granulation tissue and extension of the epidermis.<br />日本褥瘡学会の許可を得て登録_2021.9.22
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田中, 愛 ; 中谷, 壽男 ; 真田, 弘美 ; 紺家, 千津子 ; 山崎, 真代 ; 田端, 恵子 ; 川上, 重彦 ; Tanaka, Ai ; Nakatani, Toshio ; Sanada, Hiromi ; Konya, Chizuko ; Yamazaki, Masayo ; Tabata, Keiko ; Kawakami, Shigehiko
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金沢大学医薬保健研究域保健学系<br />金沢大学医学部保健学科褥瘡ケアチームが介入した坐骨結節部褥瘡患者3名において, 大小不同に突出する不良肉芽を認めた. これまでに, それら突出する不良肉芽に関する報告はなく, 今回はその形態学的特徴
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を明らかにし, 患者背景と併せて病態と原因を検討することを目的とした. 組織学的検索には, HE染色およびAzan染色を使用した. その結果, 組織学的には, フィブリン様浸出物や炎症性細胞主体の厚い膜様物と拡張した毛細血管, そして大量の炎症性細胞浸潤を3名に共通して認めた. また, 対象患者3名ともに, 日中の大半を車椅子上の座位にて生活していたことから, それら組織学的変化の要因は長時間の圧迫, 移動時の摩擦とずれが示唆された. 今後は, 坐骨結節部褥瘡患者に対して, さらに徹底した座位時の圧管理や姿勢保持を行う必要があると考える. 「はじめに」褥瘡は一定の場所に一定以上の圧力が加わり続けることにより, 局所皮膚の血流が途絶え, 阻血性の壊死が生じて発症する皮膚潰瘍である.<br />In three patients with ischial pressure ulcers who were managed by the pressure ulcer care team of Kanazawa University, we observed unhealthy granulation tissues projecting from the bed of the ulcers. To our knowledge, there are no previous reports describing such granulation tissues. Thus, we investigated to clarify the cause of the development of such pathological granulation tissue based on histological findings and the lifestyles of the patients. For histological examination, we used H-E staining and Azan staining, which demonstrated a thick fibrinoid membrane, numerous inflammatory cells, and dilated capillary vessels in the granulation tissue. These three histological findings were common to all patients. Moreover, these patients sat in wheelchairs for very long periods daily. Therefore, the long-term pressure, shear, and friction from the wheelchair were suggested as factors contributing to such histological changes. These results indicate that we should more strictly manage the pressure and posture while sitting in patients with ischial pressure ulcer.<br />日本褥瘡学会の許可を得て登録_2021.9.22
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越村, 洵子 ; 紺家, 千津子 ; 真田, 弘美 ; 中谷, 壽男 ; 須釜, 淳子 ; 矢島, 博昭 ; 田端, 恵子 ; Koshimura, Junko ; Konya, Chizuko ; Sanada, Hiromi ; Nakatani, Toshio ; Sugama, Junko ; Yajima, Hiroaki ; Tabata, Keiko
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金沢大学医薬保健研究域保健学系<br />本研究の目的は, 褥瘡のポケット形成過程の原因, 要因を明確にすることである. 13部位の褥瘡を発見からプロスペクティブに毎日観察したあと, ポケット形成あり群となし群に分類し, 創の形態と身体状況
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ならびに看護ケアを比較した. その結果, ポケットの形態は, 全周と部分, 筋層と皮下組織に達するものに分類された. ポケット形成前の創の特徴は「顕著な骨突出部と壊死組織との位置の違い」「硬く乾燥し, 限局した黒色壊死組織」「黒色壊死組織周囲に持続する発赤」であった. これらを引き起こす原因は「骨突出部による強い圧迫」「骨突出部上に起こる皮膚のずれ」「感染」であった. ポケットの形態別に原因をみると, 全周, 部分ポケットの違いにはずれの方向が関係し, 筋層, 皮下組織に達するポケットの違いには感染が関係していた. 以上の結果から, ポケット形成モデルを構築した.<br />The purpose of this study was to clearly identify the causes and influencing factors responsible for creating undermining pressure ulcers. We observed 13 pressure ulcers on a daily basis that developed on subjects who participated in this prospective study. The subjects were separated into two groups ：(1)those who developed undermining, and (2)those who did not develop undermining pressure ulcers. We then evaluated the formation changes, the subjects' physical changes and the nursing care provided. Undermining pressure ulcers were further subdivided according to their depth (reaching the fascia or the subcutaneous tissues) and their type (whether the wounds were partial margin or full margin). Distinctive characteristics of the pressure ulcers before undermining occurred were a difference in the position of necrotic tissue and bony prominence, the presence of hard, dry and black escher, and persistent erythema. The causes of undermining can be attributed to high pressure caused by bony prominence, shear occurring over the bony prominent skin, and infection. The type of undermining was determined to be related to the direction of shear, and infection was related to the wound depth. We constructed a model of formation of the undermining based on these results.<br />日本褥瘡学会の許可を得て登録_2021.09.22
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紺家, 千津子 ; 真田, 弘美 ; 須釜, 淳子 ; 大桑, 真由美 ; 中谷, 壽男 ; 永川, 宅和 ; Konya, Chizuko ; Sanada, Hiromi ; Sugama, Junko ; Okuwa, Mayumi ; Nakatani, Toshio ; Nagakata, Takukazu
概要:
金沢大学医薬保健研究域保健学系<br />本研究の目的は, ポケット形成のある褥瘡を形態的に分類し, 治癒過程を明らかにすることである. さらに, その治癒過程の分類と看護ケア要因および身体要因との関係を導き出すことにある. 65歳以上の高
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齢者69名が保有するStage III・IVの褥瘡を調査した. 褥瘡は79部位あり, そのうち45部位(57.0%)にポケット形成を認めた. 褥瘡の治癒過程を帰納的方法により分類すると, 深達度ごとにポケットと表皮化方法によって10に分類できた. 特徴的な形態の変化には, 表皮化ではなく収縮のみによる創閉鎖があった. 収縮は通常の表皮化する創より, 治癒期間が延長していた. さらに, ポケット内に壊死組織はないが創の収縮により逆にポケットが拡大するものがあった. 看護ケア要因と身体要因と関係があったのは, ポケット形成と収縮のみによる創閉鎖であった. ポケット形成は, 骨突出, 尿失禁, 拘縮, 臀部のたるみが関係していた. 収縮のみによる創閉鎖は, 骨突出, 尿失禁, ずれ, 拘縮が関係していた.<br />The purpose of this study was to categorize pressure ulcers with various forms of undermining and to examine the healing process of each category. Another attempt to determine whether nursing care and/or physical factors influence the formation of pressure ulcers was also considered. This study was performed with the consent of 69 elderly (65 years old or older) patients with stage III or IV pressure ulcers, who had a total of 79 pressure ulcers. Of the 79 pressure ulcers, 45 (57%) were undermining. Based on the pressure ulcer healing process for stage III or IV pressure ulcers with undermining and epithelialization, 10 healing patterns were inductively categorized. A significant observation was the fact that in undermining with no necrotic tissue, the undermining spread inversely to wound contraction, a phenomenon we categorized as "Us" (Undermining-spread-partial wound margin). Epithelialized wounds closed only by contraction were categorized as Ec (Epithelialization-contraction). Our results showed the wound healing period to be longer for general epithelialization than for "Ec" type wounds. Nursing care and/or physical factors that influenced the form and healing pattern of "Undermining" were externally bony prominence, urinary incontinence, contracture, and flabby skin in the buttock area. Similarly, the influencing factors of "Ec" were an externally bony prominence, urinary incontinence, shear, and contracture.<br />日本褥瘡学会の許可を得て登録_2021.09.22
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紺家, 千津子 ; 真田, 弘美 ; 須釜, 淳子 ; 大桑, 真由美 ; 永川, 宅和 ; 中谷, 壽男 ; 田端, 恵子 ; Konya, Chizuko ; Sanada, Hiromi ; Sugama, Junko ; Ookuwa, Mayumi ; Nagakawa, Takukazu ; Nakatani, Toshio ; Tabata, Keiko
概要:
金沢大学医薬保健研究域保健学系<br />本研究の目的は, 褥瘡部位の低輝度エコー所見と褥瘡の深度との関係を明らかにすることである. 対象は, 38名の49個の褥瘡である. 褥瘡の外診所見と周波数7.5MHzでのエコー所見を1週間ごとに観察
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した. 分析は, 初回の視診と触診による外診所見での深度とエコー所見の低輝度エコーにより判断した深度について, 確定深度との相違を比較した. その結果, (1)49個の褥瘡の初回観察時には, 外診所見では20個が壊死に覆われ, 7個はエコーにて低輝度所見を認めた. (2)壊死組織のないI度およびII度の褥瘡は, 確定深度も同様であった. (3)初回低輝度所見を認めた褥瘡の深度は, III度またはIV度であった. (4)初回観察時に低輝度エコー所見の有無と確定深度の全層損傷の有無との関係は, 感度58.3%, 特異度100.0%, 陽性反応適中度100%, 陰性反応適中度88.1%であった. 以上より, 褥瘡の壊死部に低輝度エコー所見を認めた場合, 全層損傷と判定するアセスメント方法は有効であることが示唆された.<br />The purpose of this study was to examine the predictive validity of ultrasound in the initial assessment for pressure ulcer staging. Forty-nine pressure ulcers of 38 patients were examined. The pressure ulcers were visually assessed using the stages defined by the NPUAP and were examined by ultrasound (7.5 MHz). The initial assessment was determined from the ratio of agreement using visual assessment and ultrasound based on the level of severity. In the first assessment, 20 of the 49 pressure ulcers were assessed to be necrotic by visual observation and 7 of 49 were hypoechoic by ultrasound observation. In the final assessment, all pressure ulcers without necrosis were stage I or stage II types. The hypoechoic pressure ulcers in the first assessment were found to be either stage III or stage IV types. Using these results, the predictive validity of the initial assessment using ultrasound was calculated. The results were as follows : sensitivity 58.3%, specificity 100.0%, positive predictive value 100.0% and negative predictive value 88.1%. This suggests that hypoechoic images detected in initial assessment using ultrasound can be predictive of full-thickness stage III : or IV wounds.<br />日本褥瘡学会の許可を得て登録_2021.09.22
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紺家, 千津子 ; Konya, Chizuko
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取得学位 : 博士（保健学）, 学位授与番号 : 医博甲第1696号, 学位授与年月日 : 平成17年3月22日, 学位授与大学 : 金沢大学, 主査 :稲垣 美智子 , 副査 :坂井 明美, 真田 弘美
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平松, 知子 ; 津田, 朗子 ; 稲垣, 美智子 ; 島田, 啓子 ; 須釜, 淳子 ; 田淵, 紀子 ; 河村, 一海 ; 泉, キヨ子 ; 長谷川, 雅美 ; 坂井, 明美 ; 木村, 留美子 ; 紺家, 千津子 ; 大桑, 麻由美 ; 多崎, 恵子 ; 松井, 希代子 ; 村角, 直子 ; 正源寺, 美穂 ; 長田, 恭子 ; 亀田, 幸枝 ; 関塚, 真美 ; 小藤, 幹恵 ; 広瀬, 育子 ; 干場, 順子 ; 千代, 恵子 ; 飛田, 敦子 ; 村上, 恵美
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