一般演題[第1会場] - 第30回日本リハビリテーション医学会

演 題
第 1 会場：臨床講義棟（ 第 4・5 講義室 ）
研究会Ⅰ 演題番号 1 ∼ 5
地方会Ⅰ 演題番号 6 ∼ 10
地方会Ⅱ 演題番号 11 ∼ 14
研究会Ⅱ 演題番号 15 ∼ 19
第 2 会場：基礎講義棟（ 第 3 講義室 ）
研究会Ⅲ 演題番号 20 ∼ 24
研究会Ⅳ 演題番号 25 ∼ 29
研究会Ⅴ 演題番号 30 ∼ 35
01
㉸㡢Ἴ Elastography ࡟ࡼࡿᐈほⓗ࡞➽◳ᗘ ᐃ
ᅜ❧⑓㝔ᶵᵓᚨᓥ⑓㝔ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⛉㸯㸪ྠᑠඣ⛉ 2㸪ྠᩚᙧእ⛉࣭ࣜࣁ
ࣅࣜࢸ࣮ࢩࣙࣥ⛉ 3
ࡳࡸࢃࡁ ࡍࡎࡇ
࠺࠼ࡴࡽ
࡞࠾ࡇ
࠿ࢃࡳࡕ ࡇ࠺ࡌ
ࡇࡶࡾ
ࡋࡲࡴࡽ
ࡲ ࡁ ࡇ
‫ۑ‬ᐑ⬥ 㕥Ꮚ1㸪᳜ᮧ ┤Ꮚ1㸪ᕝ㐨 ᖾྖ1㸪ᑠᏲ ࠸ࡘࡳ 1㸪 ᓥᮧ 㯞ᮌᏊ1 ,
ࡳࡸ 䛦 䛝
ࡓࡘࡋ
࡜࠺ࡔ
࠼࠸ࡇ
ࡓ࠿ࡓ
ࡋࢇࡌࢁ࠺
ᐑ㷂 㐩ᚿ2㸪ᮾ⏣ ᰤᏊ2㸪㧗⏣ ಙ஧㑻3㸪
࠙⤖ᯝࠚ
࠙ࡣࡌࡵ࡟ࠚ
5)࣭90 ࡜ࡶ࡟ ṓ௨ୖࡢ⩌࡟ẚࡋ࡚ (ODVWRJUDSK\ ࡣ⏕యࡢ⤌⧊ࡢ◳ࡉࢆホ౯
ṓ௨ୗࡢ⩌ࡢ 65 ࡣప࠿ࡗࡓࠋ
ࡍࡿ᪉ἲ࡛࠶ࡿ ࠋ㉸㡢Ἴ (ODVWRJUDSK\ ࡣ㠀
5)㸸sYVs㸪S㸺
౵くⓗ࡞⤌⧊デ᩿࡜ࡋ࡚ࠊங⭢ࠊ⫢⮚ࠊ๓❧
90㸸sYVs㸪S㸺
⭢ࠊ⏥≧⭢➼ࡢ㡿ᇦ࡛⮫ᗋᛂ⏝ࡀࡍ࡛࡟⾜ࢃ
5)࣭90 ࡜ࡶ࡟ࠊ⏨ዪ㛫࡛ 65 ࡢ᭷ពᕪࡣࡳ
ࢀ࡚࠸ࡿ
ࠋ
ࡽࢀ࡞࠿ࡗࡓࠋ
➽ࡢ◳ᗘホ౯ࡣ㉸㡢Ἴ (ODVWRJUDSK\ ࡢ௚
5) ࡟ẚࡋ࡚ 90 ࡢ 65 ࡣప࠿ࡗࡓࠋ
࡟ 05(ODVWRJUDSK\ ࡟࠾࠸࡚ࡶሗ࿌ࡉࢀ࡚࠾
sYV s㸪S㸺㸧
ࡾࠊ➽ࡢ◳ᗘࡣ➽ࡢ཰⦰࡟ࡼࡗ࡚ኚ໬ࡍࡿࡇ
࠙⪃ᐹࠚ
࡜ࡸ㐠ື࡟ࡼࡗ࡚ኚ໬ࡍࡿ஦ࠊ᭦࡟ࡣ➽⫗ࡢ
⤖ᯝ㸯㸧࡟࠾࠸࡚ࠊ ṓ௨ୗࡢ⩌ࡣ ṓ
✀㢮ࡢᕪࠊಶேᕪࠊྠࡌಶேࡢྠࡌ➽⫗࡛࠶
௨ୖࡢ⩌ࡼࡾࡶ 65 ್ࡀపࡃࠊ➽ࡢ◳ᗘࡣᖺ㱋
ࡗ࡚ࡶ ᐃ᫬㛫࡟ࡼࡾᕪࡀ኱ࡁ࠸஦࡞࡝ࡀሗ
࡟ࡼࡾᕪࡀㄆࡵࡽࢀࡿ஦ࡀุ᫂ࡋࡓࠋ
࿌ࡉࢀ࡚࠸ࡿ ࠋࡋ࠿ࡋࠊヲ⣽ࡣ୙࡛᫂࠶ࡿࠋ
/D­WLWLD ࡽࡣ 05(ODVWRJUDSK\ ࡢ᳨ウ࡛ࠊᖺ
ᮏ◊✲ࡣ೺ᖖ࡞➽࡟࠾࠸࡚ࠊ➽◳ᗘࢆ㉸㡢Ἴ
㱋ࡀప࠸⩌ࡣᖺ㱋ࡀ㧗࠸⩌࡟ẚ࡭࡚Ᏻ㟼≧ែ
(ODVWRJUDSK\ ࡛ ᐃࡋࠊᖺ㱋࡟ࡼࡿኚ໬ࠊᛶ
࡛ࡢ➽◳ᗘࡣప࠸ ࡜ሗ࿌ࡋ࡚࠾ࡾࠊᮏ◊✲
ᕪࠊ➽ࡢ㒊఩࡟ࡼࡿ㐪࠸࡟ࡘ࠸᳨࡚ウࡋࡓࠋ
࠙ᑐ㇟࣭᪉ἲࠚ
ࡢ⤖ᯝ࡜୍⮴ࡍࡿࠋ
ᚨᓥ⑓㝔ᩚᙧእ⛉࣭ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⛉
⤖ᯝ㸰㸧࡛ࡣྠ୍➽࡟࠾࠸࡚ࠊ➽ࡢ◳ᗘ࡟
࡟ධ㝔࠾ࡼࡧእ᮶㏻㝔ࡋ࡚࠸ࡿᝈ⪅ ྡ㸦㸬 ࡣᛶᕪࡣㄆࡵࡽࢀ࡞࠿ࡗࡓࠋ,NDL ࡽ࡟ࡼࡾࠊ
s ṓ㸧ࠋ㉸㡢Ἴ⿦⨨ +,7$&+,$9,86 ࢆ౑
➽᩿㠃✚࠶ࡓࡾࡢᙇຊ࡟ࡣᛶᕪࡣ↓࠸ࡇ࡜ࡀ
⏝ࡋࠊ
ᑐ㇟ࢆ ṓᮍ‶ࡢ⩌࡜ ṓ௨ୖࡢ⩌ࠊ
ሗ࿌ࡉࢀ࡚࠸ࡿ ࠋ⏨ᛶ࡜ዪᛶࡢ➽ຊࡢ㐪࠸
᭦࡟⏨ᛶ⩌࡜ዪᛶ⩌࡟ศࡅ࡚ࠊࡑࢀࡒࢀࡢ೺
ࡣࠊ➽㔞ࡢ㐪࠸ࡀ㛵ಀࡋ࡚࠸ࡿࡶࡢ࡜⪃࠼ࡽ
ᖖ ഃ ࡢ ኱ ⭣ ┤ ➽ 㸦 5HFWXV IHPRULV PXVFOH
ࢀࡿࠋ
㸦5)㸧㸧࠾ࡼࡧෆഃᗈ➽㸦9DVWXVPHGLDOLV
⤖ᯝ㸱㸧࡛ࡣࠊ
90 ࡣ 5) ࡼࡾࡶ 65 ್ࡀపࡃࠊ
PXVFOH 90 㸧 ࡢ Ᏻ 㟼 ᫬ ࡢ ➽ ◳ ᗘ ࢆ
90 ࡣ 5) ࡟ẚࡋ࡚➽ࡢ◳ᗘࡀప࠸ࡇ࡜ࡀุ᫂
(ODVWRJUDSK\ ࡛ ᐃࡋゎᯒࡋࡓࠋ➽◳ᗘࡢᣦ
ࡋࡓࠋ
ᶆࡣࠊᇶ‽࡜࡞ࡿ㡢㡪࢝ࣉ࣮ࣛ࡟ᑐࡍࡿṍࡳ
࠙ࡲ࡜ࡵࠚ
ẚ6WUDLQUDWLR㸦65㸧࡜ࡋ࡚⟬ฟࡋࡓࠋ65
ᮏ◊✲࡛ࡣࠊ➽ࡢ◳ᗘࡣᖺ㱋࣭ಶࠎࡢ➽࡟
ࡣᑐ㇟⤌⧊ࡀ◳࠸࡯࡝㧗ࡃࠊᰂࡽ࠿࠸࡯࡝ప
ࡼࡗ࡚㐪࠺࡟ࡶ࠿࠿ࢃࡽࡎࠊᛶู࡟ࡼࡿᕪࡣ
࠸್࡜࡞ࡿࠋ
ࡳࡽࢀ࡞࠿ࡗࡓࠋࡋ࠿ࡋࠊᮏ◊✲࡛ࡣ㝈ࡽࢀ
㸫1㸫
― 22 ―
ࡓ➽ࡋ࠿ ᐃ࡛ࡁ࡚࠾ࡽࡎࠊ௒ᚋࡣࡉࡽ࡟⑕
౛ᩘࢆቑࡸࡋ࡚ࡢ᳨ウࡸࠊ᳨ᰝ⮬యࡢಙ㢗
ᛶ࣭ጇᙜᛶࡢ◊✲ࡶᚲせ࡛࠶ࡿࠋ㉸㡢Ἴ
(ODVWRJUDSK\ ࡣࠊ➽ࡢ◳ᗘホ౯࡟࠾ࡅࡿᐈほ
ⓗᣦᶆ࡜ࡋ࡚⏝࠸ࡿࡇ࡜ࡀ࡛ࡁࡿࠋ
࠙ᩥ⊩ࠚ
1) Ophir J, Céspedes I, Ponnekanti H,
Yazdi Y, Li X : Elastography: a quantitative method for imaging the elasticity
of biological tissues. Ultrason Imaging
1991; 13: 111-134
2) Itoh A, Ueno E, Tohno E, Kammma H,
Takahashi H, Shiina T, Yamakawa M,
Matsumura T : Breast Disease: Clinical
Application of US Elastography for
Diagnosis. Radiology 2006 ;239 :
341-350
3) Gheorghe L, Iacob S, Iacob R, Dumbrava M, Becheanu G, Herlea V,
Gheorghe C, Lupescu I, Popescu I :
Real Time Elastography -a
Non-invasive Diagnostic Method of
Small Hepatocellular Carcinoma in
Cirrhosis : J Gastrointestin Liver Dis
2009; 18: 439-446
4) Cochlin DL, Ganatra RH, Griffiths
DFR : Elastography in the detection of
prostatic cancer. Clin Radiology 2002;
57: 1014-1020
5) Laëtitia D, Ludovic R, Fabrice C, Sabine FB㸸Analysis of thigh muscle
stiffness from childhood to adulthood
using magnetic resonance elastgraphy
(MRE) technique㸬Clin. Biomech
2011;26:836-840
6) Uffmann K, Maderwald S, Ajaj W,
Galban CG, Mateiescu S, Quick HH,
Ladd ME㸸In vivo elasticity measurements of extremity skeletal muscle
with MR elastography. NMR Biomed
2004㸹17㸸181-190
7) Ikai M, Fukunaga T㸸Culuculation of
muscle strength per unitcross-serectional area of human muscle
by means of ultrasonic measurement.
Internationale Zeitschrift furangewandte Physiologie
1986;26:26-32
㸫2㸫
― 23 ―
02
่⃭ᙉᗘࡢ␗࡞ࡿ▷᫬㛫㟁Ẽ่⃭ࡀᅽ③㜈್࡟ཬࡰࡍᙳ㡪
㧗▱኱Ꮫ་Ꮫ㒊㝃ᒓ⑓㝔ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ㒊㸯
ࡓ ࡞ ࠿
࠿ࡘࡼࡋ
1
࠼ࡢࡁ
ࡣ ࡸ ࡜
1
࠶ࡃࡓࡀࢃ
࡜ࡶ࠶ࡁ
1
࠺ ࠼ ࡢ
ࡲࡉࡺࡁ
1
ࡇࢇ࡝࠺
ࡦࢁࡋ
1
࠸ ࡋ ࡔ
ࡅ ࢇ ࡌ
1
‫⏣ۑ‬୰ ඞᐅ 㸪ᴮ ຬே 㸪ⰰᕝ ▱ᙲ 㸪ୖ㔝 ᑗஅ 㸪㏆⸨ ᐶ 㸪▼⏣ ೺ྖ
࠙ࡣࡌࡵ࡟ࠚ
▱ぬྍ⬟࡛➽཰⦰ࢆకࢃ࡞࠸่⃭ᙉᗘ࡛ࡢ
⤒⓶ⓗ㟁Ẽ่⃭㸦௨ୗ㸪TENS㸧࡟ࡼࡿ㙠③
ຠᯝ࡟㛵ࡍࡿሗ࿌ࡣᩓぢࡉࢀࡿ㸬ࡋ࠿ࡋ㸪ඛ
⾜◊✲࡛ࡣ᫬㛫ࡀ㛗ࡃ㸪▷᫬㛫่⃭࡛ࡢᙳ㡪
ࡸ㸪่⃭ᙉᗘࡢ㐪࠸࡟ࡼࡿ⑊③ཷᐜ࡬ࡢᙳ㡪
ࡣ᫂☜࡟࡞ࡗ࡚࠸࡞࠸㸬௒ᅇ㸪೺ᖖᡂேࢆᑐ
㇟࡟่⃭ᙉᗘࡢ␗࡞ࡿ▷᫬㛫 TENS ࡀᅽ③
㜈್㸦௨ୗ㸪PPT㸧࡟ཬࡰࡍᙳ㡪ࢆ᳨ウࡋࡓ㸬
࠙ᑐ㇟࡜᪉ἲࠚ
ᑐ㇟ࡣ೺ᖖᡂே 13 ྡ㸦⏨ᛶ 6 ྡ㸪ዪᛶ 7
ྡ㸪ᖹᆒᖺ㱋 26.4s5.4 ṓ㸧࡜ࡋࡓ㸬
TENS ࡣ฼ࡁ㊊ࡢ⭌㦵⚄⤒࡟⾜࠸㸪่⃭㛤
ጞ࠿ࡽ 10 ⛊⤒㐣ࡋࡓ᫬Ⅼ࡛ PPT ࡢィ ࢆ㛤
ጞࡋ㸪่⃭ࡣ 30 ⛊㛫⥅⥆ࡋࡓ㸬่⃭ᙉᗘࡣ
่⃭ࢆឤࡌጞࡵࡿᙉᗘࢆឤぬࣞ࣋ࣝ㸪➽཰⦰
ࡀ㉳ࡇࡾጞࡵࡿᙉᗘࡢ 1.5 ಸࡢᙉᗘࢆ㐠ືࣞ
࣋ࣝ࡜ࡋ㸪2 ✀㢮ࡢ่⃭ᙉᗘ่࡛⃭ࢆ⾜ࡗࡓ㸬
่⃭ᙉᗘ௨እࡢ᮲௳ࡣ୍ᐃ࡜ࡋࡓ㸬ྛ่⃭࡛
ࡢィ ࡣู᪥࡛⾜࠸㸪㡰ᗎࡣࣛࣥࢲ࣒࡜ࡋࡓ㸬
PPT ࡣࢹࢪࢱࣝᅽ③ィ㸦Medoc ♫〇㸪
Algomed㸧࡟࡚㸪VAS30 ࡢᅽຊࢆィ ࡋࡓ㸬
ィ Ⅼࡣ㟁Ẽ่⃭ഃ࡜ࡣᑐഃࡢ๓⬯㦵➽㸪୕
ゅ➽࡜ࡋ㸪㟁Ẽ่⃭๓㸪่⃭୰࡟ࡑࢀࡒࢀィ
ࡋࡓ㸬
࠙⤖ᯝࠚ
PPT ࡣ㸪㐠ືࣞ࣋ࣝࡢ่⃭ᙉᗘ࡛ࡣ๓⬯㦵
➽ ࡛ 257.6kPa s 32.3(mean s SE) ࠿ ࡽ
341.8kPas49.0㸪୕ゅ➽࡛ 150.7kPas23.4
࠿ࡽ 209.9kPas32.2 ࡜࡜ࡶ࡟᭷ព࡞ୖ᪼ࢆ
ㄆࡵࡓ㸦p<0.05㸧㸬ឤぬࣞ࣋ࣝࡢ่⃭ᙉᗘ࡛
ࡣ๓⬯㦵➽࡛ 275.1kPas33.4 ࠿ࡽ 270kPa
s 24.5 㸪 ୕ ゅ ➽ ࡛ 165.5kPa s 24.7 ࠿ ࡽ
176.8kPas24.0 ࡜᭷ពᕪࢆㄆࡵ࡞࠿ࡗࡓ㸬
࠙⪃ᐹࠚ
TENS ࡟࠾ࡅࡿඛ⾜◊✲࡟࠾࠸࡚㸪ෆᅉᛶ
࢜ࣆ࢜࢖ࢻ⣔ࡢ㛵୚࡟ࡼࡿ㙠③ຠᯝࡣᩓぢࡉ
ࢀࡿࡀ㸪௒ᅇࡢ่⃭᫬㛫ࡣᴟࡵ࡚▷᫬㛫࡛࠶
ࡾ㸪ࡑࡢᙳ㡪ࡣ⪃࠼࡟ࡃ࠸㸬㐠ືࣞ࣋ࣝࡢ่
⃭ᙉᗘ࡛ࡢᅽ③㜈್ࡢୖ᪼࡟ᙳ㡪ࢆཬࡰࡋࡓ
ࡶࡢ࡜ࡋ࡚㸪ୗ⾜ᛶ⑊③ᢚไ⣔ࡸᗈỗᛶ౵ᐖ
ᢚไㄪ⠇㸦௨ୗ㸪DNIC㸧ࡢ㛵୚ࡀ⪃࠼ࡽࢀ
ࡿ㸬DNIC ࡟㛵ࡋ࡚ࡣ౵ᐖࣞ࣋ࣝࡢ่⃭࡛࡞
ࡃ࡚ࡶ㐲㝸㒊ࡢ่⃭࡛ᮏ᮶ࡢ③ࡳࡀᢚไࡉࢀ
ࡿࡇ࡜ࡶሗ࿌ࡉࢀ࡚࠸ࡿ 1)㸬ࡲࡓ㸪➽཰⦰࡟
ࡼࡿ㙠③ຠᯝࡢሗ࿌ࡶࡉࢀ࡚࠾ࡾ㸪➽཰⦰⮬
యࡢᙳ㡪ࡢྍ⬟ᛶࡶ⪃࠼ࡽࢀࡿ 2)㸬
࠙ࡲ࡜ࡵࠚ
➽཰⦰ࢆక࠺㐠ືࣞ࣋ࣝࡢ่⃭ᙉᗘ࡛ࡢ▷
᫬㛫㟁Ẽ่⃭࡟ࡼࡗ࡚㸪ᑐഃ㸪㐲㝸㒊ࡢ PPT
ࡢୖ᪼ࡀᚓࡽࢀࡓ㸬▷᫬㛫࡛༶᫬ⓗ࡞ຠᯝࡀ
ᚓࡽࢀࡿࡇ࡜ࡣ㸪⾡ᚋࣜࣁࣅࣜ᫬ࡢే⏝࡜ࡋ
࡚᭷⏝࡛࠶ࡿ࡜⪃࠼ࡿ㸬
࠙ཧ⪃ᩥ⊩ࠚ
1) Lautenbacher S,et al:Inhibitory effects
do not depend on the subjective experience of pain during heterotopic noxious conditioning stimulation(HNCS):a
contribution to the phychophysics of
pain inhibition.Eur J
Pain,2002;6;365-374
2) Kelli F.Koltyn and Masataka
Umeda:Contralateral Attenuation of
Pain After Short-Duration Submaximal Isometric Exercise.J
Pain,2007;11;8;pp887-892
㸫1㸫
― 24 ―
㸫2㸫
― 25 ―
03
㛵⠇࣐ࣜ࢘ࢳᝈ⪅࡟࠾ࡅࡿ DASH ࡜ Hand 20㸪Hand10 ࡢ⾡๓ᚋࡢ᳨ウ
㸯㸧ᒸᒣ኱Ꮫ⑓㝔⥲ྜࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ㒊㸪㸰㸧ᒸᒣ኱Ꮫ⑓㝔ᩚᙧእ⛉
‫ۑ‬㏆⸨࠶࠸㸯㸪୰ཎ㱟୍ 2㸪Ἠ཭⣖Ꮚ 1㸪ᑠᕝຍⱑ㸯㸪ᯇᒣᐅஅ 1㸪
ᒸె⣧ 1㸪ᶫワㅬ୕ 2㸪ሀᒣె⨾㸯㸪す⏣ᆂ୍㑻 2㸪༓⏣┈⏕ 1
࠙ࡣࡌࡵ࡟ࠚ
㛵⠇࣐ࣜ࢘ࢳ(௨ୗ RA)ᝈ⪅ࡢ⬟ຊపୗࢆ
ᢕᥱࡍࡿࡓࡵ࡟ᚑ᮶ࡢ ADL ホ౯࡜ࡋ࡚ FIM
࡞࡝ࡀ౑⏝ࡉࢀ࡚ࡁࡓ㸬Ἠࡽࡣୖ⫥⬟ຊపୗ
࡟╔┠ࡋࡓ DASH the JSSH version(DASH
᪥ᮏᡭእ⛉Ꮫ఍∧)࡜ Hand20 ࡢ⾡๓ᚋ࡛ࡢ
ẚ㍑ࢆ⾜࠸┦㛵ࡀ࠶ࡗࡓࡇ࡜ࢆሗ࿌ࡋࡓ㸬
DASH ࡣᅇ⟅⋡ࡢḞⴠ㡯┠ࡀከ࠸࡜࠸࠺ၥ
㢟ࡀ࠶ࡿࡀ㸪Hand20 ࡣ⤮ࢆ⏝࠸ࡓタၥࡢࡓ
ࡵḞⴠ㡯┠ࡀᑡ࡞ࡃ DSAH ࡜ྠᵝ࡟౑⏝࡛
ࡁࡿᶵ⬟ホ౯࡜ࡉࢀ࡚࠸ࡿ㸬
㏆ᖺ Hand20 ࡢಙ㢗ᛶ㸪ጇᙜᛶࢆಖࡗࡓࡲ
ࡲ 10 㡯┠࡟๐ῶࡋࡓ Hand10 ࡀฟ࡚࠾ࡾ㸪
Hand20 ࡜ࡢ┦㛵㛵ಀࡀሗ࿌ࡉࢀ࡚࠸ࡿ㸬
௒ᅇ RA ᝈ⪅ࡢ࿘⾡ᮇࡢᶵ⬟ホ౯࡟ DASH㸪
Hand20㸪Hand10 ࡀ࡝ࡢ⛬ᗘ᭷⏝࡛࠶ࡿ࠿
ࢆẚ㍑ࡋ Hand10 ࡢ᭷ຠᛶࢆ᳨ウࡋࡓ㸬
࠙⤖ᯝࠚ
⾡๓ࡢ DASH ࡣ 42.0s23.0 Ⅼ㸪Hand20
ࡣ 54.5s24.1 Ⅼ㸪Hand10 ࡣ 55.0s25.4 Ⅼ
࡛࠶ࡗࡓ㸬⾡ᚋࡢ DASH ࡣ 33.0s22.8 Ⅼ㸪
Hand20 ࡣ 40.8s27.6 Ⅼ㸪Hand10 ࡣ 41.4
s27.4 Ⅼ࡛࠶ࡗࡓ㸬DASH ࡜ Hand20㸪
Hand10 ࡣ⾡๓࡟ẚ࡭㸪⾡ᚋࡣῶᑡഴྥ࡟࠶
ࡗࡓ㸬
㸦⾲ 1㸧
DASH ࡜ Hand20 ࡢ⾡๓㸸⾡ᚋࡢ┦㛵ಀᩘ
ࡣ 0.81(p<.001) 㸸 0.96(p<.001) ࡛ ࠶ ࡾ 㸪
Hand20 ࡜ Hand10 ࡢ⾡๓㸸⾡ᚋࡢ┦㛵ಀᩘ
ࡣ 0.98
(p<.001) 㸸 0.98(p<.001) ࡛ ࠶ ࡾ 㸪 DASH ࡜
Hand10 ࡢ ⾡ ๓ 㸸 ⾡ ᚋ ࡢ ┦ 㛵 ಀ ᩘ ࡣ
0.80(p<.001)㸸0.93(p<.001)࡛࠶ࡗࡓ㸬࡜ࡶ࡟
ṇࡢ㠀ᖖ࡟ᙉ࠸┦㛵㛵ಀࢆ♧ࡋࡓ(⾲ 2㸪3㸪
4)㸬
࠙ᑐ㇟࡜᪉ἲࠚ
2010 ᖺ 12 ᭶࠿ࡽ 2012 ᖺ 10 ᭶ࡢᮇ㛫࡟⾡
๓⾡ᚋࡢ DASH㸪Hand20㸪Hand10 ࡀィ ࡛ࡁࡓ RA ᝈ⪅ࢆᑐ㇟࡜ࡋࡓ㸬⾡๓⾡ᚋ඲య
࡛ィ ྍ⬟ࡔࡗࡓࡢࡣ㸪22 ౛(⏨ᛶ 3 ౛ࠊዪ
ᛶ 19 ౛) 㸪ᖹᆒᖺ㱋 58.4s14.1 ࡔࡗࡓ㸬ࡉ
ࡽ࡟⾡ᚋ⣙ 6 ࣧ᭶ࡢ DASH ࡜ Hand20 ࢆィ
ࡋ㸪
⾡๓⾡ᚋ࡛ࡢ DASH㸪Hand20㸪Hand10
ࡢ┦㛵㛵ಀࢆ᳨ウࡋࡓ㸬
(⾲ 1)
⾡๓ᚋ䛷䛾ᨵၿ⋡
Ⅼᩘ
㻝㻜㻜
㻥㻜
㻤㻜
㻣㻜
㻢㻜
㻠㻜
㻟㻜
㻞㻜
㻝㻜
㻜
㸫1㸫
― 26 ―
⾡๓
⾡ᚋ
㻡㻜
䚷㻰㻭㻿㻴
㻝
䚷䚷㻴㼍㼚㼐㻝㻜
㻞
䚷䚷㻴㼍㼚㼐㻞㻜
㻟
(⾲ 2)
DASH㻌 VS㻌 Hand20 ⾡ᚋ
㻝㻜㻜
㻥㻜
㻝㻜㻜
㻥㻜
㻤㻜
㻣㻜
㻢㻜
㻤㻜
㻣㻜
㻢㻜
㻴㼍㼚㼐㻞㻜
㻴㼍㼚㼐㻞㻜
DASH㻌 VS㻌 Hand20 ⾡๓
㻡㻜
㻠㻜
㻟㻜
㻞㻜
㻝㻜
㻜
㻡㻜
㻠㻜
㻟㻜
㻞㻜
㻝㻜
㻜
㻜
㻡㻜
㻝㻜㻜
㻜
㻡㻜
㻰㻭㻿㻴
㻝㻜㻜
㻰㻭㻿㻴
(⾲ 3)
Hand20㻌 VS㻌 Hand10㻌 ⾡๓
Hand20㻌 VS㻌 Hand10㻌 ⾡ᚋ
㻝㻜㻜
㻝㻜㻜
㻥㻜
㻥㻜
㻤㻜
㻤㻜
㻣㻜
㻢㻜
㻴㼍㼚㼐㻝㻜
㻴㼍㼚㼐㻝㻜
㻣㻜
㻡㻜
㻠㻜
㻢㻜
㻡㻜
㻠㻜
㻟㻜
㻟㻜
㻞㻜
㻞㻜
㻝㻜
㻝㻜
㻜
㻜
㻜
㻡㻜
㻝㻜㻜
㻜
㻡㻜
䠤䠽䡊䡀㻞㻜
㻝㻜㻜
䠤䠽䡊䡀㻞㻜
(⾲ 4)
DASH㻌 VS㻌 Hand10㻌 ⾡ᚋ
㻝㻜㻜
㻝㻜㻜
㻥㻜
㻥㻜
㻤㻜
㻤㻜
㻣㻜
㻣㻜
㻢㻜
㻢㻜
㻴㼍㼚㼐㻝㻜
㻴㼍㼚㼐㻝㻜
DASH VS㻌 Hand10 ⾡๓
㻡㻜
㻠㻜
㻡㻜
㻠㻜
㻟㻜
㻟㻜
㻞㻜
㻞㻜
㻝㻜
㻝㻜
㻜
㻜
㻜
㻡㻜
䠠䠝䠯䠤
㻝㻜㻜
㻜
㻞㻜
㻠㻜
㻢㻜
㻤㻜
䠠䠝䠯䠤
࠙⪃ᐹࠚ
DASH ࡣୖ⫥⬟ຊపୗࡢホ౯࡜ࡋ࡚㧗࠸
ಙ㢗ᛶ࣭ጇᙜᛶ࣭཯ᛂᛶࡀㄆࡵࡽࢀ࡚࠸ࡿ㸬
DASH ࡜ Hand20 ࡣୖ⫥ᡭ⾡࡟࠾࠸࡚ྠ⛬
ᗘࡢホ౯⬟ຊࡀ࠶ࡿ࡜ࡢሗ࿌ࡀࡉࢀ࡚࠸ࡿ 1)㸬
ୖ ⫥ ᡭ ⾡ ࡢ ⾡ ๓ ⾡ ᚋ ホ ౯ ࡟ 㸪 Hand20 ࡜
Hand10 ࡛ࡢ⤖ᯝࡶྠ⛬ᗘࡢ᭷⏝࡛࠶ࡗࡓ࡜
ሗ࿌ࡉࢀ࡚࠸ࡿ 2) 3)㸬
௒ᅇ㸪⾡ᚋ⣙ 6 ࣧ᭶ࡢ DASH ࡜ Hand20
ࢆィ ࡋ⾡๓⾡ᚋ࡛ࡢ DASH㸪Hand20㸪
Hand10 ࡢᨵၿ࡜┦㛵㛵ಀࢆ᳨ウࡋࡓ㸬
ࡑࢀࡒࢀࡢホ౯ࡢྜィⅬᩘ࡛ࡣ⾡๓ᚋᨵၿ
ࢆㄆࡵࡓ㸬ࡲࡓ㸪⾡๓࣭⾡ᚋࡢ Hand20 ࡜
Hand10㸪DASH ࡜ Hand10 ࡢ 3 ࡘࡢホ౯࡛
ࡣྛࠎࡢ┦㛵ࡀ♧ࡉࢀࡓ㸬಴ᶫࡽࡢሗ࿌࡟ࡼ
ࡿ࡜ Hand10 ࡣ 10 㡯┠࡜㠀ᖖ࡟⡆₩࡛⮫ᗋ
ୖ᭷⏝࡞ୖ⫥ᶵ⬟ホ౯⾲࡛࠶ࡿ࡜ሗ࿌ࡉࢀ࡚
࠸ࡿ 2) 㸬ࡇࡢࡇ࡜࠿ࡽࡶ㹐㸿ᝈ⪅ࡢ⾡๓ᚋホ
౯࡟࠾࠸࡚ࡶ Hand10 ࡟ࡶ᭷ຠᛶࡀ࠶ࡿ࡜♧
၀ࡉࢀࡓ㸬
Hand10 ࡣ Hand20 ࡜ẚ㍑ࡋ࡚㉁ၥ㡯┠ࡀ
ᑡ࡞ࡃᅇ⟅᫬㛫ࡀ▷⦰ࡉࢀᝈ⪅ࡢ㈇ᢸࡀ㍍ῶ
ࡉࢀࡿࡇ࡜ࡀண ࡉࢀࡿ㸬ࡲࡓ㸪DASH ࡛ၥ
㢟࡜࡞ࡿḞⴠ㡯┠ࡶᑡ࡞࠸ࡓࡵ㸪RA ᝈ⪅ࡢ
ୖ⫥ホ౯࡟࠾࠸࡚౑࠸ࡸࡍ࠸ୖ⫥⬟ຊపୗࡢ
ホ౯࡛ࡣ࡞࠸࠿࡜⪃࠼ࡓ㸬
࠙ᩥ⊩ࠚ
1) ᒾ᭶ඞஅ㸪ኟ┠၏ᘯ, ᪂஭ဴஓ, ᰩᮏ⚽,
ዟ஭ఙᖾ, ᒣᮏ⨾▱㑻, ᘓ㒊ᑗᗈ, ⠛ཎᏕ
᫂, ᖹ⏣ோ㸸ୖ⫥ᶵ⬟ホ౯⚊ DASH ࠾ࡼ
ࡧ Hand20 ࡢᡭ᰿⟶⑕ೃ⩌ᝈ⪅ࡢ἞⒪๓
ᚋ࡟࠾ࡅࡿ཯ᛂᛶ࡟ࡘ࠸࡚㸬ᮎᲈ⚄⤒
2009㸹20㸸149̿150
㸰)಴ᶫಇ࿴㸪ᰩᮏ⚽㸪ᒾ᭶ඞஅ㸪ᖹ⏣ோ㸸ᡭ
᰿⟶⑕ೃ⩌࡟ᑐࡍࡿୖ⫥ᶵ⬟ホ౯⚊
Hand10 ࡢ཯ ᛂ ᛶ㸸 ᪥ᮏ ᡭ እ⛉ 㞧ㄅ 㸸
2011㸹28㸸 S278
㸱) ᰩᮏ⚽㸪⠛ཎᏕ᫂㸪ᘓ㒊ᑗᗈ㸪ዟ஭ఙᖾ㸸
Touch screen computer ࢆ⏝࠸ࡓୖ⫥㞀
ᐖホ౯⚊(Hand10 touch)ࡢጇᙜᛶ᳨ウ࡜
᭷⏝ᛶ㸸᪥ᮏᩚᙧእ⛉㞧ㄅ㸸2012㸹86㸸
S551
㸫2㸫
― 27 ―
04
๓༑Ꮠ㠎ᖏᦆയ⭸ࡢ➽ຊ≉ᛶ
ᑠ㒆➨୍⥲ྜ⑓㝔 ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⛉
ࡲࡿࡸࡲ
࠶ࡁ࠾
ࡩࡌ࠸
࡜ࡋࡳࡘ
ࡸࡲࡔ
ࡓ࠿ࡲࡉ
‫୸ۑ‬ᒣ ᫛⏨, ⸨஭ ಇ඘, ᒣ⏣ ๛ṇ
࠙ࡣࡌࡵ࡟ࠚ
➽ຊࢆᐈほⓗ࡟ホ౯ࡍࡿࡇ࡜ࡣ, 㐠ືჾࣜ
ࣁࣅࣜࢸ࣮ࢩࣙࣥ࡟࠾࠸࡚㠀ᖖ࡟㔜せ࡛࠶ࡿ.
ᡃ ࠎ ࡣ , 1997 ᖺ ࡟ ➼ ㏿ ᛶ ➽ ຊ ᐃ ჾ
KIN-COM㸦௨ୗ, KIN-COM㸧ࢆᑟධࡋ, ᵝࠎ
࡞㐠ືჾ⑌ᝈࡢ➽ຊ ᐃ࡟౑⏝ࡋ࡚ࡁࡓ. ᮏ
◊✲࡛ࡣ, KIN-COM ࢆ⏝࠸࡚๓༑Ꮠ㠎ᖏ
㸦Anterior cruciate ligament, ௨ୗ, ACL㸧
ᦆയ⭸ࡢ➽ຊࢆホ౯ࡋ, ⱝᖸࡢ▱ぢࢆᚓࡿࡇ
࡜ࡀ࡛ࡁࡓࡢ࡛ሗ࿌ࡍࡿ.
࠙ᑐ㇟࠾ࡼࡧ᪉ἲࠚ
ᑐ㇟ࡣࢫ࣏࣮ࢶࢆཷയᶵ㌿࡜ࡋࡓ $&/ ᦆ
യ⭸࡛ ᖺ ᭶࠿ࡽ ᖺ ᭶ࡲ࡛࡟
ᙜ㝔࡛ $&/ ༢⊂෌ᘓᡭ⾡ࢆ⾜ࡗࡓ ⑕౛ ⭸㸦⏨ᛶ ⑕౛ዪᛶ ⑕౛㸧ᖹᆒᖺ㱋
s ṓ㸦⏨ᛶ s ṓዪᛶ s ṓ㸧࡛࠶ࡿ஧ᮇⓗ࡟⾜ࡗࡓ෌ᘓᡭ⾡
౛෌ࠎᘓᡭ⾡౛ࡣᮏ◊✲࠿ࡽ㝖እࡋࡓ෌
ᘓᡭ⾡࡛ࡣࡍ࡭࡚ࡢ⑕౛࡟ᑐࡋ࡚ᝈഃࡢ
༙⭝ᵝ➽⭝㺃ⷧ➽⭝ࢆ⏝࠸ࡓ
.,1&20 ࡟ࡼࡿ⭸㛵⠇➽ຊ ᐃࡣᡭ⾡๓
࠾ࡼࡧᡭ⾡ᚋ ࣨ᭶௨ᚋ ࣨ᭶ࡈ࡜࡟デ
ᐹ࡟ྜࢃࡏ࡚ᐇ᪋ࡋࡓ⭸㛵⠇ᒅ᭤ r࠿ࡽ
r࡛ࡢ᭱኱ດຊ⭸㛵⠇ఙᒎ㐠ື࠾ࡼࡧᒅ
᭤㐠ືࢆゅ㏿ᗘ rV࠾ࡼࡧ rV ࡢ
➼㏿㐠ື࡛⾜ࢃࡏ኱⭣ᅄ㢌➽࠾ࡼࡧࣁ࣒
ࢫࢺࣜࣥࢢࢫࡢồᚰᛶ཰⦰ࣆ࣮ࢡࢺࣝࢡ㸦1P㸧
ࢆ➽ຊ࡜ࡋ࡚ᐃ⩏ࡋ⟬ฟࡋࡓࡇࢀࡽࡢ ᐃ್ࡢ࠺ࡕᮏ◊✲࡛ࡣ⾡๓࠾ࡼࡧ෌ᘓ
⾡ᚋ ࣨ᭶ࡢ➽ຊ࡟ࡘ࠸᳨࡚ウࡋࡓ⾡๓➽
ຊࡣᡭ⾡๓᪥࠶ࡿ࠸ࡣᙜ᪥࡟ ᐃࡋ⾡
ᚋ ࣨ᭶➽ຊࡣ⾡ᚋ ᅇ┠௨㝆ࡢ ᐃ࡛
࠿ࡘ⾡ᚋ ࣨ᭶࡟᭱ࡶ㏆࠸ ᐃ᪥ࡢ➽ຊࢆ᥇
⏝ࡋࡓ
ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡣ⾡๓࡟➽ຊ ᐃࢆ
ྵࡴ⾡๓ホ౯ࢆ⾜࠸ᡭ⾡⩣᪥࠿ࡽ⭸㛵⠇ྍ
ືᇦ㐠ື኱⭣ᅄ㢌➽➼ᑻᛶ཰⦰➽ຊࢺ࣮ࣞ
ࢽࣥࢢᯇⴥ᮫㒊ศⲴ㔜Ṍ⾜⦎⩦࡞࡝ࢆ㛤ጞ
ࡋࡓ⾡ᚋ 㐌࠿ࡽ඲Ⲵ㔜Ṍ⾜ࢆチྍࡋ
⾡ᚋ 㐌࠿ࡽࢫࢡ࣡ࢵࢺ࡞࡝ࡢ &ORVHG
NLQHWLFFKDLQ௨ୗ&.&➽ຊࢺ࣮ࣞࢽࣥࢢ
ࣁ࣒ࢫࢺࣜࣥࢢࢫࡢ 2SHQNLQHWLFFKDLQ㸦௨
ୗ2.&㸧➽ຊࢺ࣮ࣞࢽࣥࢢ࡞࡝ࢆ㛤ጞࡋࡓ
⾡ᚋ ࣨ᭶࠿ࡽ 2.& ࡛ࡢ✚ᴟⓗ࡞኱⭣ᅄ㢌➽
➽ຊࢺ࣮ࣞࢽࣥࢢࢆ㏣ຍࡋࡓ
⤫ィฎ⌮࡟࠾࠸࡚ࡣ⤖ᯝࡣࡍ࡭࡚ᖹᆒ
್sᶆ‽೫ᕪ࡛♧ࡋࡓࡲࡓ ⩌㛫ࡢᖹᆒ
᳨್ᐃ࡟ࡣWWHVW ࢆ⾜࠸᭷ពỈ‽ࡣ S㸺
࡜ࡋࡓ
࠙⤖ᯝࠚ
ゅ㏿ᗘ rV ࡛ࡢ➽ຊࡣ኱⭣ᅄ㢌➽
ࣁ࣒ࢫࢺࣜࣥࢢࢫ࡜ࡶ⾡๓࡜ẚ㍑ࡍࡿ࡜⾡
ᚋ ࣨ᭶࡛᭷ព࡟㧗࠸್ࢆㄆࡵࡓࡲࡓ኱
⭣ᅄ㢌➽࡛ࡣ೺ഃ࡜ẚ㍑ࡋࡓᝈഃࡢ➽ຊࡣ
⾡๓⾡ᚋ ࣨ᭶࡜ࡶ᭷ព࡟ప࠸್ࢆㄆࡵࡓ
୍᪉ࣁ࣒ࢫࢺࣜࣥࢢࢫ࡛ࡣ⾡๓࡟ࡣ೺
ഃ࡜ẚ㍑ࡋ࡚ᝈഃࡢ➽ຊࡣ᭷ព࡟ప࠸್ࢆ♧
ࡋࡓࡀ⾡ᚋ ࣨ᭶࡛ࡣᝈഃ࡜೺ഃࡢ㛫࡟
᭷ពᕪࢆㄆࡵ࡞࠿ࡗࡓࡲࡓ೺ഃẚࡣ⾡
๓࡟࠾࠸࡚኱⭣ᅄ㢌➽ࡀ ࣁ࣒ࢫࢺࣜ
ࣥࢢࢫࡀ ࡛࠶ࡗࡓࡢ࡟ᑐࡋ࡚⾡ᚋ ࣨ
᭶࡛ࡣࡑࢀࡒࢀ࡛࠶ࡗࡓ᭷ព
ᕪࡣㄆࡵࡽࢀ࡞࠸ࡶࡢࡢ኱⭣ᅄ㢌➽ࡢ࡯࠺
ࡀప࠸ഴྥࢆ♧ࡋࡓ
㸫1㸫
― 28 ―
ゅ㏿ᗘ rV ࡛ࡢ➽ຊ࡟ࡘ࠸࡚ࡶゅ㏿
ᗘ rV ࡜ྠᵝࡢ⤖ᯝ࡛࠶ࡗࡓࡲࡓ⾡ᚋ
ࣨ᭶ࡢ೺ഃẚࡣ኱⭣ᅄ㢌➽ࡀ 㸣ࣁ࣒
ࢫࢺࣜࣥࢢࢫࡀ ࡜㧗Ỉ‽ࡢ್ࢆ♧ࡋࡓ
⏨ዪูࡢ⾡ᚋ ࣨ᭶➽ຊࡣᝈഃ࡜೺ഃࢆ
ẚ㍑ࡍࡿ࡜⏨ᛶ࡛ࡣゅ㏿ᗘ rV ࡢ኱
⭣ᅄ㢌➽࡛ࡢࡳᝈഃࡀ᭷ព࡟ప࠸್ࢆ♧ࡋ
ࡓ୍᪉ዪᛶ࡛ࡣゅ㏿ᗘ rV ࡢࣁ࣒
ࢫࢺࣜࣥࢢࢫ࡛ࡣ᭷ពᕪࢆㄆࡵ࡞࠸ࡶࡢࡢ
௚ࡢ୧⿕㦂➽࡟࠾࠸࡚೺ഃ࡜ẚ㍑ࡋ࡚ᝈഃ
ࡢ➽ຊࡀ᭷ព࡟ప࠸್ࢆ♧ࡋࡓ
࠙⪃ᐹࠚ
ᮏ◊✲࡟࠾࠸࡚ࡣ୧⿕㦂➽ࡢ⾡๓ᝈഃ➽
ຊࡣ೺ഃ࡜ẚ㍑ࡋ࡚᭷ព࡟పୗࡋ೺ഃẚ
ࡣࣁ࣒ࢫࢺࣜࣥࢢࢫ࡜ẚ㍑ࡋ࡚኱⭣ᅄ㢌
➽ࡀప࠸ഴྥ࡟࠶ࡗࡓࡲࡓ෌ᘓ⾡ᚋ ࣨ
᭶ᝈഃ➽ຊࡣ೺ഃ࡜ẚ㍑ࡋ࡚኱⭣ᅄ㢌➽
ࡣ᭷ព࡟పୗࡋ࡚࠸ࡓࡀࣁ࣒ࢫࢺࣜࣥࢢࢫ
ࡣ༑ศ࡟ᅇ᚟ࡋ࡚࠸ࡓࡇࢀࡣ$&/ ᦆയ⭸
࡛ࡣ⭸㛵⠇ఙᒎ㐠ື࡟࠾ࡅࡿ⬯㦵๓᪉ືᦂ
ࡢไືࡀ୙༑ศ࡛࠶ࡾ኱⭣ᅄ㢌➽ࡢ➽ຊⓎ
᥹࡟୙฼࡛࠶ࡿࡇ࡜2.& ࡛ࡢ኱⭣ᅄ㢌➽➽
ຊࢺ࣮ࣞࢽࣥࢢࢆ⾡ᚋ᪩ᮇ࡟ࡣᐇ᪋ࡋ࡚࠸࡞
࠸ࡇ࡜ࡀせᅉ࡜⪃࠼ࡽࢀࡿ
⾡ᚋ ࣨ᭶➽ຊࢆ⏨ዪู࡟ホ౯ࡍࡿ࡜೺
ഃ࡜ẚ㍑ࡋ࡚ᝈഃࡢ➽ຊࡀ᭷ព࡟పୗࡋ࡚
࠸ࡓࡢࡣ⏨ᛶ࡛ࡣゅ㏿ᗘ rV ࡢ኱⭣
ᅄ㢌➽ࡢࡳ࡛࠶ࡗࡓࡀዪᛶ࡛ࡣゅ㏿ᗘ
rV ࡢࣁ࣒ࢫࢺࣜࣥࢢࢫࢆ㝖࠸ࡓࡍ࡭࡚
࡟࠾࠸࡚᭷ព࡟పୗࡋ࡚࠸ࡓ
ࡇࢀࡽࡢ⤖ᯝࡣ$&/ ෌ᘓ⾡ᚋࡢ➽ຊࢺࣞ
࣮ࢽࣥࢢ࡛ࡣ኱⭣ᅄ㢌➽࡟↔Ⅼࢆ࠶࡚ࡿᚲ
せࡀ࠶ࡿࡇ࡜ࢆ♧၀ࡋ࡚࠸ࡿ᭦࡟ዪᛶࡢ
⭸➽ຊࢆ᪩ᮇ࡟ᅇ᚟ࡉࡏࡿࡇ࡜ࡣㄢ㢟ࡢ ࡘ࡛࠶ࡿ࡜ゝ࠼ࡿ
$&/ ෌ᘓ⾡ᚋࡢ➽ຊࢺ࣮ࣞࢽࣥࢢ࡟㛵ࡍࡿ
ㅖᐙࡢሗ࿌ 㹼㸧࡛ࡣ&.& ࢺ࣮ࣞࢽࣥࢢࡢᏳ
඲ᛶ࡟ࡘ࠸࡚ࡣពぢࡀ୍⮴ࡋ࡚࠸ࡿࡼ࠺࡛
࠶ࡿࡀ2.& ࡟ࡘ࠸࡚ࡣ෌ᘓ㠎ᖏ࡟ຍࢃࡿᙇ
ຊ࡜࠸࠺Ⅼ࡛ពぢࡀᑐ❧ࡋ࡚࠸ࡿᮏ◊✲
࡛ࡣ⾡ᚋ ࣨ᭶➽ຊࡢ೺ഃẚࡣ኱⭣ᅄ㢌
➽ࡀ 㹼㸣ࣁ࣒ࢫࢺࣜࣥࢢࢫࡀ 㹼
㸣࡛࠶ࡾඛ⾜◊✲ ࡜ẚ㍑ࡋ࡚ࡶྠ➼
ࡢⰋዲ࡞ᡂ⦼ࢆᚓࡿࡇ࡜ࡀ࡛ࡁࡓࡋ࠿ࡋ
௒ᚋࡼࡾ᪩ᮇࡢࢫ࣏࣮ࢶ᚟ᖐࢆ┠ᶆ࡟ࡋࡓ
ሙྜࡼࡾ᪩ᮇࡢ➽ຊᅇ᚟ࢆồࡵࡿᚲせࡀ࠶
ࡿᡃࠎࡣ኱⭣ᅄ㢌➽ಶูࡢ➽ຊࢆ᪩ᮇ࡟
ᅇ᚟ࡉࡏࡿࡓࡵ࡟ࡣ&.& ➽ຊࢺ࣮ࣞࢽࣥࢢ
ࡢࡳ࡛ࡣ୙༑ศ࡛࠶ࡾ2.& ࢺ࣮ࣞࢽࣥࢢࡀ
୙ྍḞ࡛࠶ࡿ࡜⪃࠼࡚࠸ࡿࡲࡓ.,1&20
࡛ࡢ➽ຊ ᐃࡀ 2.& ᮲௳࡛࠶ࡿ௨ୖ➽ຊⓎ
᥹ࡢ≉␗ᛶࡢⅬ࠿ࡽࡶ኱⭣ᅄ㢌➽ࡢ 2.& ➽
ຊࢺ࣮ࣞࢽࣥࢢࢆ࡝ࡢࡃࡽ࠸᪩ᮇ࠿ࡽࠊ࡝
ࡢࡃࡽ࠸ࡢᙉᗘ࡛㛤ጞ࡛ࡁࡿ࠿ࡣ㔜せ࡞᳨
ウㄢ㢟࡛࠶ࡿ࡜⪃࠼ࡿ
࠙ᩥ⊩ࠚ
1) E. Bruce Bynum, Robert L. Barrack, A.
Herbert Alexander : Open versus closed
chain kinetic exercises after anterior cruciate ligament reconstruction. Am J Sports
Med 23(4): 401-406, 1995.
2) Braden C. Fleming, Heidi Oksendahl,
Bruce D. Beynnon : Open- or closed-kinetic
chain exercises after anterior cruciate
ligament reconstruction? Exercise and
sport sciences reviews 33(3): 134-140, 2005.
ஂಖᮧ㐩ஓᩪ⸨᫂⩏$&/ ෌ᘓ⾡ᚋࡢ᪩
ᮇࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ̿2SHQNLQHWLFFKDLQ
ἲ࡜ FORVHGNLQHWLFFKDLQ ἲ̿ᩚ࣭⅏እ 7RNLIXPL0DMLPD.D]XQRUL<DVXGD
+LGHQREX7DJR<RVKLH7DQDEH$NLR0LQDPL
5HKDELOLWDWLRQDIWHUKDPVWULQJDQWHULRU
FUXFLDWHOLJDPHQWUHFRQVWUXFWLRQ&OLQ
LFDORUWKRSDHGLFVDQGUHODWHGUHVHDUFK
㸫2㸫
― 29 ―
05
୕ḟඖゅᗘィࢆ⏝࠸ࡓ⭸㛵⠇ᅇ᪕ゅᗘ ᐃࡢ᳨ウ
ᗈᓥ኱Ꮫ⑓㝔デ⒪ᨭ᥼㒊ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ㒊㛛㸯㸪ᗈᓥ኱Ꮫ⑓㝔ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⛉㸰
ᗈᓥ኱Ꮫ኱Ꮫ㝔་ṑ⸆ಖ೺Ꮫ◊✲⛉ᩚᙧእ⛉Ꮫ 3
࠾ࡾࡓ ࡞࠾ࡸ
ࡀࢇࡏ ࡵ࠸
ࡦࡽࡓ ࠿ࡎࡦࡇ
࠸࡜࠺ ࡼࡋࡦࢁ
ࡁࡴࡽ ࡦࢁ࠶ࡁ
࠾ ࡕ ࡳ ࡘ ࠾
‫ۑ‬ᢡ⏣ ┤ဢ㸯㸪㞜℩ ᫂㸯㸪ᖹ⏣ ࿴ᙪ㸯㸪ఀ⸨ ⩏ᗈ㸯㸪ᮌᮧ ᾈᙲ㸰㸪㉺ᬛ ගኵ3
࠙ࡣࡌࡵ࡟ࠚ
⭸๓༑Ꮠ㠌ᖏ(ACL)ᦆയࡣࢫ࣏࣮ࢶ୰࡟㢖
⦾࡟⏕ࡌࡿእയࡢ୍ࡘ࡛࠶ࡿ㸬ACL ᦆയ࡟ࡼ
ࡗ࡚⭸㛵⠇࡟ࡣ㸪๓ᚋ᪉ྥ࠾ࡼࡧᅇ᪕᪉ྥࡢ
୙Ᏻᐃᛶࢆ⏕ࡌࡿ㸬ࢫ࣏࣮ࢶ➇ᢏ࡬ࡢ᚟ᖐ࡟
ࡣ㠌ᖏ෌ᘓࢆవ൤࡞ࡃࡉࢀ㸪᪥ᮏ࡟࠾࠸࡚ࡣ
ᦆയ⪅ࡢ 50㹼70㸣ࡀ෌ᘓ⾡ࢆཷࡅ࡚࠸ࡿ 1㸬
ࢫ࣏࣮ࢶ᚟ᖐ࠾ࡼࡧ෌ᦆയண㜵ࢆ⪃៖ࡍࡿୖ
࡛ࡣ㸪෌ᘓ㠌ᖏࡢᶵ⬟࡟㛵ࡋ࡚㐺ṇ࡞ホ౯ࡀ
ᚲせ୙ྍḞ࡛࠶ࡿ㸬
ACL ᦆയᚋࡢ๓ᚋ୙Ᏻᐃᛶ࡟㛵ࡋ࡚ࡣ㸪ᐃ
㔞໬ࡢ᪉ἲࡀࡍ࡛࡟☜❧ࡉࢀ࡚࠸ࡿࡀ㸪ᅇ᪕
᪉ྥ࡟ᑐࡍࡿ୙Ᏻᐃᛶ࡟ࡘ࠸࡚ᐃ㔞໬࡛ࡁࡿ
ᶵჾ࠾ࡼࡧ᪉ἲࡣ☜❧ࡉࢀ࡚࠸࡞࠸ 2㸬௒ᅇ㸪
ᡃࠎࡣ୕ḟඖゅᗘィࢆ⏝࠸࡚㸪⭸㛵⠇ࡢᅇ᪕
㐠ື୰࡟࠾ࡅࡿᅇ᪕ゅᗘࡢᐃ㔞໬ࡀྍ⬟࡛࠶
ࡿ࠿ࢆ᳨ウࡋࡓࡢ࡛㸪ሗ࿌ࡍࡿ㸬
࠙ᑐ㇟࡜᪉ἲࠚ
1㸬ᑐ㇟
ᑐ㇟ࡣୗ⫥࡟᪤ ࡢ࡞࠸೺ᖖ⏨ᛶ 3 ྡ࠾ࡼ
ࡧዪᛶ 3 ྡࡢᕥ⭸㛵⠇࡜ࡋࡓ㸬ᑐ㇟ࡢᇶᮏ᝟
ሗࡣ⾲ 1 ࡟♧ࡍ㸬
඲࡚ࡢᑐ㇟࡟ࡣ㸪◊✲࡟ཧຍࡍࡿ๓࡟㸪◊
✲ࡢ┠ⓗ࡜ෆᐜࢆ༑ศ࡟ㄝ᫂ࡋ㸪᭩㠃࡟࡚ྠ
ពࢆᚓࡓ㸬
⾲㸯 ᇶᮏ᝟ሗ
ᖺ㱋[ṓ]
㌟㛗[cm]
య㔜[kg]
⏨ᛶ(n=3)
21.3s0.6
165.7s1.2
61.3s5.1
2㸬౑⏝ᶵჾ
ᐃ࡟ࡣ BIODEX System 3(BIODEX ♫
〇)㸪୕ḟඖゅᗘィ (ࢪ࣮ࢫ࣏࣮ࢺ♫〇㸪
PocketIMU2)(ᅗ 1)ࢆ⏝࠸ࡓ㸬BIODEX ࡢタ
ᐃ࡟ࡘ࠸࡚ࡣ㸪BIODEX ࣮ࣘࢨ࣮ࢬ࢞࢖ࢻ
(Rev 3.2.7)㸪⭸㛵⠇እ᪕/ෆ᪕ࡢ㡯┠࡟ᚑࡗࡓ㸬
3㸬 ᐃ᪉ἲ࠾ࡼࡧゎᯒ㡯┠
ᑐ㇟ࢆ BIODEX ୖᗙ఩࡟࡚㸪⭸㛵⠇ 30r
ᒅ᭤఩࡜࡞ࡿࡼ࠺࡟኱⭣࠾ࡼࡧ㊊㒊ࢆᅛᐃࡋ
(ᅗ 2)㸪௚ືⓗ࡟⭸㛵⠇᭱኱ෆ᪕࠾ࡼࡧእ᪕㐠
ືࢆ⾜ࡗࡓ㸬ඛ⾜◊✲ 3 ࡟ᚑ࠸㸪 ᐃ᫬ࡢゅ
㏿ᗘࡣ 5r/s㸪ᅇ㌿࡟࠿࠿ࡿࢺࣝࢡࡣ 7Nm ࡜
ࡋࡓ㸬ࡑࡢ㝿㸪኱⭣㒊๓㠃(⭸⵹㦵ୖ 10cm)㸪
ୗ⭣㒊๓㠃(⬯㦵๓㠃㸧࡟ࡣ 1 ಶࡎࡘ୕ḟඖゅ
ᗘィࢭࣥࢧ࣮ࢆタ⨨ࡋ㸪ྛࢭࣥࢧ࣮ࡢ┦ᑐⓗ
఩⨨೫఩ࡼࡾᅇ᪕ゅᗘࢆ ᐃࡋࡓ㸬
ࡲࡓ㸪㊊㛵⠇࡟ࡼࡿ௦ൾ㐠ືࢆῶᑡࡉࡏࡿ
ࡓࡵ࡟඲࡚ࡢᑐ㇟࡟ࡣࢩ࣮࣮ࣗ࣍ࣥࣈ࣮ࣞࢫ
ࢆ⿦╔ࡋࡓ㸬
BIODEX ࠾ࡼࡧ୕ḟඖゅᗘィ࡟ࡼࡾᚓࡽ
ࢀࡓ᭱኱ෆ᪕ゅᗘ࡜᭱኱እ᪕ゅᗘࡢᕪࢆ⭸㛵
⠇⥲ᅇ᪕ゅᗘ࡜ࡋ㸪᥇⏝ࡋࡓ㸬ゎᯒ࡟ࡣ 3 ᅇ
ࡢᖹᆒ್ࢆ⏝࠸ࡓ㸬
ዪᛶ(n=3)
21.7s0.6
161.0s3.0
49.7s0.6
MeansSD
㸫1㸫
― 30 ―
42mm
47mm
31mm
ᅗ 1 ୕ḟඖゅᗘィ PocketIMU2
୕ḟඖゅᗘィࢭࣥࢧ࣮
ᅗ 2 ᐃ㢼ᬒ
࠙⤖ᯝࠚ
ᅗ 3 ࡟୕ḟඖゅᗘィ࡟ࡼࡗ࡚ᚓࡽࢀࡓ⤖ᯝ
ࡢ୍౛ࢆ♧ࡍ㸬୍ᐃࡢ࿘ᮇ࡟࡚ ᐃࡀྍ⬟࡛
࠶ࡗࡓ㸬
ࡲࡓ㸪඲ᑐ㇟࡟࠾࠸࡚㸪⭸㛵⠇⥲ᅇ᪕ゅᗘ
ࡣ BIODEX ࡼࡾ୕ḟඖゅᗘィ࡟ࡼࡗ࡚ ᐃ
ࡉࢀࡿࡶࡢࡢ᪉ࡀᑠࡉ࠿ࡗࡓ㸬⭸㛵⠇⥲ᅇ᪕
ゅᗘࡢᖹᆒ್ࡣ㸪⏨ᛶࡼࡾࡶዪᛶࡢ᪉ࡀ኱ࡁ
ࡃ࡞ࡗ࡚࠸ࡓ(⾲ 2)㸬
⾲ 2 ⭸㛵⠇⥲ᅇ᪕ゅᗘࡢᖹᆒ್
୕ḟඖゅᗘィ
[deg]
BIODEX
[deg]
⏨ᛶ(n=3)
ዪᛶ(n=3)
41.0s9.7
45.3s7.0
87.7s9.9
102.7s25.7
MeansSD
Ќእ᪕
ᅇ᪕ゅᗘ
[deg]
Ўෆ᪕
ᅗ 3 ୕ḟඖゅᗘィ࡟ࡼࡿᅇ᪕ゅᗘ
ᐃ⤖ᯝࡢ 1 ౛
[s]
࠙⪃ᐹࠚ
ACL ᦆയᚋࡢ➇ᢏ᚟ᖐࡢᣦᶆࡸ෌ᘓ㠌ᖏ
ࡢᶵ⬟ホ౯࡟ࡣ㸪᪩ᛴ࡟ᅇ᪕Ᏻᐃᛶ࡟㛵ࡋ࡚㸪
ᐃ㔞໬ࡢ᪉ἲࢆ☜❧ࡍࡿࡇ࡜ࡀồࡵࡽࢀࡿ㸬
௒ᅇ BIODEX ࡜୕ḟඖゅᗘィࢆ⏝࠸ࡓࡇ࡜
࡛㸪BIODEX ࡢࡳ࡛ ᐃࡋࡓሙྜ࡜ẚ࡭㸪௚
㛵⠇࡟ࡼࡿ㐠ື௦ൾࢆ⿵ṇࡋࡓ≧ែ࡟࡚㸪኱
⭣㒊࡟ᑐࡍࡿ⬯㦵ࡢᅇ᪕ゅᗘࢆࡼࡾṇ☜࡟ィ
ࡍࡿࡇ࡜ࡀྍ⬟࡛࠶ࡗࡓ࡜⪃࠼ࡿ㸬ࡲࡓ㸪
ᮏ᪉ἲࡣᚑ᮶ࡢ᪉ἲ 2 ࡼࡾẚ㍑ⓗ⡆౽࡛࠶ࡗ
ࡓ࡜⪃࠼ࡿ㸬ᮏ◊✲࡟ࡼࡾ㸪ࣜࣁࣅࣜࢸ࣮ࢩ
ࣙࣥࢆᐇ᪋ࡍࡿୖ࡟࠾࠸࡚㸪෌ᘓ㠌ᖏࡢᶵ⬟
ᛶࡢホ౯ࡸືసᣦᑟ࡟࠾࠸࡚኱ࡁ࡞୍ຓ࡜࡞
ࡿࡇ࡜ࡀᮇᚅ࡛ࡁࡿ㸬
௒ᚋࡣ⿕㦂⪅ᩘࢆቑࡸࡋ㸪᳨⪅ෆ࠾ࡼࡧ᳨
⪅㛫ಙ㢗ᛶ㸪෌⌧ᛶࡢ᭦࡞ࡿ᳨ウࡀᚲせ࡛࠶
ࡿ㸬
࠙ࡲ࡜ࡵࠚ
㸯㸬೺ᖖᡂே࡟࠾࠸࡚⭸㛵⠇ࡢᅇ᪕ゅᗘࢆ
BIODEX ࡜୕ḟඖゅᗘィࢆ⏝࠸࡚ ᐃ
ࡋࡓ㸬
㸰㸬୕ḟඖゅᗘィࢆ⏝࠸ࡿࡇ࡜࡟ࡼࡗ࡚ࡼ
ࡾ⢭ᗘࡢ㧗࠸ ᐃࡀྍ⬟࡛࠶ࡗࡓ㸬
࠙ཧ⪃ᩥ⊩ࠚ
1㸧 ᪥ᮏᩚᙧእ⛉Ꮫ఍┘ಟ㸸ACL ᦆയデ⒪࢞
࢖ࢻࣛ࢖ࣥ 2012㸬༡Ụᇽ㸪ᮾி㸪2012
2㸧 Mouton C, Theisen D, Pape D,
Nuhrenborger C, and Seil R: Static rotational knee laxity in anterior cruciate
ligament injuries. Knee surg sports
traumatol arthrosc 2012;20:652-662
3㸧 Suganuma J and Ohkoshi T: Association of internal rotation of the knee
joint with recurrent subluxation of the
lateral meniscus. Arthroscopy
2011;27:1071-1078
㸫2㸫
― 31 ―
06
⥺⥔➽③⑕ࡼࡾ୙᏶඲ᆺ⥺⥔➽③⑕㸦៏ᛶᗈ⠊③⑕ࠊ៏ᛶᒁᡤ③⑕㸧ࡣ
෌デ⋡ࡀప࠸
ᘘ᪥ᕷグᛕ⑓㝔ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⛉ ‫ۑ‬ᡞ⏣ඞᗈ
࠙ࡣࡌࡵ࡟ࠚ
⥺⥔➽③⑕㸦fibromyalgia:FM㸧ࡣᑡࡋ᭷
ྡ࡟࡞ࡗࡓࡀࠊࡑࡢ୙᏶඲ᆺ࡛࠶ࡿ៏ᛶᗈ⠊
③⑕㸦chronic widespread pain:CWP㸧ࡸ៏
ᛶᒁᡤ③⑕㸦chronic regional pain:CRP㸧ࡣ
་ᖌ࡟ࡉ࠼࡯࡜ࢇ࡝▱ࡽࢀ࡚࠸࡞࠸ࠋFM ᝈ
⪅࡜ CWP/CRP ᝈ⪅ࡀ෌デࡍࡿ๭ྜࢆẚ࡭
ࡓࠋ
࠙ᑐ㇟࡜᪉ἲࠚ
2004 ᖺ 4 ᭶࠿ࡽ 2011 ᖺ 9 ᭶ࡲ࡛ᘘ᪥ᕷグ
ᛕ⑓㝔ࢆཷデࡋࡓ FM ᝈ⪅࡜ CWP/CRP ᝈ⪅
ࡢ෌デ⋡ࢆẚ㍑ࡋࡓࠋ2 ࠿᭶௨ୖࡢ㛫㝸࡛෌
ᗘཷデࡋࡓሙྜ࡟ࡣ෌デ࡜ࡳ࡞ࡉࡎࠊูே࡜
ࡳ࡞ࡋࡓࠋ
₇⪅ࡣ 1990 ᖺࡢศ㢮ᇶ‽ 1 ࡛ FM ࢆデ᩿
ࡋ࡚࠸ࡿࠋලయⓗ࡟ࡣ㌟య 5 ࠿ᡤ࡟③ࡳࡀ 3
࠿᭶௨ୖ࠶ࡾࠊ18 ࠿ᡤࡢᅽ③Ⅼࡢ࠺ࡕ 11 ࠿
ᡤ௨ୖࡀ㝧ᛶ࡛࠶ࢀࡤ⮬ືⓗ࡟ FM ࡜デ᩿ࡉ
ࢀࡿࠋ㌟య 5 ࠿ᡤ࡟③ࡳࡀ 3 ࠿᭶௨ୖ࠶ࡿࡀ
ᅽ③Ⅼࡢᩘࡀ 10 ௨ୗ࡛࠶ࡾ௚ࡢ⑌ᝈ࡛⑕≧
ࢆㄝ࡛᫂ࡁ࡞࠸ሙྜࢆ CWP ࡜デ᩿ࡋࡓࠋ
ࠕ㌟
య 5 ࠿ᡤ࡟③ࡳࡀ 3 ࠿᭶௨ୖ࠶ࡿࠖࢆ‶ࡓࡉ
ࡎ㏻ᖖࡢ⭜③⑕ࡸ⫪ࡇࡾࡼࡾ③ࡳࡢ⠊ᅖࡀᗈ
ࡃࠊ௚ࡢ⑌ᝈ࡛⑕≧ࢆㄝ࡛᫂ࡁ࡞࠸ሙྜࢆ
CRP ࡜デ᩿ࡋࡓࠋ
඲ᝈ⪅ࡀ་ᖌ࠿ࡽ FM ࢆ␲ࢃࢀ࠶ࡿ࠸ࡣ⮬
ࡽ FM ࢆ␲ࡗ࡚₇⪅ࢆཷデࡋࠊࡓࡲࡓࡲᙜ㝔
ࢆཷデࡋࡓᝈ⪅ࡣ࠸࡞࠿ࡗࡓࠋ
ࠕFM ࡛ࡣ࡞࠸
ࡀ FM ࡟㢮ఝࡢ≧ែ࡛ࡣ FM ࡜ྠࡌ἞⒪ࢆ⾜
࠺ࠋ
ࠖ࡜࠸࠺㊃᪨ࡢ᭩㢮ࢆデᐹ๓࡟ㄞࢇ࡛ࡶࡽ
ࡗ࡚࠸ࡿࠋ௨ୗࡢㄝ᫂ࢆᩥ᭩ࡸཱྀ㢌࡛⾜ࡗ࡚
࠸ࡿࠋձFM ࡛ࡣ἞⒵ࡣ 1 ๭௨ୗࠋ୙᏶඲ᆺ
FM ࡛ࡣ἞⒵ࡣ⣙ 2 ๭ࠋ࠸ࡎࢀࡶ⣙ 2 ๭ࡢᝈ
⪅ࡣ⑕≧ࡀ㍍ῶࡋ࡞࠸ࠋղ๪స⏝࡟ࡼࡿ㌿ಽ
ࡀཎᅉࡢ㦵ᢡࡸ⬨㧊ᦆയࡀ࠾ࡇࡿ࡜⸆ࢆ୰Ṇ
ࡋ࡚ࡶඖ࡟ࡣᡠࡽ࡞࠸ࠋճ⸆ࢆ㣧ࡴ࡜ࡈࡃࢃ
ࡎ࠿࡛ࡣ࠶ࡿࡀṚஸࡢ༴㝤ᛶࡀቑ࠼ࡿࠋմ᭱
ప࡛ࡶ㸯࠿᭶࡟㸯ᅇཷデࡋ࡞࠸࡜἞⒪ࡀ࡛ࡁ
࡞࠸ࠋ2 ᖺ㛫㏻㝔ࡍࡿணᐃ࡟ࡋ࡚࠸ࡓࡔࡁࡓ
࠸ࠋյႚ↮ࢆᣢ⥆ࡋ࡚ࡶ἞⒪ࡣࡍࡿࡀࠊ἞⒪
ᡂ⦼ࡀ࠿࡞ࡾᝏࡃ࡞ࡿࠋ
࠙⤖ᯝࠚ
FM ᝈ⪅ࡢ࡭ 105 ே㸦ዪᛶ 94 ேࠊ⏨ᛶ 11
ேࠊ12࣮83 ṓࠊᖹᆒᖺ㱋 45.7s15.5 ṓ㸧୰
69 ே㸦65.7㸣㸧ࡀ෌デࡋࡓࠋ୍᪉ࠊCWP ࡲ
ࡓࡣ CRP ᝈ⪅ࡢ࡭ 248 ே㸦ዪᛶ 189 ேࠊ⏨
ᛶ 59 ேࠊ22࣮91 ṓࠊᖹᆒᖺ㱋 55.3s14.8
ṓ㸧୰ 111 ே㸦44.8㸣㸧ࡀ෌デࡋࡓࠋ⤂௓་
ࡀデ᩿ࡢࡳࢆᕼᮃࡋࡓࡾࠊ㐲᪉㸦኱㜰௨ᮾ࡞
࡝㸧࠿ࡽࡢཷデࡢࡓࡵ࡟෌デࡋ࡞࠿ࡗࡓᝈ⪅
ࡶ࠸ࡓࠋ
࠙⪃ᐹࠚ
⭜③⑕ࡢࡳࡸ⫪ࡇࡾࡢࡳ࠿ࡽ CRP ࡸ CWP
ࢆ⤒⏤ࡋ࡚ FM ࡀⓎ⑕ࡍࡿ 1-2ࠋ㏻ᖖࡣ 10 ᖺ
௨ୖ⤒㐣ࡋ࡚ FM ࡀⓎ⑕ࡍࡿࠋFM ࡢ᭷⑓⋡
ࡣࢃࡎ࠿࡟⣙ 2㸣࡛࠶ࡿࡀ CWP ࡜ CRP ࢆྜ
ࢃࡏࡓ᭷⑓⋡ࡣᑡ࡞ࡃ࡜ࡶ 20㸣࡛࠶ࡿ 3ࠋୡ
⏺࡛ࡣ FM ࡢ἞⒪ࢆ⾜ࡗ࡚࠸ࡿ་ᖌࡣࠊ㏻ᖖ
CRP ࡸ CWP ࡟ᑐࡋ࡚ࡣ FM ࡜ྠࡌ἞⒪ࢆ⾜
ࡗ࡚࠸ࡿ 4ࠋ་Ꮫⓗ࡟ㄝ᫂ࡢࡘ࠿࡞࠸③ࡳࡸ
⑕≧ࢆ⢭⚄⛉ࡢᴗ⏺ࡣ㌟య⾲⌧ᛶ㞀ᐖ㸦㌟య
໬㞀ᐖࠊ⑊③ᛶ㞀ᐖ㸧࡜デ᩿ࡋࠊ᪥ᮏ௨እࡢ
៏ᛶ③ࡸ࣐ࣜ࢘ࢳࡢᴗ⏺ࡣ FM ࡸࡑࡢ୙᏶඲
ᆺ࡜デ᩿ࡋ࡚࠸ࡿ 5ࠋࡇࢀࡣ་Ꮫ⏺࡟࠾࠸࡚
チᐜ࡛ࡁ࡞࠸ΰ஘࡛࠶ࡿࠋୡ⏺ࡢ៏ᛶ③ࡸࣜ
࣐࢘ࢳࡢᴗ⏺ࡢᑡ࡞ࡃ࡞࠸་ᖌࡣ㌟య໬㞀ᐖ
㸫1㸫
― 32 ―
ࡸ⑊③ᛶ㞀ᐖࡣᏑᅾࡋ࡞࠸࡜⪃࠼࡚࠸ࡿ 6ࠋ
₇⪅ࡀ FM ࡸࡑࡢ୙඲ᆺ࡟⾜ࡗࡓᵝࠎ࡞἞⒪
ࡢ⤒㦂ࡸ௚ࡢ་⒪ᶵ㛵࡛⾜ࢃࢀ࡚࠸ࡿ἞⒪ࡢ
ᡂ⦼࡟ᇶ࡙ࡃ࡜ࠊ⌧᫬Ⅼ࡛ࡣࡑࢀࡽ࡟ FM ࡢ
἞⒪ࢆ⾜࠺ࡇ࡜ࡀ᭱ࡶ἞⒪ᡂ⦼ࢆ㧗ࡵࡿࠋ
FM ࡢཎᅉࡣ⬻ࡢᶵ⬟㞀ᐖ࡜࠸࠺ㄝࡀᐃㄝ࡟
࡞ࡗ࡚࠸ࡿࠋ⭜③ࡢཎᅉࡢ 9 ๭๓ᚋࡣ୙࡛᫂
࠶ࡿࠋ⭜③ࡢཎᅉࡢከࡃࡣ⬻ࡢᶵ⬟㞀ᐖࠊࡘ
ࡲࡾ⭜③ࡢከࡃࡣ CWP/CRP ࡑࡢࡶࡢࡸࡑ
ࢀࡽࡢ୙඲ᆺ࡛࠶ࡿ࡜࠸࠺ㄝࡀ࠶ࡾࠊ₇⪅ࡶ
ࡑࢀࢆಙࡌ࡚࠸ࡿࠋࡇࡢㄝࡀṇࡋࡅࢀࡤࠊ⭜
③ࡢ἞⒪ࡀ኱ࡁࡃኚ໬ࡍࡿࠋ
FM ࡼࡾ FM ࡢ୙඲ᆺ࡛࠶ࡿ CWP/CRP ࡢ
᪉ࡀ෌デࡍࡿ๭ྜࡀᑡ࡞࠸⌮⏤ࡣ௨ୗࡢ㏻ࡾ
࡛࠶ࡿࠋձCWP/CRP ࡢሙྜ࡟ࡣࠊFM ࡛ࡣ
࡞࠸࡜デ᩿ࡋࡓ᫬Ⅼ࡛἞⒪ࢆᕼᮃࡋ࡞࠸ᝈ⪅
ࡀ࠸ࡿࡀࠊFM ࡢሙྜ࡟ࡣࡑࢀࡣ㉳ࡇࡽ࡞࠸ࠋ
FM ࡛࡞ࡅࢀࡤ἞⒪ࢆཷࡅ࡞࠸࡜࠸࠺౯್ほ
ࢆ₇⪅ࡣ⌮ゎ࡛ࡁ࡞࠸ࡀࠊ₇⪅ࡢ౯್ほࢆᝈ
⪅࡟ᢲࡋࡘࡅࡿࡇ࡜ࡣࡋ࡚࠸࡞࠸ࠋղ⸆࡟ࡼ
ࡿ๪స⏝ࡸ⑕≧ࡀࡼࡃ࡞ࡽ࡞࠸ሙྜࡀ࠶ࡿࡇ
࡜࡞࡝୙㒔ྜ࡞஦ᐇࢆㄝ᫂ࡋ࡚࠸ࡿࠋ୍⯡ㄽ
࡜ࡋ࡚ CWP/CRP ࡼࡾ FM ࡢ᪉ࡀ⑕≧ࡀ㔜࠸
7ࠋ
⑕≧ࡀ㔜࠸ሙྜ࡟ࡣ⮴Ṛⓗ࡞๪స⏝ࡀ࠶ࡗ
࡚ࡶ἞⒪ࢆཷࡅࡿ☜⋡ࡀ㧗࠸࡜᥎ ࡋ࡚࠸ࡿࠋ
㐺ษ࡞἞⒪ࢆ⾜ࡗ࡚ࡶᝈ⪅ࡀṚஸࡍࢀࡤࠊ
᪥ᮏ࡛ࡣドᣐ㞃⁛ࡸ㏨ஸࡢྍ⬟ᛶࡀ࡞ࡃ࡚ࡶ
་ᖌࡣ㐊ᤕࡉࢀࡿྍ⬟ᛶࡀ࠶ࡿࠋ⮬ศ⮬㌟ࡢ
㌟ࢆᏲࡿࡓࡵࠊFM ࡸࡑࡢ୙඲ᆺᝈ⪅ࡢ἞⒪
ࡢሙࢆ☜ಖࡍࡿࡓࡵࠊ⤯ᑐ࡟Ṛஸࡋ࡞࠸἞⒪
ࢆᕼᮃࡍࡿᝈ⪅ࡢ἞⒪ࢆ⾜ࡗ࡚࠸࡞࠸ࠋ་⒪
࡟⤯ᑐࡢᏳ඲ᛶࢆồࡵࡿேࡀ࠸ࡿࡇ࡜ࢆ㖭グ
ࡍ࡭ࡁ࡛࠶ࡿࠋ⸆ࡢ๪స⏝࡟ࡼࡾṚஸᑍ๓࡟
࡞ࡗࡓேࡀ࠸ࡓࡀ 8ࠊ἞⒪๓ࡢㄝ᫂ࡀ࠶ࡗࡓ
ࡓࡵ኱ၥ㢟࡟ࡣ࡞ࡽ࡞࠿ࡗࡓࠋᑡ࡞ࡃ࡜ࡶᢠ
࠺ࡘ⸆ࠊ࢔ࢭࢺ࢔࣑ࣀࣇ࢙ࣥࠊ㠀ࢫࢸࣟ࢖ࢻ
ᛶᢠ⅖⑕⸆ࡢⓎ⒴ᛶࠊ╧╀⸆ࡸᢠ୙Ᏻ⸆࡟ࡼ
ࡿṚஸ⋡ቑຍࢆ▱ࡗ࡚࠸ࡿᚲせࡀ࠶ࡿࠋFM
ࡸࡑࡢ୙඲ᆺࡢ἞⒪࡟࠾࠸୍࡚ᐃࡢ་⒪Ỉ‽
ࢆ☜ಖࡍࡿࡓࡵ࡟ࡣ 1 ᫬㛫࡟ 6 ேࡲ࡛ࡢデᐹ
ࡀ㝈ᗘ࡛࠶ࡿࠋពᅗࡋࡓࢃࡅ࡛ࡣ࡞࠸ࡀࠊ෌
デࡋ࡞࠸ᝈ⪅ࡀ࠸ࡿࡇ࡜ࡀ୍ᅉ࡜࡞ࡾࠊ1 ᫬
㛫࡟ 6 ேࡲ࡛ࡢデᐹࡸึデᝈ⪅ࡢᚅࡕᮇ㛫ࡀ
ཎ๎ 1 㐌㛫௨ෆࡀᏲࡽࢀ࡚࠸ࡿࠋ
࠙ࡲ࡜ࡵࠚ
FM ᝈ⪅ 105 ே୰ 69 ே㸦65.7㸣㸧ࡀࠊ
CWP/CRP ᝈ⪅ 248 ே୰ 111 ே㸦44.8㸣㸧ࡀ
෌デࡋࡓࠋ
࠙ཧ⪃ᩥ⊩ࠚ
1) ᡞ⏣ඞᗈ: ⥺⥔➽③⑕ࡀࢃ࠿ࡿᮏ. ᮾி:
୺፬ࡢ཭♫; 2010
2) ᡞ⏣ඞᗈ: ⭜③ࠊ⫪ࡇࡾ࠿ࡽ៏ᛶᗈ⠊③⑕ࠊ
⥺⥔➽③⑕࡬࣮୰ᯡᛶ㐣ᩄ⑕ೃ⩌࣮. URL :
http://fibro.exblog.jp/12998832/
3) Toda K, Harada T. Prevalence,
classification, and etiology of pain in
Parkinson's disease: association between
Parkinson's disease and fibromyalgia or
chronic widespread pain. Tohoku J Exp
Med. 2010;222:1-5
4) Toda K: Treatment of chronic
widespread pain is similar to treatment of
fibromyalgia throughout the world. J
Musculoskelet Pain. 2010;18:317-318
5) ᡞ⏣ඞᗈ: ⥺⥔➽③⑕ࡢᇶᮏ. CareNet.
URL :http://carenet.com/special/1208/contr
ibution/index.html
6) Merskey H. Somatization: or another
God that failed. Pain. 2009;145:4-5
7) Toda K. Comparison of symptoms among
fibromyalgia syndrome, chronic
widespread pain, and an incomplete form
of chronic widespread pain. J
Musculoskelet Pain. 2011;19:52-55
8) ᡞ⏣ඞᗈ: ୕⎔⣔ᢠ࠺ࡘ⸆࡟ࡼࡾᙅ࠸⮬
ẅᛕ៖ࡀ㑅ᢥⓗࢭࣟࢺࢽࣥ෌ྲྀࡾ㎸ࡳ㜼ᐖ⸆
࡟ࡼࡾᙉ࠸⮬ẅᛕ៖࡜௚ẅᛕ៖ࡀ⏕ࡌࡓᡂே
៏ᛶᗈ⠊③⑕ࡢ㸯౛. ᭱᪂⢭⚄་Ꮫ.
2011;16:205-208
㉁ၥࡣࢶ࢖ࢵࢱ࣮KatsuhiroTodaMD@࡬
㸫2㸫
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07
②⦰἞⒪ࡢᐈほⓗᣦᶆ
㉸㡢Ἴ (ODVWRJUDSK\ ࢆ⏝࠸ࡓ➽②ᛶ࠾ࡼࡧ◳ᗘࡢ ᐃ
ᅜ❧⑓㝔ᶵᵓᚨᓥ⑓㝔ᑠඣ⛉㸯㸪ྠᩚᙧእ⛉࣭ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⛉ 2㸪
ྠࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⛉ 3
ࡳࡸ 䛦 䛝
ࡓࡘࡋ
࡜࠺ࡔ
࠼࠸ࡇ
ࡓ࠿ࡓ
ࡋࢇࡌࢁ࠺
ࡳࡸࢃࡁ ࡍࡎࡇ
ࡋࡲࡴࡽ
ࡲ ࡁ ࡇ
࠺࠼ࡴࡽ
࡞࠾ࡇ
࠿ࢃࡳࡕ ࡇ࠺ࡌ
‫ۑ‬ᐑ㷂 㐩ᚿ㸯㸪ᮾ⏣ ᰤᏊ1㸪㧗⏣ ಙ஧㑻㸰㸪᳜ᮧ ┤Ꮚ3㸪ᕝ㐨 ᖾྖ3㸪
ࡇࡶࡾ
ᑠᏲ ࠸ࡘࡳ 3㸪ᐑ⬥ 㕥Ꮚ3㸪ᓥᮧ 㯞ᮌᏊ3
࠙ࡣࡌࡵ࡟ࠚ
(ODVWRJUDSK\ ࡣ⏕యࡢ⤌⧊ࡢ◳ࡉࢆホ౯ࡍ
ࡿ᪉ἲ࡛࠶ࡿ ࠋ㉸㡢Ἴ (ODVWRJUDSK\ ࡣ㠀౵
くⓗ࡞⤌⧊デ᩿࡜ࡋ࡚ࠊங⭢ࠊ⫢⮚ࠊ๓❧⭢ࠊ
⏥≧⭢➼ࡢ㡿ᇦ࡛⮫ᗋᛂ⏝ࡀࡍ࡛࡟⾜ࢃࢀ࡚
࠸ࡿ ࠋ㏆ᖺࠊ࣎ࢶࣜࢾࢫ⒪ἲࡣᡂேࡢ⬻
༞୰ࡢ②ᛶ㯞⑷ᝈ⪅ࡔࡅ࡛࡞ࡃࠊᑠඣࡢ②ᛶ
ࢆ᭷ࡍࡿ⬻ᛶ㯞⑷ᝈ⪅ࠊ⬻⅖ᚋ㑇⑕ࠊ㢌㒊እ
യᚋ㑇⑕➼࡟㐺ᛂࡣᣑ኱ࡋ࡚࠸ࡿࠋࡋ࠿ࡋࠊ
἞⒪ຠᯝࡣ⑕౛࡟ࡼࡗ࡚␗࡞ࡿࠋᮏ◊✲ࡣᑠ
ඣࡢᅄ⫥࣭యᖿࡢ②ᛶࢆ᭷ࡍࡿᝈ⪅ࡢ࣎ࢶࣜ
ࢾࢫ⒪ἲࡢ἞⒪ຠᯝࢆࠊ㉸㡢Ἴ (ODVWRJUDSK\
ࢆ⏝࠸ࡓ➽◳ᗘ ᐃ࡟ࡼࡾᐈほⓗ࡟ホ౯ࡋࡓࠋ
࠙ᑐ㇟࣭᪉ἲࠚ
ᚨᓥ⑓㝔ධ㝔୰ࡢᅄ⫥࣭యᖿࡢ②ᛶࢆ᭷ࡍࡿ
ᝈ⪅ ྡࠋ㉸㡢Ἴ⿦⨨ +,7$&+,$9,86 ࢆ౑⏝
ࡋࠊ➽⫗ࡢ◳ࡉࢆ (ODVWRJUDSK\ ࡛ホ౯ࡋࡓࠋ
➽⫗ࡢ◳ࡉࡣࠊᇶ‽࡜࡞ࡿ㡢㡪࢝ࣉ࣮ࣛ࡟ᑐ
ࡍࡿṍࡳẚ6WUDLQUDWLR࡜ࡋ࡚⟬ฟࡉࢀࡿࠋ
65 ࡣ⤌⧊ࡀ◳࠸࡯࡝㧗ࡃࠊᰂࡽ࠿࠸࡯࡝ᑠࡉ
࡞್࡜࡞ࡿࠋ࣎ࢺࢵࢡࢫ๓ࠊ἞⒪ᚋ ᪥ࠊ
᪥ࠊ ᪥࡜ ᐃࢆ⾜ࡗࡓࠋ⌮Ꮫ⒪ἲኈ࡟ࡼࡿ
0$6 ᐃࡶྠ᫬࡟⾜࠸ࠊ᭦࡟෗┿᧜ᙳ➼ࡶ⾜
࠸ࠊẚ㍑᳨ウࡋࡓࠋ
࠙⤖ᯝࠚ
⑕౛㸯࠾ࡼࡧ㸰ࡣࠊ἞⒪ᚋ ᪥࡛②ᛶࡀᨵၿ
ࡋࠊ0$6 ࡜ 65 ࡀపୗࡋࡓࠋ⑕౛㸱ࡣࠊ②ᛶࡀ
ᨵၿࡋࡓࡀࠊ65 ࡢኚ໬ࡣ࡞࠿ࡗࡓࠋ⑕౛ ࡣࠊ
⑕≧ࡢኚ໬ࡸ 0$6 ࡢኚ໬ࡣ࡞࠿ࡗࡓࡀ 65 ࡢప
ୗࢆࡳࡓࠋ
࠙⪃ᐹࠚ
ᮏ◊✲ࡣࠊ㸲౛୰㸯౛ࢆ㝖ࡁࠊ65 ࡢኚ໬࡜⮫
ᗋ⑕≧ࡢኚ໬࡜ࡀྜ⮴ࡋࡓࠋ65 ࡢኚ໬ࡀ࡞࠿
ࡗࡓ⑕౛ࡣࠊᒁᡤࡢ᣺ᡓࡸ୙㝶ព㐠ືࡀࠊ65
ᐃ್࡟ᙳ㡪ࢆཬࡰࡋࡓྍ⬟ᛶࡀ࠶ࡿࠋ
࠙⤖ㄽࠚ
HODVWRJUDSK\ ࡟ࡼࡾ➽⫗ࡢ◳ᗘ ᐃࡣ㠀౵
くⓗ࡞᪉ἲ࡜ࡋ࡚ྍ⬟࡛࠶ࡾࠊࡅ࠸ࢀࢇࡸ୙
㝶ព㐠ືࡀከ࠸ᝈ⪅ࢆ㝖࠸࡚࣎ࢶࣜࢾࢫ⒪ἲ
ࡢ἞⒪ຠᯝࡢᐈほⓗᣦᶆ࡜ࡋ࡚⮫ᗋᛂ⏝࡛ࡁ
ࡿྍ⬟ᛶࡀ♧၀ࡉࢀࡓࠋ
࠙ᩥ⊩ࠚ
1) Ophir J, Céspedes I, Ponnekanti H,
Yazdi Y, Li X : Elastography: a quantitative method for imaging the elasticity
of biological tissues. Ultrason Imaging
1991; 13: 111-134
2) Itoh A, Ueno E, Tohno E, Kammma H,
Takahashi H, Shiina T, Yamakawa M,
Matsumura T : Breast Disease: Clinical
Application of US Elastography for
Diagnosis. Radiology 2006 ;239 :
341-350
㸫1㸫
― 34 ―
3) Gheorghe L, Iacob S, Iacob R, Dumbrava M, Becheanu G, Herlea V,
Gheorghe C, Lupescu I, Popescu I : Real
Time Elastography -a Non-invasive Diagnostic Method of Small Hepatocellular Carcinoma in Cirrhosis : J Gastrointestin Liver Dis 2009; 18: 439-446
4) Cochlin DL, Ganatra RH, Griffiths
DFR : Elastography in the detection of
prostatic cancer. Clin Radiology 2002;
57: 1014-1020
5) Rago T, Santini F, Scutari M, Pinchera A,
Vitti P : Elastography: New Developments in Ultrasound for Predicting Malignancy in Thyroid Nodules J Clin Endocrinol Metab 2007; 92: 2917-2922
㸫2㸫
― 35 ―
08
㧗఩㢁㧊ᦆയ㸦C2 㸧࡛ NPPV ࢆ౑⏝ࡋ࡚࠸ࡿᝈ⪅ࡢᅾᏯㄪᩚࡢ⤒㦂
ᗈᓥᕷ⥲ྜࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢭࣥࢱ࣮㸯
ࡍࡂࡣࡽ ࠿ࡘࡢࡪ
‫ۑ‬ᮡཎ ຾ᐉ㸯㸪⃝⾰㔛Ꮚ㸯 ᪩⏣⨾࿴㸯 㞴ἼᏕ♩㸯 ụ⏣㡰Ꮚ㸯 ຍୡ⏣ࡺࡳᏊ㸯 ᮧୖᜏ஧㸯
࠙ࡣࡌࡵ࡟ࠚ
ேᕤ࿧྾ჾ࡟౫Ꮡࡏࡊࡿࢆᚓ࡞࠸㧗఩㢁㧊
ᦆയᝈ⪅࡟ᑐࡋࠊᚑ᮶ࡢẼ⟶ᤄ⟶࡛࡞ࡃࠊ㠀
౵ く ᛶ 㝧 ᅽ ᥮ Ẽ 㸦 1RQLQYDVLYH 3RVLWLYH
3UHVVXUH9HQWLODWLRQ㸧ࡢ฼⏝ࡀሗ࿌ࡉࢀࠊ
ࡑࢀ࡟ࡼࡾ఍ヰࡸᄟୗ࡛ࡢ᭷⏝ᛶࡀᣦ᦬ࡉࢀ
࡚࠸ࡿ㸯㸧㸰㸧ࡀࠊࡲࡔ୍⯡ⓗ࡛ࡣ࡞࠸ࠋ௒ᅇࠊ
1339 ࡀᑟධࡉࢀ඲㌟≧ែࡀⴠࡕ╔࠸ࡓᝈ⪅
࡟ࡘࡁࠊᅾᏯ࡬ࡢᑟධ࡟㛵ࢃࡿᶵ఍ࢆᚓࡓࡢ
࡛ࡇࢀࢆሗ࿌ࡍࡿࠋ
࠙⑕౛ࠚ
ṓ⏨ᛶࠋ+ ᖺ ᭶᯾᪥ ࣂ࢖ࢡ㉮⾜୰࡟
㌴࡜᥋ゐࠊ୕ཎᕷ . ⑓㝔࡟ᩆᛴᦙ㏦ࡉࢀࡓࡀ
㢁㒊௨ୗࡢឤぬᾘኻࠊ⫠㛛཯ᑕ࡞ࡃࠊẼ⟶ᤄ
⟶࡛ேᕤ࿧྾ჾ⟶⌮࡜࡞ࡗࡓࠋ23//㸦&㹼㸧
ࡶేᏑࡋ࡚࠾ࡾࠊ05, ࡛ &ࣞ࣋ࣝࡢ㢁㧊ᦆയ
࡜デ᩿ࡉࢀࡓࠋ⫵⅖࡜↓Ẽ⫵ࢆ⧞ࡾ㏉ࡋẼ⟶
ᨭࣇ࢓࢖ࣂ࣮࡛⫵Ὑίࢆẖ㐌⾜ࡗ࡚࠸ࡓࠋࡈ
ᐙ᪘ࡀ⇕ᚰ࡟࿧྾ࣜࣁࣅࣜࡢ⑓㝔ࢆ᥈ࡋࠊ⚄
⤒➽ᨻ⟇་⒪᪋タ࡛࠶ࡿ໭ᾏ㐨 < ⑓㝔࡟ ᭶
㌿㝔ࠊయ఩᤼⑱ࡸ࢝ࣇ࢔ࢩࢫࢺࢆ⧞ࡾ㏉ࡋࡓࠋ
᭶⫶⑭ቑタࠋ⫵⅖ࡸ↓Ẽ⫵ࡣⴠࡕ╔ࡁࠊᙜ
ึࡣ᫨㛫ࡢࡳࠊࡑࡢᚋࠊ⤊᪥ 1339 ࡀᑟධࡉࢀ
ࡓࠋ ᭶࡟ࡣẼ⟶ษ㛤Ꮝࡣࣞࢸ࢕ࢼ࢝ࢽ࣮ࣗ
࡛ࣞሰࡂࠊ㰯ࣉࣛࢢ࡟ࡼࡿ⤊᪥ 1339 ࡜࡞ࡗࡓࠋ
+ᖺ ᭶ᙜ㝔㌿㝔ࡉࢀࡓࠋ
࠙ึデ᫬ᡤぢࠚ
ㄆ▱ࡣၥ㢟࡞ࡋࠋ㢌㒊ᨭᣢ୙⬟ࠊ& ௨ୗࡢ
ឤぬ㞀ᐖࠋேᕤ࿧྾ჾ㸦7ULORJ\㸧࿧Ẽ࡟
࠶ࢃࡏࡓⓎኌࠋ᤼⑱ࡢࡓࡵࠊ࢝ࣇ࢔ࢩࢫࢺ ᪥ ᅇࠊၚᾮ྾ᘬࡢࡓࡵࠊཱྀඖ࡟྾ᘬ࢝ࢸඛ
タ⨨ࠋᕥ⫤㛵⠇࡟␗ᡤᛶ௬㦵࡛ᒅ᭤ ᗘࠋ⭠
⽸ື㡢࠶ࡿࡶ኱⭠࢞ࢫⴭ᫂ࠋ㓟⣲㣬࿴ᗘࣔࢽ
ࢱ࣮ࠋᒀ࢝ࢸ␃⨨ࠋ
࠙⤒㐣ࠚ
᪥୰ࡣᐙ᪘㸦ẕ࠿ጜ㸧ࡢ௜ࡁῧ࠸ࡀ࠶ࡾࠊᐙ
᪘ᣦᑟࡶ⾜ࡗࡓࠋᙜึࡣኪ໅┳ㆤᖌࢆ ྡቑ
ࡸࡋࠊ᪥୰ࡶ ேࢆᑓᒓ࡜ࡋᑐᛂࡋࡓࠋᅾᏯ
ࢆ᝿ᐃࡋࠊ⤒⟶ᰤ㣴ᅇᩘࡸෆ᭹ࡢᩚ⌮ࠊ௓ㆤ
ࢆ᭱ᑠ㝈࡟ῶࡽࡋࠊၥ㢟࡞࠸ࡇ࡜ࢆ☜ㄆࡋࡓࠋ
ᄟୗホ౯㸦୰ဗ㢌⭍௨㝆࡟ᄟୗᅽࡀ࠿࠿ࡽࡎࠊ
㏦ࡾ㎸ࡳࡀ୙༑ศ㸧
ࠊ௓ຓ⏝㌴᳔Ꮚࡢసᡂ㸦ே
ᕤ࿧྾ჾ࡜྾ᘬᶵᦚ㍕㸧ࠊ㟁ື㌴᳔Ꮚࡢ᳨ウࠊ
⎔ቃไᚚ⿦⨨㸦ཱྀ၁ࢱࢵࢳࢭࣥࢧ࣮࡛ࡢ 79
ࡸ࢖ࣥࢱ࣮ࢿࢵࢺ⎔ቃࠊ࿧ࡧ㕥㸧ࡢㄪᩚࠊᐙ
ᒇᨵಟࠊヨ㦂⮬Ꮿእฟࠊ࠿࠿ࡾࡘࡅ་ࡸᅾᏯ
௓ㆤࢫࢱࢵࣇ࡜ࡢ࢝ࣥࣇ࢓ࢆ࠸ࠊ⣙ ࣨ᭶ࡢ
ධ㝔࡛ᅾᏯ⏕ά࡬ࡢ⎔ቃㄪᩚࢆ⾜ࡗࡓࠋ
࠙⪃ᐹࠚ
ከࡃࡢ⫋ဨࡀ㛵ࢃࡿࡓࡵࠊ࠿࠿ࡾࡘࡅ་ࡸᅾ
Ꮿࢫࢱࢵࣇ࡜ྜྠ࢝ࣥࣇ࢓ࣞࣥࢫࢆ ᅇ⾜࠸ࠊ
ᡭᢏⓗ࡞ఏ㐩ࡣ࣊ࣝࣃ࣮࡟ᐇ㝿࡟⑓㝔࡟⦎⩦
࡟᮶࡚ࡶࡽࡗࡓࠋ㟁ື㌴᳔Ꮚ࡟㛵ࡋ࡚ࡣࢪࣙ
࢖ࢫࢸࢵ࢕ࢡࡢᕤኵ࡛ᖹᆅ᧯సࡣ࠶ࡿ⛬ᗘྍ
⬟࡞ࣞ࣋ࣝ࡟ࡣ࡞ࡗࡓࡀࠊᴗ⪅࠿ࡽࣞࣥࢱࣝ
࡛ࡁࡿᮇ㛫ࡶ㝈ࡽࢀࠊ௒ᚋࠊᅾᏯ࡛౑⏝⎔ቃ
ࡀ☜ಖ࡛ࡁࡿ࠿୙࡛᫂࠶ࡗࡓࡢ࡛ᅾᏯ⏕άࡀ
ⴠࡕ╔࠸࡚෌ᗘධ㝔カ⦎ᚋุᐃࡍࡿࠊ࡜ࡋࡓࠋ
࠙ᩥ⊩ࠚ
1)ᅵᒱ ᫂Ꮚࠊ ఫ⏣ ᖿ⏨㸸NPPV ࡜࿧྾
ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ ᛴᛶᮇࢆ୰ᚰ࡟ 㧗఩
㢁㧊ᦆയ࡜ NPPV ⮫ᗋࣜࣁ 2007㸹 3㸸
235-241
2)▼ᕝ ᝆຍ ࡇࢀ࠿ࡽࡢேᕤ࿧྾ჾ NPPV
ࡢࡍ࡭࡚ ་Ꮫ᭩㝔
㸫1㸫
― 36 ―
㸫2㸫
― 37 ―
09
㢕㧊ᦆയ࡟ᄟୗ㞀ᐖࢆྜేࡋࡓ୍⑕౛࡬ࡢࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ
ᕝᓮ་⛉኱Ꮫ௜ᒓ⑓㝔 ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ་Ꮫᩍᐊ 1
ᕝᓮ་኱㝃ᒓ⑓㝔ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢭࣥࢱ࣮2
ࡇࢇࡌࡁ
ࡺ
ࡳ
ࡸ
ࡇ
ࡇ
ࡼࡇࡸࡲ
ࡳࡘࡦࢁ
ࡦࡽ࠾࠿
ࡓ࠿ࡋ
࡬ࢇࡳ
࠿
ࡼ
ࡼࡋࡴࡽ
ࡲ࡞ࡪ
ࡼࡋࡔ
ࡇ࠺ ࡌ
‫ۑ‬㏆႞ ⏤⨾Ꮚ1ࠊᶓᒣ ගὒ1ࠊᖹᒸ ᓫ 1ࠊ㐓ぢ ె௦2ࠊྜྷᮧ Ꮫ 2ࠊྜྷ⏣ ⪔἞2ࠊ
ࡋࡳࡎ
ࡉ
ࡵ ࡓ࡟
ࡦࢁࡳࡕ
ࡘࡤࡣࡽ
࠶ࡁ࠾
ΎỈ ஬ᘺᏊ1ࠊ┠㇂ ᾈ㏻1ࠊᳺཎ ᙲኵ1
>ࡣࡌࡵ࡟@
ᮇࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⑓Ჷ㌿⛉ࠋ㌿⛉᫬
㏆ᖺ㢁㧊ᦆയ࡟ᄟୗ㞀ᐖࢆక࠺⑕౛ࡀᩓぢࡉ
ASIA(American Spinal Injury Association)
ࢀࡿࠋ௒ᅇᡃࠎࡣ C4/5 㢕㧊ᦆയᝈ⪅࡟ᄟୗᶵ
ࡣ Motor 30 Ⅼ,Light touch 54 Ⅼ,Pin prick
⬟㞀ᐖࢆྜేࡋࡓ⑕౛ࢆ⤒㦂ࡋࡓࡢ࡛ࠊࡑࡢ
53 Ⅼ ASI Impairment score D ࡢ୙඲ᅄ⫥㯞
ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⤒㐣ࢆྵࡵሗ࿌ࡍࡿࠋ
⑷ࢆㄆࡵࡓࠋ6 ᭶ 7 ᪥▐┠཯ᑕ᳨ᰝ࡜ࠊ⯉㦵
>⑕౛@
ୖ➽⩌(㢡஧⭡➽๓⭡࣭࢜ࢺ࢞࢖⯉㦵➽)࣭⬚㦵
67 ṓࠊ⏨ᛶࠊྑ฼ࡁࠋ
⯉㦵➽࡟ᑐࡋ࡚㔪➽㟁ᅗ᳨ᰝࢆᐇ᪋ࠋ▐┠཯
>⌧⑓Ṕ@
ᑕࡣ␗ᖖ࡞ࡋࠋ㢡஧⭡➽๓⭡࡛ࡣከ┦Ἴࡀ┠
2012 ᖺ 4 ᭶ 2 ᪥⮬㌿㌴࡛㉮⾜୰࡟⣙ 1m ࡢ⏝
❧ࡕࠊ㝶ព཰⦰᫬࡟ 5mV ࡲ࡛ࡢ㧗᣺ᖜ㟁఩ࢆ
Ỉ㊰࡬㌿ⴠࡋཷയࠋྠ᪥ᙜ㝔ᩆᛴእ᮶࡬ᦙ㏦
ㄆࡵࡓࡓࡵࠊఱࡽ࠿ࡢᮎᲈ⚄⤒㞀ᐖ࡟ࡼࡿ⯉
࡜࡞ࡿࠋᅄ⫥㯞⑷ࢆㄆࡵࠊ㢕㒊 MRI ࡛ C4/5
㦵ୖ➽⩌ࡢ➽ຊపୗࡀᄟୗ㞀ᐖࡢ୍ᅉ࡜࡞ࡗ
㢁㧊ᦆയࡢデ᩿࡜࡞ࡾᩆᛴ⛉࡬ධ㝔࡜࡞ࡿࠋ
࡚࠸ࡿ࡜ุ᩿ࡋࡓࠋࡑࡢࡓࡵ⯉㦵ୖ➽⩌ࡢ➽
㢌㒊⏬ീୖ᭷ព࡞௨ୖᡤぢࡣㄆࡵ࡞࠿ࡗࡓࠋ
ຊᙉ໬ࢆ┠ⓗ࡟ࠊప࿘Ἴ㟁Ẽ่⃭⿦⨨ࢆ౑⏝
>⤒㐣@
ࡋࡓ㛫᥋ᄟୗカ⦎ࢆ㛤ጞࡋࡓࠋࡲࡓᖹ⾜ࡋ࡚
ධ㝔⩣᪥ࡢ 4 ᭶ 3 ᪥ᙜ⛉⤂௓࡜࡞ࡾ࣋ࢵࢻࢧ
ᄟୗࢮ࣮࡛ࣜࡢ┤᥋ᄟୗカ⦎ࡶ㛤ጞࡋࡓࠋ἞
࢖ࢻࣜࣁ㛤ጞࠋࡑࡢᚋ 4 ᭶ 16 ᪥㢕᳝ᚋ᪉ᅛᐃ
⒪ຠᯝุᐃ┠ⓗ࡛ࡢ VF ᐃᮇ᳨ᰝ࡛ࠊ᫂ࡽ࠿
⾡ࢆ᪋⾜ࠋ⾡ᚋࡢ㣗஦㛤ጞ┤ᚋ࠿ࡽᄟୗᅔ㞴
࡟⯉㦵ࡢ๓ୖ᪉⛣ືࡢᨵၿ࡜ႃ㢌⵹㇂࡬ࡢṧ
ឤࢆ⮬ぬࠋ⫵⅖ࡶేⓎࡋࡓࡓࡵ 4 ᭶ 26 ᪥࡟
␃ῶᑡࢆㄆࡵࡓࠋ10 ᭶ 2 ᪥࡟ࡣ 3 㣗࡜ࡶ③ᖖ
VF
㣗ࡢ⤒ཱྀᦤྲྀࡀྍ⬟࡜࡞ࡗࡓࡓࡵࠊゝㄒ⫈ぬ
(videofluoroscopic
examination
of
swallowing)ࢆ᪋⾜ࠋVF ࡛ࡣࠊᄟୗ᫬ࡢ⯉㦵
ኈ࡟ࡼࡿᄟୗࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢆ⤊஢ࡋࡓࠋ
ࡢ๓ୖ᪉࡬ࡢ⛣ື୙Ⰻ࡜ⴭ᫂࡞ဗ㢌ṧ␃ࢆㄆ
>⪃ᐹ@
ࡵࡓࡓࡵࠊᄟୗ㞀ᐖ࡟ᑐࡋᄟୗࣜࣁࣅࣜࢸ࣮
㏆ᖺ㢁㧊ᦆയ࡟ᄟୗ㞀ᐖࢆక࠺⑕౛ࡀከࡃࡳ
ࢩࣙࣥࡀ㏣ຍฎ᪉࡜࡞ࡿࠋ5 ᭶ 28 ᪥ᙜ⛉ᅇ᚟
ࡽࢀࡿࡼ࠺࡟࡞ࡗࡓཎᅉ࡜ࡋ࡚ࠊCIP(clinical
― 38 ―
illness polyneuropathy)ࠊ㯞㓉ࡸ⸆๣ࡢᙳ㡪ࠊ
110(4):819-841.doi:10.1093/brain/110.4.
㢕㒊ᡭ⾡ࡢ⾡ᘧࡢᙳ㡪ࠊఱࡽ࠿ࡢឤᰁ⑕ࠊᝈ
819
⪅ࡢ㧗㱋໬࡞࡝ࡀ⪃࠼ࡽࢀࡿࠋCIP ࡜ࡣࠊከ
2) van Mook, Walther
⮚ჾ୙඲ࡸ඲㌟㯞㓉/ேᕤ࿧྾ჾ⟶⌮ࢆ⤒㦂
N.K.A.MD;Hulsewe-Evers,Riquette
ࡋࡓᝈ⪅࡟㉳ࡇࡾ࠺ࡿᮎᲈ⚄⤒㞀ᐖ࡛࠶ࡾࠊ
P.M.G.MD:Critical illness
ᮏ⑕౛ࡶࠊ⑓Ṕ࣭⮫ᗋ⑕≧ࡸ➽㟁ᅗᡤぢ࠿ࡽࠊ
polyneuropathy.Current Opinion in
CIP ࡟ࡼࡿᄟୗ㞀ᐖ࡛࠶ࡗࡓྍ⬟ᛶࡀ࠶ࡿࠋ
Critical Care.8(4):302-310,August 2002
ࡲࡓ㧗㱋㢕ᦆᝈ⪅࡟࠾࠸࡚ࡣࠊ⫼ᬒ࡟௦ൾྍ
3) Yonmi Onogi, Tetduji Oota, Eiji
⬟࡞㍍ᗘᄟୗ㞀ᐖࢆ᭷ࡋ࡚࠸ࡿ࡜ࡇࢁ࡟ࠊ⯉
Motonaga, Hiroyuki Jinnai, Minoru
㦵ୗ➽⩌ࢆᨭ㓄ࡍࡿ C2/3 ࡛ࣞ࣋ࣝࡢ㧗఩㢕
Toyokura;Dysphasia due to Diffuse
ᦆࢆྜేࡋ㢧ᛶᄟୗ㞀ᐖࢆࡁࡓࡋࡓྍ⬟ᛶࡶ
Brain Injury with Cervical Vertebrae
ྰᐃ࡛ࡁ࡞࠸ࠋࡍ࡞ࢃࡕ」ᩘࡢཎᅉࡀ」ྜⓗ
Fracture and Thoracic Spinal Cord
࡟⤡ࡳྜࡗࡓ⤖ᯝࠊᄟୗ㞀ᐖࢆᘬࡁ㉳ࡇࡋ࡚
Injury.ゝㄒ⫈ぬ◊✲ 17(1), 8-11,
࠸ࡿྍ⬟ᛶࡀ࠶ࡿࠋ
2000-4-30
ࡲࡓᮏ⑕౛࡟ᑐࡍࡿࠊࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢆ
ྵࡴ἞⒪࡟㛵ࡋ࡚ࡣࠊ㟁Ẽ⏕⌮Ꮫⓗ࢔ࣉ࣮ࣟ
ࢳࢆྵࡴࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡀዌຌࡋࡓྍ⬟
ᛶࡀ࠶ࡿࠋ
>ࡲ࡜ࡵ@
ᮎᲈ⚄⤒㞀ᐖ࡟ࡼࡿ࡜⪃࠼ࡽࢀࡿᄟୗ㞀ᐖࢆ
ྜేࡋࡓ C4/5 㢕㧊ᦆയᝈ⪅࡟ᑐࡋࠊ㟁Ẽ⏕⌮
Ꮫⓗ࢔ࣉ࣮ࣟࢳࢆྵࡴࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢆ
⾜ࡗࡓ⤖ᯝࠊ⤒ཱྀᦤྲྀࡀྍ⬟࡜࡞ࡗࡓ⑕౛ࢆ
⤒㦂ࡋࡓࠋ
>ཧ⪃ᩥ⊩@
1) Douglas.w.Aochodne, Charles F.Bolton,
George A.Wells, Joseph J.Gilbert,
Angelika F.Hahn, John D.Brown,
William A.Sibbald;Critical Illness
Polyneuropathy A Complication Of
sepsis And Multiple Organ
Failure.Brain(1987)
― 39 ―
10
ᙜ㝔࡛ࡢ⬻༞୰ᝈ⪅࡬ࡢ⌮Ꮫ࣭సᴗ࣭ゝㄒ⒪ἲࡢ௓ධ᫬㛫
ᗈᓥ኱Ꮫ⑓㝔ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⛉
‫ۑ‬Ọ෠ᙲோ ᮌᮧᾈᙲ
࠙┠ⓗࠚ⬻༞୰⑕౛࡬ࡢ᪩ᮇࣜࣁࣅࣜࢸ࣮ࢩ
(18%)ࠊ㌿㝔 35 ౛(80%)ࠊࡑࡢ௚ࡣ 1 ౛(2%)
ࣙࣥ(ࣜࣁ)࡟ࡘ࠸࡚ࡢ⌮ゎࡀ㐍ࢇ࡛࠸ࡿࠋᙜ㝔
࡛࠶ࡗࡓࠋ㌿㝔ඛ࡜ࡋ࡚ࡣࠊᅇ᚟ᮇࣜࣁࣅࣜ
࡛ࡢᐇ᪋≧ἣࢆ♧ࡋࠊ௒ᚋࡢᑐᛂ࡟ࡘ࠸࡚⪃
ࢸ࣮ࢩࣙࣥ⑓Ჷࢆ᭷ࡍࡿ⑓㝔࡬ࡢ㌿㝔ࡀ 28
࠼ࡓ࠸ࠋ࡞࠾ࠊᙜ㝔ࡣ 700 ᗋࢆ᭷ࡋࠊ⌧ᅾ⌮
౛(14 ⑓㝔)ࠊ⒪㣴⑓Ჷ࡬ࡢ㌿㝔ࡀ 7 ౛࡜࡞ࡗ
Ꮫ⒪ἲኈ 19 ྡࠊసᴗ⒪ἲኈ 8 ྡࠊゝㄒ⫈ぬኈ
࡚࠸ࡓࠋ
3 ྡࡀ໅ົࡋ࡚࠸ࡿࠋ⌮Ꮫ⒪ἲ࡛ࡣ⑓Ჷࡢᑓ
࠙⪃ᐹࠚ⬻༞୰࢞࢖ࢻࣛ࢖ࣥ 2009 ࡟࠾࠸࡚ࠊ
ᚑไࢆᐇ᪋ࡋࠊᩆᛴᩆ࿨ࢭࣥࢱ࣮࡛⌮Ꮫ⒪ἲ
ᛴᛶᮇࣜࣁ࡟࠾ࡅࡿカ⦎㔞ࡣࠊ᪩ᮇ࠿ࡽ 1 ᪥
ኈ 3 ྡࠊ⬻⚄⤒ෆ⛉࣭⬻⚄⤒እ⛉⑓Ჷ࡛⌮Ꮫ
ᙜࡓࡾࡢカ⦎㔞ࢆከࡃ⾜࠺࡜᪩ᮇ㞳ᗋ࡟ࡘ࡞
⒪ἲኈ 2 ྡࡀ୺࡟⑓Ჷ࡛ࡢࣜࣁࢆᐇ᪋ࡋ࡚࠸
ࡀࡾࠊ᪩ᮇࡢ ADL ᨵၿࡀ♧ࡉࢀࡿ࡜ࡍࡿሗ࿌
ࡿࠋࡲࡓࠊᄟୗ࡟ࡘ࠸࡚ࡣ⑓Ჷෆ࡛ࡢᦤ㣗ᄟ
ࡀከ࠸࡜ࡋ࡚࠸ࡿࠋ୍᪉࡛ࠊᶵ⬟㞀ᐖࡸ ADL
ୗࢳ࣮࣒ࡢάືࡀ࡞ࡉࢀ࡚࠸ࡿࠋ
ࡣカ⦎㔞࡟౫Ꮡࡋ࡞࠸࡜࠸࠺ሗ࿌ࡶ♧ࡉࢀ࡚
࠙ᑐ㇟ࠚ2011 ᖺ࡟⬻༞୰࡜ࡋ࡚ࣜࣁ⤂௓ࡉࢀ
࠸ࡿࠋ
ࡓ 44 ⑕౛(⏨ᛶ 25 ౛࣭ዪᛶ 19 ౛ࠊᖹᆒᖺ㱋
௒ᅇࡢㄪᰝ࡛ࡣ⌮Ꮫ࣭సᴗ࣭ゝㄒ⒪ἲኈࡀ⑓
72.7s11.1 ṓ)ࠋ⑌ᝈෆヂࡣ⬻᱾ሰ 23 ౛(53%)ࠊ
Ჷ࡛ᑐᛂ࡛ࡁ࡚࠸ࡿ᫬㛫ᩘࡣ㞟ィ༢఩ᩘࢆ࣋
⬻ฟ⾑ 16 ౛(36%)ࠊࡃࡶ⭷ୗฟ⾑ 5 ౛(11%)ࠋ
࣮ࢫ࡜ࡍࡿ࡜ 1.46 ༢఩࡜ 1 ᪥ 30 ศ㊊ࡽࡎ࡜
࠙᪉ἲࠚᑐ㇟⑕౛ࡢᅾ㝔᪥ᩘ࣭ADL ኚ໬
࡞ࡗ࡚࠸ࡿࠋࡇࢀࡲ࡛ࡢሗ࿌࡜ẚ࡭ᑡ࡞ࡃ࡞
(Barthel Index㸸B.I.࡛ホ౯)࠾ࡼࡧධ㝔୰ࡢ
ࡗ࡚࠸ࡿࡀࠊ⌧ᅾ⒪ἲኈ 1 ேᙜࡓࡾࡢ 1 ᪥ᐇ
⌮Ꮫ࣭సᴗ࣭ゝㄒ⒪ἲᐇ᪋༢఩ᩘ࡟ࡘ࠸࡚ᚋ
᪋༢఩ᩘ࡟ࡣୖ㝈ࡀタᐃࡉࢀࠊࡑࡢ୰࡛ከࡃ
᪉どⓗ࡟ㄪᰝࡋࡓࠋ
ࡢᑐ㇟⑕౛࡬ࡢ᫬㛫㓄ศࢆ⾜ࢃ࡞ࡅࢀࡤ࡞ࡽ
࠙⤖ᯝࠚᖹᆒᅾ㝔᪥ᩘࡣ 32.8s16.6 ᪥ࠊධ㝔
ࡎࠊ1 ேᙜࡓࡾࡢࣜࣁᐇ᪋᫬㛫ࢆ༑ศ☜ಖࡍ
ᚋࣜࣁࣅࣜ㛤ጞࡲ࡛ࡢᮇ㛫ࡣᖹᆒ 4.1s4.8 ᪥
ࡿࡇ࡜ࡣ㞴ࡋ࠸ࠋ
࡛࠶ࡗࡓࠋධ㝔୰ࡢᝈ⪅ ADL ࡣ㛤ጞ᫬ᖹᆒ
ࡑࡢࡓࡵࠊ⬻༞୰ᝈ⪅࡬ࡢᛴᛶᮇࣜࣁࢆ㐍ࡵ
B.I.=0.5 ࡛ࠊ㏥㝔᫬࡟ࡣᖹᆒ B.I.=11.8 Ⅼ࡜࡞
ࡿࡓࡵ࡟ࡣࠊ⌧≧࡛ࡣࣜࣁᑓ㛛⫋ࡀᦠࢃࡿ௨
ࡗ࡚࠸ࡓࠋࡑࡢ㛫ࣜࣁᐇ᪋༢఩ᩘࡣ 1 ᪥ᖹᆒ
እࡢ᫬㛫࡟࠾ࡅࡿࣜࣁᑐᛂࡀồࡵࡽࢀࠊ⑓Ჷ
࡛ 1.46 ༢఩࡛࠶ࡗࡓࠋ㌿ᖐඛࡣ⮬Ꮿ㏥㝔 8 ౛
࡛ࡢ┳ㆤᖌ࡜ࡢ༠ാࡀᚲせ࡜࡞ࡿࠋ⌧ᅾ⒪ἲ
― 40 ―
ኈࡀ⑓Ჷ࢝ࣥࣇ࢓ࣞࣥࢫ➼࡟㛵ࢃࡗ࡚࠸ࡿࡀࠊ
௒ᚋࡶࡑࡢࢳ࣮࣒ࡢάື࡟㛵ࢃࡗ࡚࠸ࡃࡇ࡜
ࡀᚲせ࡜࡞ࡿࠋࡲࡓࠊ᪩ᮇࡢ㌿㝔࡟ࡼࡿ᪩ᮇ
ࣜࣁᑟධࡢಁ㐍ࡸࠊ㝔ෆ࡛ࡢ⒪ἲኈᩘࡢቑဨ
࠾ࡼࡧ⑌ᝈẖࡢࣜࣁ᫬㛫㓄ศࡢኚ᭦ࡶゎỴ⟇
ࡢ୍ࡘ࡜࡞ࡾ࠺ࡿ࠿ࡶࡋࢀ࡞࠸ࠋ
࠙⤖ㄒࠚᮏ㝔࡛ࡢ⬻༞୰ᛴᛶᮇ࡟࠾ࡅࡿ⌮
Ꮫ࣭సᴗ࣭ゝㄒ⒪ἲࡢ௓ධ᫬㛫࡟ࡘ࠸࡚ᥦ♧
ࡋࡓࠋ᪩ᮇ௓ධ࡜㉁ࡢ☜ಖ࡜࡜ࡶ࡟㐺ษ࡞ᐇ
᪋᫬㛫࡟ࡘ࠸࡚ࡶ⪃៖ࡋ࡚࠸ࡃࡇ࡜ࡀᚲせ࡛
࠶ࡿࠋ
― 41 ―
11
ୗ⫥㛵⠇ᣊ⦰ࢆకࡗࡓ㔜ᗘ②ᛶ୧㯞⑷࡟ᑐࡋ࡚ OSSCS ࢆ⾜࠸
ADL ࡀⴭ᫂࡟ᨵၿࡋࡓ㸯౛
಴ᩜᖹᡂ⑓㝔ᩚᙧእ⛉ 1㸪ྠࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⛉ 2
‫ۑ‬῰㇂ ၨ 1ࠊ▼஭ ♸Ꮚ 2ࠊụ⏣ ೺஧ 2
ྥୖࡋࡓࠋᖹ⾜Წෆ࠾ࡼࡧṌ⾜ჾṌ⾜ࡀᬑ㏻
࠙ࡣࡌࡵ࡟ࠚ
㠐࡛ྍ⬟࡟࡞ࡗࡓࠋ࣋ࢵࢺ࠿ࡽ㌴࠸ࡍ࡬ࡢ⛣
ୗ⫥㛵⠇㸦⫤࣭⭸࣭㊊㸧࡟㛵⠇ᣊ⦰ࢆకࡗࡓ
஌ࠊධᾎࠊࢺ࢖ࣞ࡞࡝ࡢ ADL ࡀ⮬❧ࡋࡓࠋ
㔜ᗘ②ᛶ୧㯞⑷ᝈ⪅࡟ᑐࡋࠊᩚᙧእ⛉ⓗ㑅ᢥ
࠙⪃ᐹࠚ
ⓗ②ᛶࢥࣥࢺ࣮ࣟࣝᡭ⾡(OSSCS)ࡀ᭷⏝࡛
እ⛉ᡭ⾡ࡢ฼Ⅼࡣ┤どୗ࡟➽⭝ࠊ㛵⠇ࢆ᧯స
࠶ࡗࡓ 1 ౛࡟ࡘ࠸࡚ሗ࿌ࡍࡿࠋ
࡛ࡁࡿⅬ࡛࠶ࡿࠋࡇࡢ⑕౛ࡢࡼ࠺࡟ᙉ࠸㛵⠇
࠙ᑐ㇟࡜᪉ἲࠚ
ᣊ⦰ࢆకࡗࡓ②⦰࡟ᑐࡋ࡚ࡣ࣎ࢶࣜࢾࢫ⒪ἲ
⑕౛ࡣ 29 ṓዪᛶࠊ⸽⏕ᚋ⬻⑕࡟ࡼࡿ㔜ᗘ②
ࡸࣇ࢙ࣀ࣮ࣝࣈࣟࢵࢡ࡛ࡣ㝈⏺ࡀ࠶ࢁ࠺ࠋࡶ
ᛶ୧㯞⑷(5 ᖺ⤒㐣)࡛࠶ࡿࠋ๓་࡟ࡼࡾୗ⫥ࣇ
࡜ࡶ࡜ୗ⫥㛵⠇࡟㝶ពᛶࡀṧᏑࡋ࡚࠸ࡓࡇ࡜
࢙ࣀ࣮ࣝࣈࣟࢵࢡࡀヨࡳࡽࢀࡓࡀࠊ②⦰ࡀᙉ
ࡍࡂ࡚ࣈࣟࢵࢡᅔ㞴ࡢࡓࡵᙜ⛉⤂௓࡜࡞ࡗࡓࠋ ࡸ➽ຊࡀ༑ศ࡟࠶ࡗࡓࡇ࡜ࡀⰋዲ࡞ᡂ⦼࡟ࡘ
࡞ࡀࡗࡓࡢ࡛ࡣ࡞࠸࠿࡜⪃࠼ࡿࠋ
ึデ᫬ࠊ⫤࣭⭸࣭㊊ࡢᣊ⦰ࢆక࠺㔜ᗘ②⦰࡛
࠙⤖ㄒࠚ
❧఩୙⬟ࠊADL ࡣせ௓ຓ࡛࠶ࡗࡓࠋ୧ୗ⫥
ᡭ⾡௓ධ࡟ࡼࡗ࡚②ᛶࡢᢚไ࡟ຍ࠼࡚㛵⠇ᣊ
(⫤࣭⭸࣭㊊)࡟ᑐࡋ࡚ᡭ⾡ࢆ⾜ࡗࡓࠋྛ㛵⠇
⦰ࡀ㝖࠿ࢀࠊጼໃࡀⰋࡃ࡞ࡾ ADL ࡀᨵၿࡋ
࡟࠾࠸࡚㛵⠇ໟษ㛤ࢆຍ࠼ࠊ㛵⠇ᣊ⦰ࢆ㝖࠸
ࡓࠋ
ࡓࠋ㊊㒊࡟ࡣ࢔࢟ࣞࢫ⭝ᘏ㛗ࢆ⾜ࡗࡓࠋᡭ⾡
ࡣࡲࡎᕥୗ⫥࠿ࡽ⾜࠸ࠊ㸴㐌㛫ᚋ࡟ྑୗ⫥ࢆ
⾜ࡗࡓࠋ⾡ᚋ 5 㐌㛫ࡢචⲴ㔜ᮇ㛫ࡢᚋࠊSLB
⿦╔ୗ࡟㉳❧Ṍ⾜⦎⩦ࢆ㛤ጞࡋࡓࠋ඲㒊࡛㸲
ࣨ᭶㛫ࡢධ㝔࡜࡞ࡗࡓࠋ㏥㝔ᚋࡶ㐌㸰ᅇࡢእ
᮶ࣜࣁࣅࣜࢆ⥅⥆ࡋ࡚࠸ࡿࠋ⾡๓࠾ࡼࡧ⾡ᚋ
㸴ࣧ᭶ࡵ࡟ホ౯ࢆ⾜ࡗࡓࠋホ౯ࡣ
Brunnstrom Stage(Br.stage) ࠊ Stroke Impairment Assessment Set(SIAS)ࠊ⭸࣭㊊࡟
࠾ࡅࡿ Modified Ashworth Scale(MAS)ࠊ㛵
⠇ྍືᇦィ ࠊࣅࢹ࢜ື⏬ࢆ⏝࠸ࡓࠋ
࠙⤖ᯝࠚ
Br.stage( ୗ ⫥ )IVńV ࠋ SIAS(76 Ⅼ ‶
Ⅼ)55ń64ࠋMAS ࡣ⭸ 4Ѝ1ࠊ㊊ 4Ѝ1ࠋୗ⫥
㛵⠇ྍືᇦ࡛ࡣ⫤ఙᒎ㸸ྑ-15rЍ25rᕥ
-30rЍ10rࠊ⭸ఙᒎ㸸ྑ-35rЍ-10rᕥ-30r
Ѝ0rࠊ㊊⫼ᒅ㸸ྑ-30rЍ5rᕥ-45rЍ5r
࡟ᨵၿࡋࡓࠋ⾡๓ࡣ②⦰ࡀⴭࡋࡃࠊ❧఩ࢆ࡜
ࡿ࡜ࢡࣛ࢘ࢳࣥࢢ⫥఩࡜࡞ࡾࠊᨭᣢᛶ࡟ஈࡋ
ࡃࠊᖹ⾜Წෆ❧఩ࡀ࡜ࢀ࡞࠿ࡗࡓࠋ⾡ᚋࡣ㛵
⠇ᣊ⦰ࡀ㝖࠿ࢀ࡚ጼໃࡀⰋࡃ࡞ࡾࠊᨭᣢᛶࡀ
㸫1㸫
― 42 ―
㸫2㸫
― 43 ―
12
ࣔࢪ࣮ࣗࣛᆺ◳ᛶ⬚⭜௝᳝⿦ලࡢヨస
ᒸᒣ኱Ꮫ⑓㝔⥲ྜࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ㒊㸯㸪ᒸᒣ኱Ꮫᩚᙧእ⛉㸰
࠿ࡓࡸࡲ
ࡼࡋ ࡳ
‫ۑ‬ሀᒣ ె⨾㸯㸪༓⏣ ┈⏕㸯㸪㏕㛫 ᕦᑗ㸯㸪㤿㷂 ဴᮁ㸯㸪ᑿ㷂 ᩄᩥ㸰
࠙ࡣࡌࡵ࡟ࠚ⬚᳝ୗ㒊ࡸ⭜᳝ࡢ㌿⛣ᛶ㦵⭘⒆
࠾ࡼࡧឤᰁ⑕࡞࡝ࡢཎᅉ࡟ࡼࡾࠊ⑊③ࡀᙉࡃ
ᗙ఩ࡸ஌ࡾ⛣ࡾࡀᅔ㞴࡛࠶ࡿሙྜࠊ࠶ࡿ࠸ࡣ
ᑡࡋ࡛ࡶᏳᐃᛶࢆ⋓ᚓࡋࡓ࠸ሙྜ࡟ࠊ◳ᛶ⬚
⭜௝᳝⿦ලࢆฎ᪉ࡍࡿࡇ࡜ࡀ࠶ࡿࠋ࣏ࣜࣉࣟ
ࣆࣞࣥ〇ࡢ◳ᛶ⬚⭜௝᳝⿦ලࢆస〇ࡍࡿ࡟ࡣࠊ
❧఩ࢆ࡜ࡗ࡚᥇ᆺࡍࡿᚲせࡀ࠶ࡿࡀࠊ❧఩ࡀ
࡜ࢀ࡞࠸᫬࡟ࡣస〇ࡍࡿࡇ࡜ࡀ࡛ࡁ࡞࠸ࠋ◳
ᛶ⬚⭜௝᳝⿦ලࢆㅉࡵࠊࢲ࣮࣓ࣥࢥࣝࢭࢵࢺ
࡛ᑡࡋ࡛ࡶᨭᣢᛶࢆᚓࡼ࠺࡜ࡋ࡚ࡶࠊ⑊③ࡢ
⦆࿴ࡸᏳᐃᛶࢆ⋓ᚓࡍࡿࡇ࡜ࡣᅔ㞴࡛࠶ࡿࠋ
ࡑࡇ࡛௒ᅇ᪂ࡓ࡟ࠊ❧఩࡛᥇ᆺࡍࡿᚲせࡀ࡞
ࡃ࠶ࡿ⛬ᗘࡢᨭᣢᛶࡀ⋓ᚓ࡛ࡁࡿࣔࢪ࣮ࣗࣛ
ᆺࡢ◳ᛶ⬚⭜௝᳝⿦ලࢆヨసࡋࡓࠋ
࠙ࣔࢪ࣮ࣗࣛᆺ◳ᛶ⬚⭜௝᳝⿦ල࡟ࡘ࠸࡚ࠚ
ᵓ㐀ࡣࠊᕥྑࡢ⭠㦵࡟ྜࢃࡏࡓࣃࢵࢻ࡜⫘㦵
㒊ࢆᕥྑ࡛ᨭ࠼ࡿࣃࢵࢻࢆᨭᰕ࡛㐃⤖ࡋࠊ๓
᪉㒊ศ࡜ᚋ᪉㒊ศࡣ࣋ࣝࢺ࡛㐃⤖ࡍࡿࠋ⭠㦵
ࡢࣃࢵࢻࠊ࠶ࡿ࠸ࡣ⫘㦵ࡢࣃࢵࢻࡣᩘ✀㢮ࢆ
⏝ពࡋࠊయᆺ࡟ྜࢃࡏ࡚ࣇ࢕ࢵࢺࡍࡿࡶࡢࢆ
㑅ᢥࡍࡿࠋᕥྑ࡜ࡶ⭠㦵࡜⫘㦵࡛ᨭ࠼ࡿࡼ࠺
࡟ᨭᰕࢆㄪ⠇ࡋࠊ๓ᚋࡢ࣋ࣝࢺ୍࡛య໬ࡍࡿ
ࡼ࠺࡟࡞ࡗ࡚࠸ࡿࠋࣃࢵࢻࡢ⓶⭵࡜ࡢ᥋ゐ㠃
࡟ࡣࠊᰂࡽ࠿࠸ᮦᩱࢆ⏝࠸࡚⑊③ࡀ⏕ࡌ࡞࠸
ࡼ࠺࡟ᕤኵࡍࡿࠋᴟᗘ࡞⫧‶ࡸኚᙧࡀᙉ࠸ሙ
ྜ࡟ࡣ㞴ࡋ࠸࡛࠶ࢁ࠺ࡀࠊ᥇ᆺࡍࡿࡇ࡜ࡀᅔ
㞴࡞ሙྜ࡟ࡣ᭷ຠ࡞⿦ල࡛࠶ࡿ࡜⪃࠼ࡿࠋ
S,M,L ࡞࡝ࡢ኱ࡁࡉ࡛ᝈ⪅ࡢయᆺ࡟ྜࢃࡏ࡚㸪
࣋ࣝࢺ࡛ㄪᩚࡋ㸪⿦╔࡛ࡁࡿࠋ㔜㔞ࡣ⣙
1,100g ࡛࠶ࡿࠋ
ࣔࢪ࣮ࣗࣛᆺ⿦ලࡢ≉ᚩࡣ㸪๓ࡶࡗ࡚㒊ရࢆ
స〇ࡋ࡚࠾ࡾ㸪᥇ᆺࡢᚲせࡀ࡞࠸ࠋ
⬚㒌࠾ࡼࡧ⭠㦵㒊࡛ᨭᣢࡋ㸪Th8࣭9 ࠿ࡽ L5
ࡢ⠊ᅖ࡛࠶ࢀࡤ࠶ࡿ⛬ᗘࡢᅛᐃᛶࡀᚓࡽࢀࡿࠋ
࠙⑕౛㸯ࠚ74 ṓ⏨ᛶ ➨ 1 ⭜᳝ᅽ㏕㦵ᢡ
⿦╔ឤࡣ
1㸬 ⭜ࡀᴦ࡛࠶ࡿ
2㸬 ⿦╔ࡍࡿࡢࡀ⡆༢
3㸬 ๓࡟࠿ࡀࢇࡔࡾືࡃࡢࡀᴦ
4㸬 ③ࡳࡀ࡞࠸
5㸬 ࢲ࣮࣓ࣥࢥࣝࢭࢵࢺࡼࡾⰋ࠸
࠙⑕౛㸰ࠚ85 ṓ⏨ᛶ ➨ 3 ⭜᳝ᅽ㏕㦵ᢡ
⿦╔ឤࡣ
1㸬 ⬚ࡢ㒊ศ࡟ᅽ㏕ឤࡀ࠶ࡿ
2㸬 ࡋࡗ࠿ࡾ࡜ࡋࡓᅛᐃឤࡀ࠶ࡿ
3㸬 ࣋ࣝࢺࢆ⥾ࡵ࡚ࡶ❓ᒅ࡞ឤࡌࡀࡋ࡞࠸
4㸬 ⬚ࡢ㒊ศࡀࡶ࠺ᑡࡋᴦ࡟⿦╔࡛ࡁࢀࡤ࠸
࠸
࠙⪃ᐹࠚ⬚⭜᳝ࡢ㌿⛣ᛶ㦵⭘⒆ࡸ໬⮋ᛶ⬨᳝
⅖࡞࡝ࡣ㸪◳ᛶ⬚⭜௝᳝⿦ලࡢ㐺ᛂ࡜ࡉࢀ࡚
࠸ࡿࠋ
ࡋ࠿ࡋ㸪ᚑ᮶ࡢ◳ᛶ⬚⭜௝᳝⿦ලࡣ㸪᥇ᆺ
᫬❧఩ࢆྲྀࡽ࡞ࡅࢀࡤ࡞ࡽ࡞࠸ࡢ࡛㸪❧఩ࢆ
࡜ࢀ࡞࠸ሙྜࡣస〇࡛ࡁ࡞࠸ࠋ
ࡲࡓ㸪ᚑ᮶ࡢ◳ᛶ⬚⭜௝᳝⿦ලࡣ࣮ࣔࣝࢻ
ᆺ࡛࠶ࡾ㸪᥇ᆺ࠿ࡽฟ᮶ୖࡀࡾ⿦╔ࡍࡿࡲ࡛
࡟⣙ 2 㐌㛫ࡢᮇ㛫ࢆせࡍࡿࠋࡑࡢ㛫㸪ᝈ⪅ࡣ
⮩ᗋࡋ࡚࠸࡞ࡅࢀࡤ࡞ࡽ࡞࠸ࠋ࡜ࡇࢁࡀ௒ᅇ
ヨసࡋࡓࣔࢪ࣮ࣗࣛᆺ◳ᛶ⬚⭜௝᳝⿦ලࡣ㸪
యᆺ࡟ྜࢃࡏ࡚࣋ࣝࢺ࡞࡝࡛ㄪᩚ࡛ࡁ㸪ฎ᪉
ࡋࡓᙜ᪥࠿ࡽ⿦╔ࡀྍ⬟࡛࠶ࡿࠋ
௒ᅇヨసࡋࡓࣔࢪ࣮ࣗࣛᆺ⬚⭜௝᳝⿦ලࡢ
ḞⅬࡢࡦ࡜ࡘࡣ㸪㧗౯࡞ࡇ࡜࡛࠶ࡿࠋࡋ࠿ࡋ
⑓㝔ࡢഛရ࡜ࡋ࡚㸪ᚑ᮶ࡢ◳ᛶ⬚⭜௝᳝⿦ල
ࡀฟ᮶ୖࡀࡿࡲ࡛ࡢ 2 㐌㛫ࡢᮇ㛫౑⏝ࡋ㸪⮩
ᗋ࡟ࡼࡿᗫ⏝ࢆண㜵ࡋࡓࡾ㸪▷ᮇ㛫ࡢ౑⏝ࡢ
㸫1㸫
― 44 ―
ሙྜࡣ㈚ࡋฟࡋࡓࡾࡍࡿࡇ࡜ࡶ᳨ウࡋ࡚࠸ࡿࠋ
ࡇࢀࡲ࡛࡟ࣔࢪ࣮ࣗࣛᆺ◳ᛶ⬚⭜௝᳝⿦ල
ࡢሗ࿌ࡣ࡯࡜ࢇ࡝࡞࠸ࠋ௒ᚋࡢㄢ㢟ࡣ㸪⿦╔
ࡀ୍ே࡛ࡣᅔ㞴࡛࠶ࡾ㸪⿦╔᪉ἲࢆ᳨ウࡋࡓ
࠸ࠋࡲࡓ⑕౛ࢆቑࡸࡋ᭷ຠᛶࢆ☜ㄆࡋࡓ࠸ࠋ
㸫2㸫
― 45 ―
13
⭘⒆⏝ேᕤ⭸㛵⠇◚ᦆ౛ࡢ᳨ウ
㫽ྲྀ኱Ꮫᩚᙧእ⛉㸯㸪㫽ྲྀ኱Ꮫ་Ꮫ㒊㝃ᒓ⑓㝔ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ㒊㸰
ࡸࡲࡋࡓ
ࡦ࡛ࡁ
࠼ࢇ࡝࠺
ࡇ࠺ ࡌ
ࡸࡲࢃࡁ
ࡳ ࠿
࡚ࡋࡲ
ࡾࡻ࠺ ࡓ
‫ۑ‬ᒣୗ ⱥᶞ㸯㸪㐲⸨ ᏹ἞㸯㸪㇏ᓥ Ⰻ ኴ㸯 ࠾ࡉࡁ
ࡣࡂࡢ
ࡦࢁࡋ
ᑿᓮ ࡲࡾ㸰㸪ᒣ⬥ ⨾㤶㸰㸪ⴗ㔝 ᾈ 㸰
࠙┠ⓗࠚ኱⭣㐲఩㒊Ⓨ⏕㦵࣭㌾㒊⭘⒆࡟ᑐ
ࡍࡿ⭘⒆⏝ேᕤ⭸㛵⠇⨨᥮ᚋࠊ࢖ࣥࣉࣛࣥ
ࢺ࡟◚ᦆࢆࡁࡓࡋࡓ 4 ౛ࡢㄪᰝࢆ⾜ࡗࡓࡢ
࡛ሗ࿌ࡍࡿࠋ
࠙ᑐ㇟࡜᪉ἲࠚ⑕౛ࡣ⏨ᛶ 2 ౛ࠊዪᛶ 2 ౛ࠋ
ᡭ⾡᫬ᖹᆒᖺ㱋 37.3(11-58)ṓࠊᖹᆒ⤒㐣ほ
ᐹᮇ㛫ࡣ 5 ᖺ 9 ࢝᭶(2 ᖺ㹼13 ᖺ)࡛࠶ࡗࡓࠋ
ཎ⑌ᝈࡢෆヂࡣ㦵⫗⭘ 1 ౛ࠊ㌾㦵⫗⭘ 1 ౛ࠊ
⬡⫫⫗⭘ 1 ౛ࠊ㦵ᕧ⣽⬊⭘ 1 ౛࡛࠶ࡗࡓࠋ
౑ ⏝ ᶵ ✀ ࡣ Kyocera Limb Salvage
System㸦KLS system㸧ࡀ 3 ౛ࠊఙ㛗ᆺ⭘
⒆⏝ேᕤ㛵⠇(Growing kotz)ࡀ 1 ౛࡛ࠊ඲
౛ࢭ࣓ࣥࢺࣞࢫᅛᐃ࡛࠶ࡗࡓࠋࡇࢀࡽࡢ⑕
౛࡟ࡘ࠸࡚Ⲵ㔜㛤ጞ᫬ᮇࠊ⾡ᚋ⭸㛵⠇ྍື
ᇦ㸦ROM㸧ࠊMSTS scoreࠊ⾡ᚋṌ⾜⬟ຊࠊ
◚ᦆ᫬ᮇࠊ◚ᦆ㒊఩ࠊ኱⭣㦵ࢫࢸ࣒┤ᚄࢆ
ㄪᰝࡋࡓࠋ
࠙⤖ᯝࠚⲴ㔜㛤ጞ᫬ᮇࡣ⾡ᚋᖹᆒ 7(4㸫12)
㐌 ࠊ ⾡ ᚋ ᖹ ᆒ ⭸ 㛵 ⠇ ROM ࡣ ఙ ᒎ
-2.5(-10-0)rࠊᒅ᭤ 89(80-95)rࠊ㏥㝔᫬
MSTS score ࡣᖹᆒ 24.8(19-28)Ⅼࠊ⾡ᚋṌ
⾜⬟ຊࡣ⊂Ṍ 3 ౛ࠊ1 ᮏ᮫Ṍ⾜ 1 ౛࡛࠶ࡗ
ࡓࠋ࢖ࣥࣉࣛࣥࢺࡢ◚ᦆ᫬ᮇࡣ⾡ᚋ 12 㐌
ࡀ 2 ౛ࠊ⾡ᚋ 15 㐌ࠊ⾡ᚋ 6 ᖺ 5 ࢝᭶ᚋࡀ 1
౛ࡎࡘ࡛࠶ࡗࡓࠋ◚ᦆ㒊఩ࡣ኱⭣㦵ࢫࢸ࣒
ࡢᇶ㒊ᢡᦆࡀ 2 ౛ࠊ኱⭣㦵ࢫࢸ࣒ࡢࢧ࢖ࢻ
࣎ࣝࢺᢡᦆࡀ 3 ౛࠶ࡗࡓࠋࢫࢸ࣒࿘ᅖᚄࡣ
10 ੈࡀ 1 ౛ࠊ12 ੈࡀ 3 ౛࡛࠶ࡗࡓࠋ◚ᦆ
ཎᅉ࡜᥎ ࡉࢀࡿάື࣭ືస࡜ࡋ࡚ࡣࠊ
LIVE ୰ࡢ⧞ࡾ㏉ࡍࢪࣕࣥࣉືస┤ᚋ࡟ᢡ
ᦆࡋࡓ౛ࡸࠊ
⾡ᚋ 3 ࢝᭶࡛㔜ປാ࡟᚟⫋ࡋࠊ
ປാ୰࡟ᢡᦆࡋࡓ౛ࡀ࠶ࡗࡓࠋ෌ᡭ⾡࡜ࡋ
࡚ 3 ౛࡟ KLS system ࡢ෌⨨᥮ࢆࠊ1 ౛࡟
඲኱⭣㦵⨨᥮ࢆ⾜ࡗࡓࠋ
࠙⪃ᐹࠚ
⭘⒆⏝ேᕤ㛵⠇⨨᥮ᚋࡢ⾡ᚋྜే⑕ࡢ୍ࡘ
࡜ࡋ࡚࢖ࣥࣉࣛࣥࢺࡢ◚ᦆࡀ࠶ࡿࠋࢫࢸ࣒
ᢡᦆࡢࣜࢫࢡ࡜ࡋ࡚኱⭣㦵ࢫࢸ࣒ᚄ㸦11 ੈ
ᮍ‶㸧ࡸࠊ⨯ᝈ㦵ษ㝖⠊ᅖ㸦30%௨ୖ㸧࡞
࡝ࡀሗ࿌ࡉࢀ࡚࠸ࡿࠋ⮬㦂౛ࡢ 2 ౛࡛ࡣࢫ
ࢸ࣒ᚄࡀࡑࢀࡒࢀ 10 ੈࠊ12 ੈᚄ࡛࠶ࡾࠊ
ࢫࢸ࣒ࡢ㔠ᒓᙉᗘ࡟ຍ࠼ࠊ㐣๫࡞㐠ື㈇Ⲵ
࡟ࡼࡿ㔠ᒓ⑂ປࡀᢡᦆࢆࡁࡓࡋࡓྍ⬟ᛶࡀ
⪃࠼ࡽࢀࡓࠋ
ࢧ࢖ࢻ࣎ࣝࢺࡢᢡᦆ࡟㛵ࡋ࡚ࡣ⮬㦂౛࡛
3 ౛⏕ࡌ࡚࠸ࡓࡀࠊ࠸ࡎࢀࡶ KLS system
࡛⏕ࡌ࡚࠸ࡓࠋKLS system ࡢࢭ࣓ࣥࢺࣞ
ࢫࢫࢸ࣒ࡣࠊᅇ᪕ࢆࢧ࢖ࢻࣉ࣮ࣞࢺ࡜ࢧ࢖
ࢻ࣎ࣝࢺ࡛ไᚚࡍࡿࢹࢨ࢖࡛ࣥ࠶ࡾࠊᙉᗘ
ࡢపୗࡀᠱᛕࡉࢀࡿࠋࡲࡓ⮬㦂౛࡛ࡣⲴ㔜
㛤ጞ᫬ᮇࡀ⾡ᚋ 4㹼6 㐌࡜ẚ㍑ⓗ᪩ᮇ࡛࠶
ࡗࡓࡇ࡜ࡶせᅉࡢ୍ࡘ࡛࠶ࡗࡓ࡜⪃࠼ࡽࢀ
ࡓࠋ⾡ᚋࡢṌ⾜⬟ຊࠊMSTS score ࡀẚ㍑
ⓗⰋዲ࡛࠶ࡿᝈ⪅࡛ࡣࠊⲴ㔜᫬ᮇࡸࠊ㐠ື
㈇Ⲵ࡞࡝ࡢ⾡ᚋ᪩ᮇᚋ⒪ἲࡸࠊ⏕άᣦᑟ࡟
ᑐࡋ࡚ࡶ༑ศὀពࢆᡶ࠺ᚲせࡀ࠶ࡿ࡜ᛮࢃ
ࢀࡓࠋ
㸫1㸫
― 46 ―
㸫2㸫
― 47 ―
14
ኚᙧᛶ⭸㛵⠇⑕࡟ᑐࡍࡿ኱⭣ᅄ㢌➽カ⦎ࡢ᭷⏝ᛶ
㫽ྲྀ኱Ꮫ་Ꮫ㒊㝃ᒓ⑓㝔ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ㒊㸯㸪㫽ྲྀ኱Ꮫ་Ꮫ㒊ᩚᙧእ⛉㸰㸪
⡿Ꮚᮾ⑓㝔ᩚᙧእ⛉ 㸪᪥㔝⑓㝔ᩚᙧእ⛉ 㸪㫽ྲྀ኱Ꮫ་Ꮫ㒊ಖ೺Ꮫ⛉ ࠾ ࡉࡁ
ࡲ ࡾ
࠾࠿ࡢ
࡜࠾ࡿ
ࡸࡲࡋࡓ
ࡦ࡛ࡁ
࠼ࡢࡁࡔ
ࡲࡇ࡜
ࡸࡲࡡ
ࡉࡔࡺࡁ
‫ۑ‬ᑿ㷂 ࡲࡾ㸯㸪ᒸ㔝 ᚭ 㸰㸪ᒣୗ ⱥᶞ㸰㸪ᴮ⏣ ㄔ 㸰㸪ᒣ᰿ ㈆அ 㸪 ࡣࡸࡋ
࠸ࡃ ࡓ
ࡣࡂࡢ
ࡦࢁࡋ
࡚ࡋࡲ
ࡾࡻ࠺ ࡓ
ᯘ ⫱ኴ㸪ⴗ㔝 ᾈ 㸪㇏ᓥ Ⰻ ኴ㸰
࠙ࡣࡌࡵ࡟ࠚ
ኚᙧᛶ⭸㛵⠇⑕㸦⭸ 2$㸧࡟ᑐࡍࡿ㐠ື⒪ἲ
࡟㛵ࡋ࡚ࡣከ✀ከᵝ࡞᪉ἲࡀሗ࿌ࡉࢀ࡚࠸ࡿࠋ
≉࡟ 8 㐌㛫ࡢୗ⫥ఙᒎᣙୖ㐠ື㸦SLR㸧ࡣ
NSAID ෆ᭹⒪ἲ࡜ྠ➼࠶ࡿ࠸ࡣࡑࢀ௨ୖࡢ
἞⒪ຠᯝࡀᚓࡽࢀࡿ࡜࠸࠺ሗ࿌ࡶ࠶ࡿࠋ㏆ᖺࠊ
㛵⠇㌾㦵 ᏑࢆಁࡍಖᏑⓗ἞⒪࡜ࡋ࡚᣺ࡾᏊ
㐠ື⒪ἲࡢຠᯝࡀሗ࿌ࡉࢀ࡚࠸ࡿࠋ
࠙┠ⓗࠚ
௒ᅇᡃࠎࡣ⭸ 2$ ᝈ⪅࡟ᑐࡍࡿ᣺ࡾᏊ㐠ື
ࡢຠᯝࢆࠊୗ⫥ఙᒎᣙୖ㐠ື㸦6/5㸧࡜ẚ㍑ࡋ
᳨࡚ウࡋࡓࠋ
࠙ᑐ㇟ࠚ
ṓ௨ୖࡢዪᛶ࡛ࠊ⌧ᅾࡲ࡛㐠ື⒪ἲࢆ⾜
ࡗࡓࡇ࡜ࡢ࡞࠸⭸ 2$ ⑕౛ࢆᑐ㇟࡜ࡋࡓࠋ❧఩
ṇ㠃 ; ⥺ീ࡟࡚ .HOOJUHQ/DZUHQFH㸦./㸧ศ
㢮 ᗘࡢ⑕౛ࢆᑐ㇟࡜ࡋࠊ ᗘࡣ㝖እࡋࡓࠋ
᣺ࡾᏊ⩌ࠊ6/5 ⩌ࢆ஺஫࡟๭ࡾ௜ࡅࡓࠋ᣺ࡾ
Ꮚ㐠ືࡣୗ⭣㛗ࡼࡾ㧗࠸᳔Ꮚ࡟⭜࠿ࡅ࡚ࡶࡽ
࠸ࠊ㔜ຊ࡛ୗᆶࡋࡓ≧ែ࡛᣺ࡾᏊ㐠ືࢆ ᅇ⧞ࡾ㏉ࡋ࡚ࡶࡽ࠺㐠ືࢆ ࢭࢵࢺ࡜ࡋ࡚ࠊ
ᮅኤࡢ ࢭࢵࢺ⾜ࡗ࡚ࡶࡽࡗࡓࠋ 㐌㛫ࡈ࡜
࡟デᐹࡋࠊデᐹ᫬࡟࢔ࣥࢣ࣮ࢺ࡟グධࡋ࡚ࡶ
ࡽ࠸ࠊ 㐌ᚋࡲ࡛ほᐹࡋࡓࠋ
࠙⤖ᯝࠚ
౛ ⭸ࡢ⭸ 2$ ᝈ⪅ࡀᑐ㇟࡛࠶ࡾࠊ./
ศ㢮ࡢ ᗘࡀ ౛ࠊ ᗘࡀ ౛࡛࠶ࡗࡓࠋ᣺
ࡾᏊ⩌ ౛ࠊ6/5 ⩌ ౛࡛࠶ࡗࡓࠋ6/5 ⩌࡛
ࡣ㛤ጞ᫬࡜ẚ㍑ࡋ࡚ 㐌ࠊ 㐌ࠊ 㐌ࠊ
㐌࡛ࠊ⑊③ࢫࢥ࢔㸦9$6㸧ࡀ᭷ព࡟ᨵၿࡋࡓࡀࠊ
᣺ࡾᏊ⩌࡛ࡣᨵၿࢆㄆࡵ࡞࠿ࡗࡓࠋ⭸ࡢࡇࢃ
ࡤࡾࠊ᪥ᖖ⏕άࡢ≧ែࠊ᪥ᖖ⏕άάືࠊ೺ᗣ
≧ែ࡞࡝ࡶࢫࢥ࢔໬ࡋ࡚ẚ㍑ࡋࡓࡀࠊ୧⩌࡜
ࡶᨵၿࢆㄆࡵ࡞࠿ࡗࡓࠋࡲࡓ⭸㛵⠇ࡢྍືᇦ
ࡸࣄ࢔ࣝࣟࣥ㓟㛵⠇ὀᑕࡢ㢖ᗘ࡟㛵ࡋ࡚ࡶᕪ
ࢆㄆࡵ࡞࠿ࡗࡓࠋ
࠙ࡲ࡜ࡵࠚ
⭸ 2$ ࡟ᑐࡍࡿ 6/5 カ⦎ࡣࠊ⑊③࡟㛵ࡋ࡚ᨵ
ၿࡉࡏࡿຠᯝࡀ࠶ࡿࡀࠊ᣺ࡾᏊ⩌࡛ࡣࡑࡢຠ
ᯝࡀㄆࡵࡽࢀ࡞࠿ࡗࡓࠋ᪥ᖖ⏕άάືࡸ೺ᗣ
≧ែ࡟ࡣᕪࢆㄆࡵ࡞࠿ࡗࡓࠋ᣺ࡾᏊ㐠ື࡟㛵
ࡋ࡚ࡣ⡆౽࡟ᐇ᪋ྍ⬟࡛࠶ࡿࡢ࡛ࠊ௒ᚋࡉࡽ
࡟⑕౛ࢆ㔜ࡡ᳨࡚ウࡋ࡚࠸ࡁࡓ࠸ࠋ
㸫1㸫
― 48 ―
㸫2㸫
― 49 ―
15
ᗈᓥ┴ᚰ୙඲ᆅᇦ㐃ᦠࢧ࣏࣮ࢺࢳ࣮࣒యไࡢᵓ⠏࡟ྥࡅ࡚
ᙜ㝔ᚰ୙඲ࢭࣥࢱ࣮ࡢάື
ᗈᓥ኱Ꮫ⑓㝔 ᚰ୙඲ࢭࣥࢱ࣮ 㸪ᗈᓥ኱Ꮫ኱Ꮫ㝔་ṑ⸆ಖ೺Ꮫ◊✲⛉ ᡂே┳ㆤ㛤ⓎᏛ ᗈᓥ኱Ꮫ⑓㝔デ⒪ᨭ᥼㒊ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ㒊㛛 ᗈᓥ኱Ꮫ⑓㝔ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⛉ ᗈᓥ኱Ꮫ኱Ꮫ㝔་ṑ⸆ಖ೺Ꮫ◊✲㝔ᚠ⎔ჾෆ⛉Ꮫ ‫ۑ‬Ỉᕝ┿⌮Ꮚ 㸪⏣௦ᑦ⠊ 㸪ᮌᮧᾈᙲ 㸪ᮌཎᗣᶞ ྲྀࡾ⤌ࡳձᚰ➽᱾ሰ࣭ᚰ୙඲ࣃࢫᡭᖒࡢ㓄
࠙ࡣࡌࡵ࡟ࠚ
ᕸ࣭ᬑཬάືղᚰ⮚࠸ࡁ࠸ࡁ࢟ࣕࣛࣂࣥ◊ಟ
ᚰ୙඲ࡣࡍ࡭࡚ࡢჾ㉁ⓗᚰ⑌ᝈࡀ⮳ࡿᮎᮇ
㸺ᚰ⮚⑓ᩍᐊ㸼
ീ࡛࠶ࡾࠊ㧗㱋໬ࡀ㐍ࡴࡇ࡜࡟ࡼࡾ௒ᚋ┈ࠎ
ᖺ ᭶ࡼࡾ㛤ጞࠋ㐌㸰ᅇ㛤ദࡋከ⫋✀
ᚰ୙඲ᝈ⪅ࡀቑຍࡍࡿࡇ࡜ࡀண ࡉࢀ࡚࠸ࡿ
㸯㸧
ࡀᣢࡕᅇࡾ࡛ㅮᖌࢆົࡵ࡚࠸ࡿࠋᩍᐊࡢ ᅇ
ࠋ ᚰ୙඲ࡣࠊᛴᛶቑᝏࠊ෌ධ㝔ࢆ⧞ࡾ㏉
㸰㸧
ᖹᆒཧຍ⪅ᩘࡣ ྡ࡛ࠊཧຍ⪅ෆヂࡣᝈ⪅ᮏ
ࡋ࡞ࡀࡽᝏ໬ࡍࡿࡀ ࠊ་Ꮫⓗ⟶⌮ࡔࡅ࡛ࡣ
ேࡀ ࠊ㓄അ⪅ࡀ ࠊᖺ௦ࡣ ௦ࡀ ࠊ
࡞ࡃࠊሷศ࣭Ỉศไ㝈ࠊ᭹⸆ࠊࢫࢺࣞࢫ⟶⌮
௦ࡀ ࠊࡘ࠸࡛ ௦ࡀ ࡛࠶ࡗࡓࠋཧ
࡞࡝ࡢከ⫋✀࡟ࡼࡿᑓ㛛ⓗࢣ࢔࡟ࡼࡾᚰ୙඲
ຍ⪅ࡢ⌮ゎᗘࡣࠕࡼࡃ⌮ゎ࡛ࡁࡓࠖ࡜ࠕ኱య
ቑᝏࡸ෌ධ㝔ࢆண㜵࡛ࡁࡓ࡜࠸࠺◊✲⤖ᯝࡀ
㸱㸧
⌮ゎ࡛ࡁࡓࠖࢆྜࢃࡏ࡚ ࠊ௒ᚋࡢ⒪㣴⏕
ሗ࿌ࡉࢀ࡚࠸ࡿ ࠋ
ά࡟ᙺ❧ࡘ࠿࡟ᑐࡋ࡚ࡣࠕࡣ࠸ࠖ࡜ࠕᑡࡋࠖ
ᖹᡂ ᖺࡢᗈᓥ┴ࡢṚஸ⪅ᩘ ேࡢ
ࢆྜࢃࡏ࡚ ࡛࠶ࡗࡓࠋᩍᐊ࡟ཧຍࡋࡓᝈ
࠺ࡕࠊࠕᚰ⑌ᝈࠖ࡟ࡼࡿṚஸ⪅ࡣࠊ ே
⪅ࡢ࢔ࣥࢣ࣮ࢺ࠿ࡽࠕཎᅉࡀ⏕ά⩦័⑓࡛࠶
㸦㸧࡛ࠊ➨ ఩࡜࡞ࡗ࡚࠾ࡾࠊࡑࡢ࠺ࡕ
ࡾࡑࢀࢆᨵࡵ࡞࠸࡜ྠࡌ⑓Ẽ࡟࡞ࡿࡇ࡜ࡀ࠶
ࠕᚰ୙඲ᝈ⪅ࠖࡀ ே㸦㸧࡛ࠊ᭱ࡶ
㸲㸧
ࡿࠖࠕ೺ᗣ࡟࡞ࡿⅭ᪥ࠎ⠇ไࡀ኱ษ࡜▱ࡗࡓࠖ
ከ࠸๭ྜࢆ༨ࡵ࡚࠸ࡿ ࠋ
࡞࡝ࡢពぢࡀࡳࡽࢀࡓࠋ᪂ࡋࡃ▱ࡗࡓࡇ࡜ࡣࠊ
ᖹᡂ ᖺᗘࡼࡾᗈᓥ┴࡛ࡣᆅᇦ་⒪෌⏕
ࠕ㐠ືࡍࡿேࡢ࡯࠺ࡀ㛗⏕ࡁ࡛ࡁࡿࠖ
ࠕሷศ㸯
ィ⏬࡟࠾࠸࡚ࠊᚰ୙඲ᝈ⪅ࡢ 42/ ࡢᨵၿࠊ෌
㹥ࡢ㔞ࠖࠕࢼࢺ࣒ࣜ࢘ࡢィ⟬᪉ἲࠖࠕ㧗⾑ᅽࡢ
ධ㝔⋡ࡢపୗࢆ┠ⓗ࡜ࡋࠊᚰ୙඲ᆅᇦ㐃ᦠࢧ
⟶⌮ࡀ኱ษࠖ
ࠕయ㔜 ᐃࡢ௙᪉ࠖ࡞࡝ࡀ࠶ࡗࡓࠋ
࣏࣮ࢺయไࡢᵓ⠏࡟ྲྀࡾ⤌ࢇ࡛࠾ࡾࠊᙜ㝔ᚰ
㸺ᚰ୙඲ࢭࣥࢱ࣮࢝ࣥࣇ࢓ࣞࣥࢫ㸼
୙඲ࢭࣥࢱ࣮ࡣࠊ┴ෆࡢ㸲ᚰ⮚࠸ࡁ࠸ࡁࢭࣥ
ᖺ ᭶ࡼࡾ㛤ጞࡋࠊ᭶࡟ ᅇ⛬ᗘ㛤ദ
ࢱ࣮࡜༠ാࡋࠊ┴ᇦ࡛ࡢᚰ⮚ࣜࣁࣅࣜࢸ࣮ࢩ
ࡋ࡚࠸ࡿࠋ᳨ᰝ⛉࡛㐌࡟㸯ᅇ 17SUR%13㸼
ࣙࣥࡢ᥎㐍ࠊከ⫋✀࡟ࡼࡿໟᣓⓗࢳ࣮࣒་⒪
ࡢᝈ⪅ࢆࢫࢡ࣮ࣜࢽࣥࢢࡋࠊ෌ධ㝔ࢆ⧞ࡾ㏉
ࡢᥦ౪యไ࡙ࡃࡾ࡟ྲྀࡾ⤌ࢇ࡛࠸ࡿࠋࡑࡇ࡛ࠊ
ࡍᝈ⪅࡞࡝ࢆᑐ㇟࡜ࡋ࡚ከ⫋✀࢝ࣥࣇ࢓ࣞࣥ
⌧ᅾࡲ࡛ࡢάືࡢ⤒㐣࡜௒ᗘࡢㄢ㢟࡟ࡘ࠸࡚
ࢫࢆ㛤ദࠋᝈ⪅ࡢᐙ᪘⫼ᬒࡸ⏕ά≧ἣࡢᢕᥱ
ሗ࿌ࡍࡿࠋ
ࢆ⾜ࡗࡓ࠺࠼࡛ࠊ⮬ᕫ⟶⌮⒪㣴⾜ືࡢ⋓ᚓᨭ
᥼ࡸࠊ♫఍㈨※ࡢᥦ౪ࠊࡲࡓ⤊ᮎᮇᝈ⪅࡟ᑐ
࠙άືෆᐜࠚ
ࡋ࡚ࡣ⦆࿴ࢣ࢔ࡢໟᣓⓗ௓ධࢆ⾜ࡗ࡚࠸ࡿࠋ
㸯㸬㝔ෆᚰ୙඲ࢭࣥࢱ࣮άື㸸ձᚰ⮚⑓ᩍ
᭶ᮎࡲ࡛࡟ ྡࡢᝈ⪅ࡢ௓ධࢆࡋ࡚࠾ࡾࠊ
ᐊղᚰ୙඲ࢭࣥࢱ࣮࢝ࣥࣇ࢓ࣞࣥࢫ
ᝈ⪅⫼ᬒࡣ ௦㹼 ௦ࡀ 㸣ࢆ༨ࡵ࡚࠸ࡿࠋ
㸰㸬ᗈᓥ┴ࡢᚰ୙඲ᆅᇦ㐃ᦠయไ࡙ࡃࡾ࡬ࡢ
㸫1㸫
― 50 ―
1<+$ ศ㢮ϩ㸣ࠊϪ㸣ࠊϫ㸣࡛ࠊᇶ♏⑌
ᝈࡣ⹫⾑ ࠊᘚ⭷⑕ ࠊᚰ➽⑌ᝈ ࡛࠶
ࡗࡓࠋ࢝ࣥࣇ࢓ࣞࣥࢫࡢຠᯝ࡜ࡋ࡚ࡣࠊ௓ධ
๓࡟෌ධ㝔ࢆ⧞ࡾ㏉ࡋ࡚࠸ࡓᝈ⪅ࡀࠊ௓ධᚋ
࡟⮬ᕫ⟶⌮⾜ືࢆ⋓ᚓࡋࠊ෌ධ㝔࡞ࡃ⤒㐣ࡋ
࡚࠸ࡿ⑕౛ࢆ⤒㦂ࡋࡓࠋ
㸺ᚰ➽᱾ሰ࣭ᚰ୙඲ᡭᖒ㸼
ᗈᓥ┴ᆅᇦᑐ⟇༠㆟఍ࡢసᡂࡋࡓᡭᖒࢆ⏝
࠸࡚ᝈ⪅ࡢ⮬ᕫ⟶⌮⋓ᚓ࡜ᆅᇦ㐃ᦠࢆ┠ᣦࡋ
࡚࠸ࡿࠋᚑ᮶ࡢࣃࢫ࡜ࡣ␗࡞ࡾࠊᝈ⪅ᦠᖏᆺ
ࡢᡭᖒ࡛࠶ࡾࠊᝈ⪅ࡀᣢࡕṌࡃࡇ࡜࡛ᆅᇦࡢ
⑓㝔ࠊデ⒪ᡤࠊゼၥ┳ㆤࢫࢸ࣮ࢩࣙࣥࠊ⸆ᒁࠊ
ࢹ࢖ࢧ࣮ࣅࢫ࡞࡝࡛᝟ሗࡢඹ᭷ࡀ⾜࠼ࡿࠋ㝔
ෆ࡛ࡣᚠ⎔ჾ⛉ࡢධ㝔ᝈ⪅඲ဨ࡟㓄ᕸࡋࠊ㝔
እ࡜ࡢ㐃ᦠࠊᡭᖒࡢᬑཬࡢࡓࡵࡢ◊ಟ఍ࡢ㛤
ദࢆ⾜ࡗ࡚࠸ࡿࠋ
㸺ᚰ⮚࠸ࡁ࠸ࡁ࢟ࣕࣛࣂࣥ◊ಟ㸼
ᚰ୙඲ࢭࣥࢱ࣮࡜㸲ᚰ⮚࠸ࡁ࠸ࡁࢭࣥࢱ࣮
࡛ᚰ୙඲ᆅᇦ㐃ᦠయไࡢᵓ⠏ࡢࡓࡵࡢ◊ಟ఍
ࢆ⾜࠸ࠊ㸳ࣧᡤ࡛ྜィ ྡࡢཧຍ⪅ࡀ࠶ࡗ
ࡓࠋᆅᇦࡢデ⒪ᡤࠊ⸆ᒁࠊゼၥ௓ㆤ஦ᴗᡤ࡞
࡝ࡼࡾࠊ་ᖌࠊ┳ㆤᖌࠊಖ೺ᖌࠊࢣ࢔࣐ࢿࠊ
⌮Ꮫ⒪ἲኈࠊ⟶⌮ᰤ㣴ኈࠊ⸆๣ᖌ࡞࡝ከ⫋✀
ࡀ㞟ࡲࡾࠊᚰ୙඲ࡢᆅᇦ㐃ᦠయไ࡙ࡃࡾ࡟ᑐ
ࡍࡿ㛵ᚰࡢ῝ࡉࡀࡳࡽࢀࠊᆅᇦࡢࢫࢱࢵࣇ࡛
஺ὶࡋ࡞ࡀࡽ஦౛᳨ウࢆ⾜࠸ࡓ࠸࡞࡝ࡢពぢ
ࡀ࠶ࡗࡓࠋ
࠙⪃ᐹࠚ
㝔ෆ࡛ࡣከ⫋✀ࢳ࣮࣒ࡢ௓ධ࡟ࡼࡾࠊᝈ⪅
ࡣ⮬ศࡢ⑓Ẽ࡟ࡘ࠸࡚᪂ࡓ࡞Ꮫࡧࢆᚓࠊ⑓Ẽ
࡜ྥࡁྜ࠸ࠊࡘࡁ࠶ࡗ࡚࠸ࡃࡇ࡜ࡢ㔜せᛶࢆ
ㄆ㆑ࡋࠊ⮬ᕫ⟶⌮⒪㣴⾜ືࡢ⋓ᚓࡀ࡛ࡁ࡚࠸
ࡿ࡜⪃࠼ࡿࠋࡲࡓࠊ᪂ࡓ࡞άືࢆ㏻ࡌࢫࢱࢵ
ࣇ⮬㌟ࡀᚰ୙඲་⒪ࡢຮᙉࢆ㔜ࡡࡿࡼ࠺࡟࡞
ࡾࠊᚰ୙඲ࢳ࣮࣒་⒪ࢆᢸ࠺ேᮦ⫱ᡂࡶྠ᫬
࡟⾜࠼࡚࠸ࡿࠋ
ᗈᓥ┴࢟ࣕࣛࣂࣥ◊ಟ࡛ࡣࠊᆅᇦࡢከ⫋✀
ࡢཧຍࡀከࡃᚰ୙඲ࢣ࢔࡟ᑐࡍࡿၥ㢟ព㆑ࠊ
ᆅᇦ㐃ᦠయไ࡙ࡃࡾ࡬ࡢពḧࡀఛ࠼ࠊ◊ಟ㛤
ദࢆ⥅⥆ࡋ࡚࠸ࡃព⩏ࡀぢ࠸ࡔࡏࡓࠋ
࠙௒ᚋࡢㄢ㢟ࠚ
ᚰ୙඲ᝈ⪅࡟ᑐࡍࡿໟᣓⓗࢳ࣮࣒་⒪
ࡢຠᯝࡢ᳨ド
ᚰ➽᱾ሰ࣭ᚰ୙඲ᡭᖒࡢᬑཬάື࡜࢟ࣕ
ࣛࣂࣥ◊ಟࡢ⥅⥆࡟ࡼࡿᆅᇦ㐃ᦠయไ
࡙ࡃࡾࡢᙉ໬
࠙ཧ⪃ᩥ⊩ࠚ
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ᗈᓥ┴ ᖹᡂ ᖺேཱྀືែ⤫ィᖺሗ➨
ྕ 3
㸫2㸫
― 51 ―
16
ᛴᛶᮇ⑓㝔࡟࠾ࡅࡿᚋᮇ㧗㱋ᚰ୙඲ᝈ⪅ࡢࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ㐍⾜≧ἣ
㸫᪩ᮇࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ㛤ጞࡢ᭷⏝ᛶ㸫
㸦㈈㸧಴ᩜ୰ኸ⑓㝔ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢭࣥࢱ࣮
ࡋ ࡶ ࡀ ࠸ ࡓ࠿ࡺࡁ
࠿ ࢃ ࡔ ࡳࡢࡿ
࠿ ࢃ ࡔ ࡵࡄࡳ
ࡣ ࡞ ࡓ ࡲࡉࡼࡋ
ࡣ ࡲ ࡢ ࡓ࠸ࡊࡪࢁ࠺
࡚ࡽࡸࡲ ࡲ ࡉ ࡜
ࡓ࠿ࡣࡋࡅ࠸ࡍࡅ
‫ۑ‬ୗ㞞ពᓫ஽㸪ᕝ⏣ ⛱ 㸪ᕝ⏣ ᜨ 㸪ⰼ⏣┿჆㸪὾㔝Ὀ୕㑻㸪ᑎᒣ㞞ே㸪㧗ᶫᩗ௓
࠙ࡣࡌࡵ࡟ࠚ &+) ᝈ⪅࡟ᑐࡍࡿᚰ⮚ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ
㸦௨ୗࠊᚰࣜࣁ㸧࡟࠾࠸࡚ࠊ㧗㱋⪅ࡢᚰࣜࣁ
ࡢ㐍⾜ᗘࢆ᫂ࡽ࠿࡟ࡋࡓ◊✲ࡣᑡ࡞࠸ࠋࡑࡇ
࡛ࠊධ㝔᪩ᮇ࠿ࡽᚰࣜࣁࡀ㛤ጞࡉࢀࠊṌ⾜⮬
❧ࡀྍ⬟࡛࠶ࡗࡓ &+) ⑕౛࡟ᑐࡋࠊᚋᮇ㧗㱋
⪅ࡢᚰࣜࣁࡢ㐍⾜≧ἣ࡟ࡘ࠸᳨࡚ウࢆ⾜ࡗࡓࠋ
࠙ᑐ㇟ࠚ
ᖺ㸯᭶࠿ࡽ ᖺ㸷᭶࡟ᙜ㝔࡟ධ㝔
ࡋࡓ &+) ᝈ⪅ࡢ࠺ࡕࠊᚰ⮚㞟୰἞⒪ᐊ௨ୗࠊ
&&8࠿ࡽᚰࣜࣁࡀ㛤ጞ࡜࡞ࡾࠊࡑࡢᚋࠊṌ⾜
⮬❧࡜ุ᩿ࡉࢀࡓᝈ⪅ ౛㸦⏨ᛶ ౛ࠊዪ
ᛶ ౛ࠊs ṓ㸧࡛࠶ࡿࠋ&+) ࡟⮳ࡿ
ཎᅉ⑌ᝈࡢෆヂࡣ⹫⾑ᛶᚰ⑌ᝈ ౛ࠊᘚ⭷⑕
౛ࠊᚰ➽⑕ ౛ࠊࡑࡢ௚㸦㧗⾑ᅽࠊ୙ᩚ
⬦ࠊឤᰁ࡞࡝㸧 ౛࡛࠶ࡗࡓࠋᮏ◊✲࡛ࡢṌ
⾜⮬❧ࡣࠊP ௨ୖࡢṌ⾜ࡀྍ⬟࡜࡞ࡗࡓ⑕
౛ࠊࡲࡓࡣධ㝔๓ࡢṌ⾜⬟ຊ࡜ྠ➼ࡲ࡛ᅇ᚟
ࡋࡓ⑕౛࡜ᐃࡵࡓࠋ
࠙᪉ἲࠚ
ᖺ㱋࡟ࡼࡿᙳ㡪ࢆㄪᰝࡍࡿⅭ࡟ୖグᑐ㇟ࢆ
ᚋᮇ㧗㱋⩌㸦 ṓ௨ୖ㸧 ౛࡜ⱝᖺ⩌㸦
ṓᮍ‶㸧 ౛ࡢ㸰ࡘ࡟⩌ศࡅࢆ⾜ࡗࡓࠋᝈ⪅
ࡢ⫼ᬒᅉᏊ࡜ࡋ࡚ࠊᛶูࠊ%RG\0DVV,QGH[
㸦௨ୗࠊ%0,㸧ࢆㄪᰝࡋࠊධ㝔୰⤒㐣࡜ࡋ࡚ධ
㝔᫬ཬࡧ㏥㝔᫬ࡢ⬻ᛶࢼࢺ࣒ࣜ࢘฼ᒀ࣌ࣉࢳ
ࢻ㸦௨ୗࠊ%13㸧ࠊ& ཯ᛂᛶ⺮ⓑࡢ᭱኱್㸦௨
ୗࠊ᭱኱ &53㸧
ࠊࢡࣞ࢔ࢳࣥࣇ࢛ࢫࣇ࢛࢟ࢼ࣮
ࢮࡢ᭱኱್㸦௨ୗࠊ᭱኱ &3.㸧ࠊᕥᐊ㥑ฟ⋡㸦௨
ୗࠊ/9()㸧ࠊ⭸㛵⠇ఙᒎ➽ຊ㸭య㔜ẚ㸦௨ୗࠊ
➽ ຊ ್ 㸧ࠊ PRGLILHG̽)XQFWLRQDO 5HDFK
7HVWP)57ࢆㄪᰝࡋࡓࠋᛴᛶᮇ⟶⌮㡯┠࡜
ࡋ࡚ࠊᣢ⥆ⓗ⾑ᾮℐ㐣㏱ᯒ㸦௨ୗࠊ&+')㸧ࠊ
6ZDQ*DQW] ࢝ࢸ࣮ࢸࣝ㸦௨ୗࠊ6* ࢝ࢸ࣮ࢸࣝ㸧ࠊ
኱ື⬦ෆࣂ࣮ࣝࣥࣃࣥࣆࣥࢢ࣭⤒⓶ⓗᚰ⫵⿵
ຓ⿦⨨➼ࡢ⿵ຓᚠ⎔ࡢ౑⏝᭷↓ࢆㄪᰝࡋࡓࠋ
ᚰࣜࣁࡢ㐍⾜≧ἣ࡜ࡋ࡚ࠊᅾ㝔᪥ᩘࠊධ㝔᪥
࠿ࡽᚰࣜࣁ㛤ጞࡲ࡛ࡢ᪥ᩘ㸦௨ୗࠊᚰࣜࣁ㛤
ጞ᪥㸧
ࠊධ㝔࠿ࡽ➃ᗙ఩㛤ጞࡲ࡛ࡢ᪥ᩘ㸦௨ୗࠊ
➃ᗙ఩㛤ጞ᪥㸧
ࠊධ㝔࠿ࡽ㉳❧㛤ጞࡲ࡛ࡢ᪥ᩘ
㸦௨ୗࠊ㉳❧㛤ጞ᪥㸧ࠊධ㝔࠿ࡽṌ⾜㛤ጞࡲ࡛
ࡢ᪥ᩘ㸦௨ୗࠊṌ⾜㛤ጞ᪥㸧
ࠊධ㝔࠿ࡽṌ⾜⮬
❧ࡲ࡛ࡢ᪥ᩘ㸦௨ୗࠊṌ⾜⮬❧᪥㸧ࢆㄪᰝࡋ
ࡓࠋ⭸㛵⠇ఙᒎ➽ຊࡢ ᐃࡣ➽ຊィ㸦࢔ࢽ࣐
♫〇࣑࣮ࣗࢱࢫ )̺㸧ࢆ౑⏝ࡋࡓ㸦NJI㸧ࠋ⤫
ィゎᯒ࡟ࡣ ,%063666WDWLVWLFVYHUVLRQ
ࢆ౑⏝ࡋࠊȮ ᳨ᐃࠊ0DQQ:KLWQH\ ࡢ 8 ᳨ᐃࠊ
ᑐᛂࡢ࡞࠸W ᳨ᐃࢆ⏝࠸ࠊ᭷ពỈ‽ࢆ༴㝤⋡
㸣ᮍ‶࡜ࡋࡓࠋࢹ࣮ࢱࡣṇつศᕸࡍࡿኚᩘࡣ
ᖹᆒsᶆ‽೫ᕪࠊṇつศᕸࡋ࡞࠸ኚᩘࡣ୰ኸ
್㸦ᅄศ఩⠊ᅖ㸧ࢆ♧ࡋࡓࠋ࡞࠾ࠊᮏ◊✲ࡣ
ᙜ㝔ࡢಶே᝟ሗಖㆤ᪉㔪࡟‽ࡌ࡚ࠊᝈ⪅࠾ࡼ
ࡧᐙ᪘࡟ࡼࡾྠពࢆᚓ࡚ᐇ᪋ࡋ࡚࠸ࡿࠋ
࠙⤖ᯝࠚᚋᮇ㧗㱋⩌࡜ⱝᖺ⩌࡜ࡢẚ㍑࡟ࡘ࠸
࡚⾲㸯࡟♧ࡍࠋ
࠙⪃ᐹࠚ
௒ᅇࡢ᳨ウ࡛ࡣࠊᝈ⪅⫼ᬒᅉᏊࡸධ㝔୰⤒㐣
ࡢ࠺ࡕࠊ/9() ࡟᭷ពᕪࢆㄆࡵ࡚࠸ࡓࠋ/9()
ࡣ⮫ᗋⓗ࡟ỗ⏝ࡉࢀ࡚࠸ࡿᚰᶵ⬟ᣦᶆ࡛࠶ࡿ
ࡀࠊࡇࢀࡣຍ㱋࡟ᚑࡗ࡚ᚰᶵ⬟ࡀపୗࡍࡿ 㸧
ࡇ࡜࡟ࡼࡾ᭷ពᕪࢆㄆࡵࡓࡶࡢ࡜⪃࠼ࡓࠋ
ᚰࣜࣁ㐍⾜≧ἣ࡛ࡣࠊᅾ㝔᪥ᩘࡣ୧⩌࡛᭷ព
ᕪࡀㄆࡵࡽࢀ࡞࠸ࡀࠊධ㝔࠿ࡽᚰࣜࣁ㛤ጞࠊ
➃ᗙ఩ࠊ㉳❧㛤ጞࡲ࡛ࡢᮇ㛫ࡀᚋᮇ㧗㱋⩌࡛
▷࠿ࡗࡓࠋࡇࢀ࡟ࡣձᚰࣜࣁฎ᪉ࡢࢩࢫࢸ࣒
໬ղ㐺ษ࡞ࣜࢫࢡ⟶⌮ୗ࡛ࡢᚰࣜࣁᐇ᪋࡟ࡼ
ࡿ㐠ືᶵ⬟⥔ᣢࡢ㸰Ⅼࢆ⌮⏤࡟⪃࠼ࡓࠋձࡢ
ᚰࣜࣁฎ᪉ࡢࢩࢫࢸ࣒໬࡟ࡘ࠸࡚ࡣࠊᙜ㝔ࡢ
㸫1㸫
― 52 ―
ࣜࣁ⛉་ᖌᩘࡣ㸰ྡ࡛࠶ࡾࠊ⤂௓ᝈ⪅ᩘࡢቑ
ຍ࡟క࠸ฎ᪉ࡲ࡛ࡢᮇ㛫ࡀ㛗ࡃ࡞ࡾࠊࣜࣁ㛤
ጞࡀ㐜ᘏࡍࡿ஦ࡀㄢ㢟࡜࡞ࡗ࡚࠸ࡓ⫼ᬒࡀ࠶
ࡿ ࠋࡑࡇ࡛ࠊᚠ⎔ჾෆ⛉࡟࠾࠸࡚ࡣ ᖺ
᭶ࡼࡾ┤᥋ฎ᪉ࡀ㛤ጞࡉࢀࠊ&&8 ࡛ࡣᚰࣜ
ࣁ㛤ጞᇶ‽ࢆᐃࡵࡓࠋࡇࡢ㛤ጞᇶ‽ࡣࠊᚠ⎔
ືែࡢᏳᐃࢆ๓ᥦ࡟ࠊ ṓ௨ୖࠊ୍㐌㛫௨ୖ
&&8 ࡟ᅾᐊࡍࡿぢ㎸ࡳࡢ࠶ࡿሙྜࠊᐃᮇⓗ࡟
⾜ࢃࢀࡿࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ࢝ࣥࣇ࢓ࣞࣥࢫ
࡛≉࡟ᚲせ࡜ุ᩿ࡉࢀࡓሙྜࠊࡢ㸱᮲௳࠸ࡎ
ࢀ࠿ࡀヱᙜࡍࡿሙྜ࡛࠶ࡾࠊ୺἞་࣭&&8 ᑓ
⾲ 1 ⱝᖺ⩌࡜ᚋᮇ㧗㱋⩌ࡢྛ㡯┠ẚ㍑
ⱝᖺ⩌
ᚋᮇ㧗㱋⩌
p್
62.9±9.8
83.0±4.4
p㸺0.05
ᝈ⪅⫼ᬒᅉᏊ
ᖺ㱋㸦ṓ㸧
ᛶู㸦⏨㸸ዪ㸧
BMI㸦kg/੍㸧
37㸸29
40㸸14
p㸺0.05
21.8(3.6)
22.2(5.5)
n.s
4/62㸦6 %㸧
8/46㸦14.8%㸧
n.s
ᛴᛶᮇ⟶⌮㡯┠
CHDF㸦᭷/↓㸧
SG 㺔㺡㺎㺡㺷㸦᭷/↓㸧 18/48㸦27.3%㸧 22/32㸦40.7%)
n.s
5/61㸦7.5%㸧
5/49㸦9.2%㸧
n.s
ධ㝔᫬ BNP
㸦pg/ml㸧
805(1463)
838(930)
n.s
㏥㝔᫬ BNP
㸦pg/ml㸧
264(461.0)
326(388.3)
n.s
⿵ຓᚠ⎔㸦᭷/↓㸧
ධ㝔୰⤒㐣
maxCRP(mg/dl)
5.0(8)
4.5(9)
n.s
maxCPK(IU/l)
198.0(432)
221.0(477)
n.s
LVEF(%)
45.7±14.4
37.1±14.9
p㸺0.05
➽ຊ್㸦kgf/kg㸧
0.35(0.16)
0.32(0.16)
n.s
m-FRT(cm)
30.0(7.0)
28.0(11.0)
n.s
ᚰࣜࣁ㛤ጞ㸦᪥㸧
6(6)
5(4)
p㸺0.05
➃ᗙ఩㛤ጞ㸦᪥㸧
7(6)
5(3)
p㸺0.05
㉳❧㛤ጞ㸦᪥㸧
7(6)
6(3)
p㸺0.05
Ṍ⾜㛤ጞ㸦᪥㸧
7(8)
7(5)
n.s
Ṍ⾜⮬❧㸦᪥㸧
13(9)
15(7)
n.s
ᅾ㝔᪥ᩘ㸦᪥㸧
24(21)
19(10)
n.s
ᚰࣜࣁ㐍⾜≧ἣ
௵་ࡼࡾᚰࣜࣁࡢฎ᪉ࡀ࡞ࡉࢀ࡚࠸ࡿࠋࡘࡲ
ࡾࠊ≉࡟㧗㱋⪅࡟࠾ࡅࡿᚰࣜࣁฎ᪉ࡢࢩࢫࢸ
࣒໬ࡀ࡞ࡉࢀ࡚࠾ࡾࠊ᪩ᮇ࠿ࡽᚰࣜࣁࡀᐇ᪋
࡛ࡁ࡚࠸ࡿ≧ἣࡀዌຌࡋ࡚࠸ࡿ⤖ᯝ࡜⪃࠼
ࡓࠋղࡢ㐺ษ࡞ࣜࢫࢡ⟶⌮ୗ࡛ࡢᚰࣜࣁᐇ᪋
࡟ࡼࡿ㐠ືᶵ⬟⥔ᣢ࡟ࡘ࠸࡚ࡣࠊ㧗㱋⪅࡟ࡶ
࠿࠿ࢃࡽࡎ㐠ືᶵ⬟ࢆ♧ࡍ➽ຊ್ࡸ P̽)57 ࡛
୧⩌࡟᭷ពᕪࢆㄆࡵ࡞࠿ࡗࡓࡇ࡜࠿ࡽࠊᚰࣜ
ࣁࡢᐇ᪋࡟ࡼࡾ෇⁥࡞㞳ᗋࡀᅗࢀ࡚࠸ࡿࡇ࡜
࡛ࠊ㐠ືᶵ⬟ࡀ⥔ᣢ࡛ࡁ࡚࠸ࡓࡶࡢ࡜⪃࠼ࡓࠋ
ᒣ⏣ࡽ 㸧ࡣࠊᚋᮇ㧗㱋 &+) ᝈ⪅࡛ࡣࠊᛴᛶᮇ
἞⒪࡜୪⾜ࡋ࡞ࡀࡽ㞳ᗋࡸ࣋ࢵࢻୖࡸ࣋ࢵࢻ
ࢧ࢖ࢻ࡛ྍ⬟࡞➽ຊࢺ࣮ࣞࢽࣥࢢ࡞࡝ࠊࢹࢥ
ࣥࢹ࢕ࢩࣙࢽࣥࢢண㜵┠ⓗ࡟᪩ᮇ࠿ࡽࣜࣁࣅ
ࣜࡢᐇ᪋ࡀ㔜せ࡛࠶ࡿ࡜㏙࡭࡚࠸ࡿࠋᙜ㝔࡛
ࡶࠊྠᵝࡢᚰࣜࣁࢆᐇ᪋࡛ࡁ࡚࠸ࡿࡇ࡜ࡀࠊ
ᚋᮇ㧗㱋⩌࡛ࡢṌ⾜⮬❧࡟ࡘ࡞ࡀࡗ࡚࠾ࡾࠊ
᪩ᮇ࠿ࡽࡢᚰࣜࣁ㛤ጞࡢព⩏ࡀ࠶ࡿ࡜⪃࠼ࡓࠋ
࠙ࡲ࡜ࡵࠚ
௒ᚋࡣⱝᖺ⪅ࡸṌ⾜⮬❧ᅔ㞴⪅࡟ࡶ┠ࢆྥࡅࠊ
᪩ᮇ㞳ᗋࢆᅗࡾᅾ㝔᪥ᩘࡢ▷⦰໬ࡸ෌ධ㝔⋡
ࡢῶᑡࢆᅗࢀࡿࡼ࠺ࠊᚰࣜࣁࢫࢱࢵࣇ㛫࡛᭦
࡟༠ຊࡋయไࢆ☜❧ࡋ࡚࠸ࡃ࡭ࡁ࡛࠶ࡿࠋ
࠙ཧ⪃ᩥ⊩ࠚ
㸧᳃ᑿ⿱ᚿ㸸ᣦ♧Წࢆ⏝࠸ࡓ )XQFWLRQDO
5HDFK7HVW ࡢ㛤Ⓨ⥲ྜࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ
㸸
㸧ୖ᭶ṇ༤㸸㧗㱋⪅ࡢᚠ⎔㞀ᐖࡢ≉ᛶ⌮Ꮫ
⒪ἲ 㸸
㸧Ọ⏣ᖾ⏕Ἡ೺ኴ୰ᑿ཭⨾ᒣཱྀ៞Ꮚᅵᒃ
ెዉ㔛⨾ྐ⩏୰ᓮྐỤᑠ➟ཎ⌮ᜨ⣒ᒣඞ
ဢᕝ⏣⛱ఀໃ┾ᶞ⯆ᲆ㝧ᖹ㸸ෆ⛉⣔࡟࠾ࡅ
ࡿ ࿧ ྾ ࣜ ࣁ ࣅ ࣜ ࢸ ࣮ ࢩ ࣙ ࣥ -RXUQDO RI
&OLQLFDO5HKDELOLWDWLRQ㸸
㸧ᒣ⏣ᬛ⨾㰺⸨ṇ࿴ᰗᇼ᫂ஂୖ⬥⋹ዉ
᱓ཎᬗᏊ▼஭඾Ꮚఀ㐩฼ᜨㅖᐩఙኵ㛗ᒣ
㞞ಇ㸸㔜⑕ᚰ୙඲ᝈ⪅࡟ᑐࡍࡿධ㝔ᮇᚰ⮚ࣜ
ࣁࣅࣜࢸ࣮ࢩࣙࣥࡢ᳨ウᚰ⮚ࣜࣁࣅࣜࢸ࣮
ࢩࣙࣥ 㸸
㸫2㸫
― 53 ―
17
≉Ⓨᛶᣑᙇᆺᚰ➽⑕ࢆ࿊ࡋࡓ⤊ᮎᮇᚰ୙඲ᝈ⪅࡟ᑐࡍࡿ
ᚰ⮚ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࡢ⤒㦂
ᗈᓥ኱Ꮫ⑓㝔デ⒪ᨭ᥼㒊ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ㒊㛛㸯㸪ᗈᓥ኱Ꮫ⑓㝔ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⛉㸰
ࡉ࠿ࡢ
ࡋࡹ࠺࡬࠸
ࡓࡋࢁ
࡞࠾ࡢࡾ
ࡁࡴࡽ
ࡦࢁ࠶ࡁ
‫ۑ‬ᆏ㔝 ࿘ ᖹ㸯㸪⏣௦ ᑦ⠊㸯㸪ᮌᮧ ᾈᙲ㸰
࠙ࡣࡌࡵ࡟ࠚ
≉Ⓨᛶᣑᙇᆺᚰ➽⑕ࡣ㐍⾜ᛶ࡟ᚰ➽཰⦰
㞀ᐖ࡜ᕥᐊෆ⭍ࡢᣑᙇࢆࡁࡓࡋࠊᕥᐊᶵ⬟ప
ୗ࠿ࡽ㔜ᗘᚰ୙඲࡟⮳ࡿ⑓ែࢆ࿊ࡍࡿணᚋ
୙Ⰻࡢ⑌ᝈ⩌࡛࠶ࡿ㸯㸧ࠋࡇࡢᗘ㸪ᮏ⑌ᝈࢆ࿊
ࡋ⸆≀἞⒪࣭ᶵᲔⓗ⿵ຓ἞⒪ࡸእ⛉ⓗ἞⒪ࡀ
ᐇ᪋ࡉࢀࡓᚋࡶᚰ୙඲⑕≧ࡀㄆࡵࡽࢀࡓ⑕
౛ࢆᢸᙜࡋࡓࠋ⤊ᮎᮇ࡟㝿ࡋࡓ࡜⪃࠼ࡽࢀࡓ
⑕౛࡟ᑐࡋ࡚㸪42/ ⥔ᣢࡢࡓࡵ࡟⮬Ꮿ㏥㝔ࢆ
┠ᶆ࡜ࡋࡓࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢆ⾜ࡗࡓ⤒
㐣ࢆሗ࿌ࡍࡿࠋ
࠙⑕౛ࠚ
ṓዪᛶࠋ ᖺ๓ࡼࡾ㠀⹫⾑ᛶᚰ➽⑕ࡢデ
᩿࡟࡚㏆་ࣇ࢛࣮ࣟ୰࡛࠶ࡗࡓࠋ ᖺ ᭶㸪
ᙜ㝔࡟࡚୧ᐊ࣮࣌ࢩࣥࢢᶵ⬟௜ࡁ᳜㎸ࡳᆺ
㝖⣽ືჾ㸦&57'㸧᳜㎸ࡳ⾡᪋⾜ࠋ ᖺ ᭶㸪ᚰ୙඲ຍ⒪ࡢࡓࡵᙜ㝔ධ㝔ࡋ㠀౵くⓗ㝧
ᅽ᥮Ẽ⒪ἲ㸦1339㸧ࢆᑟධࠋ௨㝆እ᮶ࣇ࢛ࣟ
࣮ࡀ⥅⥆ࡉࢀࡓࠋ ᖺ ᭶࡟ᚰ୙඲⑕≧ࡢ
ቑᝏࢆㄆࡵ㸪ຍ⒪ࡢࡓࡵᙜ㝔ධ㝔ࠋ ᭶ୗ᪪
࡟㏥㝔࡜࡞ࡿࡀ㸪㏥㝔ᚋ ᪥࡛ᚰ୙඲⑕≧ࡀ
෌ቑᝏࡋ෌ධ㝔࡜࡞ࡗࡓࠋධ㝔ᚋ࡟ࢻࣈࢱ࣑
ࣥሷ㓟ሷȚᣢ⥆㟼ὀୗ࡛἞⒪㛤ጞࡉࢀ㸪
➨ ⑓᪥ࡼࡾࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ㛤ጞ࡜࡞
ࡿࠋ
࠙ධ㝔᫬ᡤぢࠚ
1<+$ ศ㢮ϫᗘࠋᚰ࢚ࢥ࣮ᕥᐊᣑᙇ⤊ᮇ
཰⦰⤊ᮇᚄ㸦/9'G/9'V㸧PPPPᕥᐊ
ᣑᙇ⤊ᮇᐜ㔞PO㸪ᕥᐊ཰⦰⬟ᚰᐊቨ඲
࿘ⓗ࡟ప཰⦰㹼↓཰⦰㸪ᕥᐊ㥑ฟ⋡
㸦/9()㸧㸪(H̓ࠋᕥᐊᶵ⬟పୗ
ࡣ㧗ᗘ࡛࠶ࡾ㸪㔜ᗘࡢᶵ⬟ᛶൔᖗᘚ㛢㙐୙඲
ࢆ࿊ࡋ࡚࠸ࡓࠋ
࠙἞⒪⤒㐣ࠚ
ධ㝔ᚋ㸪ᚰᶵ⬟ࡢ⿵ຓ࡜యỈศࢥࣥࢺ࣮ࣟ
ࣝ┠ⓗࡢ἞⒪ࡀ࡞ࡉࢀࡓࡀ࢝ࢸࢥ࣑ࣛࣥ㞳
⬺ࡀᅔ㞴࡛࠶ࡗࡓࡓࡵ㸪➨ ⑓᪥࡟పᚰᶵ
⬟࡟క࠺ᶵ⬟ᛶൔᖗᘚ㛢㙐୙඲࡟ᑐࡋ࡚ൔ
ᡣᘚ⨨᥮⾡᪋⾜ࠋ⾡ᚋ㸪⣙ ࣨ᭶㛫ࡣᚰ୙඲
⑕≧ࡢቑᝏ࡜ᐶゎࢆ⧞ࡾ㏉ࡋࡓࡀ㸪ᚎࠎ࡟⑕
≧ࡢᅇ᚟ࡀぢࡽࢀ㸪➨ ⑓᪥࡟࢝ࢸࢥ࣑ࣛ
ࣥ㞳⬺࡜࡞ࡿࠋ➨ ⑓᪥࡟ࡣ⮬ᏯእἩࢆ⤒
㦂ࡉࢀ㸪➨ ⑓᪥࡟⮬Ꮿ㏥㝔࡜࡞ࡿࠋ
࠙ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⤒㐣ࠚ
ධ㝔㹼ᡭ⾡ࡲ࡛㸦㹼➨ ⑓᪥㸧
⾡๓ᮇ࡟࠾࠸࡚ࡣ㸪⮬ᐊࢺ࢖ࣞࡲ࡛ࡢ P
⛬ᗘࡢṌ⾜࡛ᜥษࢀឤࡀฟ⌧ࡋ࡚࠾ࡾ㸪᪥୰
ࡣ࡯ࡰ⮩ᗋࡉࢀ࡚࠸ࡿ≧ែ࡛࠶ࡗࡓࠋ┠ⓗࢆ
㐠ື⪏ᐜ⬟࣭㦵᱁➽➽ຊࡢ⥔ᣢ࡜ᐃࡵ㸪ᢞ⸆
≧ἣࡸ඲㌟≧ែࡢࣔࢽࢱࣜࣥࢢୗ࡛㍍㈇Ⲵ
࡛ࡢ⮩఩࣭ᗙ఩࡛ࡢ࢔ࢩࢫࢺ௜⡆࢚᫆ࣝࢦ࣓
࣮ࢱ࣮㐠ື㸪ୗ⫥⮬ື௓ຓ㐠ືࢆᐇ᪋ࡋࡓࠋ
㐠ືᐇ᪋ᇶ‽࡟㛵ࡋ࡚ࡣ (6&:RUNLQJ*URXS
ࡢ່࿌ 㸧ࢆཧ⪃࡟ࡋࡓࠋ㐠ື⒪ἲᐇ᪋࡟㝿ࡋ
࡚㸪༶᫬ⓗ཯ᛂ࡜ࡋ࡚㐠ື୰࡟཰⦰ᮇ⾑ᅽࡀ
PP+J ௨ୖపୗࡋ࡞࠸ࡇ࡜㸪㐠ືᚋ 㸫 ᪥
௨ෆࡢᛴ⃭࡞ᒀ㔞పୗࡸయ㔜ቑຍࡀ⏕ࡌ࡞
࠸ࡇ࡜ࢆ㐠ືᐇ᪋ᇶ‽࡜ࡋࡓࠋ
― 54 ―
ᡭ⾡ᚋ㹼㏥㝔ࡲ࡛㸦➨ 㹼➨ ⑓᪥㸧
ᡭ⾡ᚋ㸪኱ື⬦ࣂ࣮ࣝࣥࣃࣥࣆࣥࢢ㞳⬺ᚋ
ࡼࡾࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢆ෌㛤ࠋ⾡๓࡟‽ࡌ
ࡓ㐠ືᐇ᪋ᇶ‽ୗ࡛ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥࢆ
ᐇ᪋ࠋ἞⒪≧ἣࡸ඲㌟≧ែࡢ⤒㐣࡟ᛂࡌࡓ㐠
ື⒪ἲࢆᐇ᪋ࡋࡓࡀ㸪▷ᮇⓗ࡟ࡣᚰᶵ⬟ࡸ඲
㌟≧ែ㸪ୗ⫥ᚐᡭ➽ຊ᳨ᰝ㸦007㸧ୖ࡛ࡢᨵ
ၿࡣᚓࡽࢀ࡞࠿ࡗࡓ㸦⾲ 㸧ࠋࡑࡢࡓࡵ㸪ᚎࠎ
࡟㐍⾜ࡍࡿᚰ୙඲⑕≧࡟క࠺⢭⚄ⓗ୙Ᏻࡢ
㍍ῶࢆᅗࡾࡘࡘ㸪⾡๓Ỉ‽ࡢ㌟యᶵ⬟࣭ᒇෆ
⛣ື⬟ຊࢆ⥔ᣢࡋ⮬Ꮿ㏥㝔ࢆ┠ᣦࡍࡇ࡜ࢆ
┠ᶆ࡜ࡋࡓࠋ⛣ື⬟ຊ࡟㛵ࡋ࡚ࡣ㸪⾡ᚋ㸯ࣨ
᭶ࡢ᫬Ⅼ࡛ P ⛬ᗘࡢṌ⾜ࡀྍ⬟࡜࡞ࡾ㸪㏥
㝔๓ࡢ᫬Ⅼ࡛㸪ᡭࡍࡾ➼ࢆ౑⏝ࡋࡓ⑓Ჷෆ࡛
ࡢ P ⛬ᗘࡢṌ⾜ࡀྍ⬟࡜࡞ࡗࡓࠋ
⾲ 1 ᚰᶵ⬟࣭඲㌟≧ែ࡜ୗ⫥➽ຊࡢ᥎⛣
ධ㝔
ᡭ⾡
⾡ᚋ
㏥㝔
᫬
┤๓
1 ࣨ᭶
๓
NTpro
BNP
LVDd
LVDs
LVEF
E/e’
య㔜
⫤ఙᒎ
⫤እ㌿
⭸ఙᒎ
11641
34537
5.8
5.3
32
18.6
40.5
㸫/㸫
㸫/㸫
㸫/㸫
5.9
5.1
30
13.3
36.5
㸫/㸫
㸫/㸫
26401
16875
5.7
6.1
5.5
5.7
13
11
37.2
27.3
38.3
34.7
3/2
3/2
2/2
3/2
4/4
3/3
4/3
➽ຊࡣྑഃᕥഃ࡛⾲グ
➨ 53 ⑓᪥࡟ᡭ⾡ᐇ᪋
࠙⪃ᐹࠚ
$&&$+$ ࡢ៏ᛶᚰ୙඲࡟ᑐࡍࡿデ᩿࡜⟶⌮
ࡢ࢞࢖ࢻࣛ࢖ࣥ 㸧࡛ࡣ 6WDJH'㸸㞴἞ᛶ⤊ᮎᮇ
ᚰ୙඲࡟ᑐࡍࡿ່࿌ࡀ♧ࡉࢀ࡚࠸ࡿࠋࡑࡇ࡛
ࡣ㔜⠜࡞⑕≧ࢆ᭷ࡍࡿᝈ⪅࡟ᑐࡋ࡚⤊ᮎᮇ
ࢣ࢔࡟㛵ࡍࡿ᳨ウࢆ⾜࠺ࡇ࡜ࡀ᥎ዡࡉࢀ࡚
࠸ࡿࠋᮏ⑕౛࡟࠾࠸࡚ࡣ་ᖌࢆ୰ᚰ࡜ࡋ࡚ࡈ
ᐙ᪘࡜༠㆟ࡋࡓ⤖ᯝ㸪⑕౛⮬㌟ࡢពྥࢆᑛ㔜
ࡋ࡚㸪ࡼࡾⰋዲ࡞ 42/ ࢆ⥔ᣢ࡛ࡁࡿࡼ࠺࡟⮬
Ꮿ㏥㝔ࢆ┠ᣦࡍ᪉㔪࡜࡞ࡗࡓࠋ
㐠ື⒪ἲࡢᐇ᪋࡟㛵ࡋ࡚㸪୍⯡ⓗ࡟ 1<+$
ᚰᶵ⬟ศ㢮ϫᗘࡢࡼ࠺࡞㔜⑕ᚰ୙඲⑕౛ࡣ
඲㌟ⓗ࡞㐠ື⒪ἲࡢ㐺ᛂ࡜ࡣ࡞ࡽ࡞࠸ࡀ㸪ಶ
ูⓗ㦵᱁➽ࢺ࣮ࣞࢽࣥࢢࡢ㐺ᛂ࡜࡞ࡿྍ⬟
ᛶࡀ࠶ࡿ࡜ࡉࢀ࡚࠸ࡿ 㸧ࠋᮏ⑕౛࡟࠾࠸࡚ࡣ
඲㌟≧ែࡢࣔࢽࢱࣜࣥࢢୗ࡟࡚㸪㦵᱁➽➽ຊ
⥔ᣢࢆ┠ⓗ࡜ࡋࡓ࢔ࢩࢫࢺ௜⡆࢚᫆ࣝࢦ࣓
࣮ࢱ࣮⦎⩦㸪$'/ ⬟ຊࡢ⥔ᣢࢆ┠ⓗ࡜ࡋࡓ▷
㊥㞳Ṍ⾜⦎⩦ࢆᐇ᪋ࡋࡓࠋࡑࡢ⤖ᯝ࡜ࡋ࡚⾡
๓Ỉ‽ࡢ㐠ືᶵ⬟ࢆ⥔ᣢ࡛ࡁࡓࡇ࡜ࡣ㸪⮬Ꮿ
㏥㝔ࡀᐇ⌧ࡋࡓ୍ᅉ࡛࠶ࡗࡓ࡜⪃࠼ࡽࢀࡿࠋ
࠙ࡲ࡜ࡵࠚ
඲㌟≧ែࡀ⦆ᚎ࡟పୗࡍࡿ⤒㐣ࢆࡓ࡝ࡗ
ࡓ⤊ᮎᮇᚰ୙඲ᝈ⪅࡟ᑐࡋ㸪㌟యᶵ⬟ࡢ⥔ᣢ
ࢆ┠ⓗ࡜ࡋࡓ㍍㈇Ⲵ࡛ࡢࣜࣁࣅࣜࢸ࣮ࢩࣙ
ࣥࢆᐇ᪋ࡋࡓࠋ⛣ື⬟ຊ࡟ࡘ࠸࡚ᶵ⬟⥔ᣢࡀ
ᅗࢀࡓ⤖ᯝ㸪⮬Ꮿ㏥㝔ࡀᐇ⌧ࡋࡓࠋ
࠙ཧ⪃ᩥ⊩ࠚ
᪥ᮏᚠ⎔ჾᏛ఍㸬ᚠ⎔ჾ⑓ࡢデ᩿࡜἞⒪
࡟㛵ࡍࡿ࢞࢖ࢻࣛ࢖ࣥ㸦Ѹ ᖺᗘྜ
ྠ◊✲⌜ሗ࿌㸧㸸ᣑᙇᆺᚰ➽⑕࡞ࡽࡧ࡟㛵
㐃ࡍࡿ஧ḟᛶᚰ➽⑕ࡢデ⒪࡟㛵ࡍࡿ࢞࢖
ࢻࣛ࢖ࣥ
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([HUFLVH3K\VLRORJ\DQG:RUNLQJ*URXS
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― 55 ―
18
⫵⒴ᝈ⪅ࡢ࿘⾡ᮇ࡟࠾ࡅࡿ QOL ࡢኚ໬࡟ࡘ࠸࡚
⚟ᒣᕷẸ⑓㝔ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⛉
࠿ࢃࡉࡁ
࠼ ࡾ ࡞
࠺ࡕࡔ
࠶ࡸ
ࡁࡋ
ࡸࡍࡦࢁ
ࡩࡌ࠸
࡜ࡋࡦࢁ
‫ۑ‬ᕝ㷂 ⱥ㔛ዉ㸪ෆ⏣ ⥤㸪ᓊ Ὀᘯ㸪⸨஭ ಇᏹ
࠙ࡣࡌࡵ࡟ࠚ
⒴ࡣ᪥ᮏேࡢṚஸཎᅉࡢ➨ 1 ఩࡜࡞ࡾ㸪
2000 ᖺ࡟⒴࡛Ṛஸࡋࡓேࡣᖺ㛫Ṛஸ⪅ᩘࡢ
⣙ 1/3 ࡟㐩ࡍࡿ㸬ࡋ࠿ࡋ㸪⭘⒆㒊఩ࡢ 5 ᖺ⏕
Ꮡ⋡ࡣ╔ᐇ࡟ᨵၿࢆ♧ࡋ࡚࠾ࡾ㸪⒴ᝈ⪅ࡢ༙
ᩘ௨ୖࡣ἞ࡿࡼ࠺࡟࡞ࡗ࡚࠸ࡿ㸬⒴ࡀ୙἞ࡢ
⑓࡛࠶ࡗࡓ᫬௦࠿ࡽ㸪⒴࡜ඹᏑࡍࡿ᫬௦࡟࡞
ࡗ࡚ࡁࡓ௒᪥㸪⒴ࡑࡢࡶࡢࡸ⒴἞⒪ࡢ㐣⛬࡛
⏕ࡌࡓ QOL ࡢపୗ࡟ࡶ⪃៖ࡍ࡭ࡁ࡜ᛮࢃࢀ
ࡿ 1)㸬ࡋ࠿ࡋ㸪⒴࿘⾡ᮇࡢ QOL ࡢኚ໬࡟ࡘ
࠸᳨࡚ドࡉࢀࡓሗ࿌ࡣᑡ࡞࠸㸬ࡑࡇ࡛㸪ᮏ◊
✲࡛ࡣ SF-362)ࢆ౑⏝ࡋ࡚⫵⒴࿘⾡ᮇᝈ⪅ࢆ
ᑐ㇟࡟࿘⾡ᮇࡢ QOL ኚ໬ࢆ ᐃࡋ㸪ഴྥࢆ
᳨ドࡋࡓ㸬
࠙ᑐ㇟࡜᪉ἲࠚ
ᙜ㝔࡛ࡣእ᮶ཷデ᫬࡟ᡭ⾡ࡀỴᐃࡍࡿ࡜㸪
ᝈ⪅ࡣࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⛉࡬⤂௓ࡉࢀ⾡๓
ホ౯࡞ࡽࡧ࡟⾡๓ᣦᑟࢆཷࡅࡿ㸬ධ㝔ࡲ࡛ࡢ
ᮇ㛫ࡣ࣮࣒࢚࣍ࢡࢧࢧ࢖ࢬࢆཎ๎࡜ࡋ࡚࠸ࡿ㸬
⾡ᚋࡣ⾡⩣᪥࠿ࡽ⾡ᚋ࿧྾ჾྜే⑕ࡢண㜵࡜
᪩ᮇ㞳ᗋ࡟ດࡵ࡚࠸ࡿ㸬ᮏ◊✲ࡢᑐ㇟⪅ࡣ
2012 ᖺ 6 ᭶࠿ࡽ 2012 ᖺ 10 ᭶ࡲ࡛ࡢ㛫࡟㸪
ᙜ㝔࡟࠾࠸࡚⫵ษ㝖⾡ࢆ᪋⾜ࡋ㸪ࣜࣁࣅࣜࢸ
࣮ࢩࣙࣥࢆᐇ᪋ࡋࡓᝈ⪅࡛㸪⾡๓ࡢ࢚࢜ࣜࣥ
ࢸ࣮ࢩࣙࣥ᫬࡟ ᐃࡢព⩏㸪┠ⓗࢆㄝ᫂ࡋྠ
ពࢆᚓࡓ 10 ྡࢆᑐ㇟࡜ࡋࡓ㸬㝖እᇶ‽ࡣ⾡
ᚋ࡟㔜⠜࡞࿧྾ჾྜే⑕ࡀฟ⌧ࡋࡓ⑕౛ࡸᨵ
ゞ㛗㇂ᕝᘧ⡆᫆▱⬟ホ౯ࢫࢣ࣮ࣝ 20 Ⅼ௨ୗ
࡛࠶ࡿㄆ▱ᶵ⬟పୗ⑕౛࡜ࡋࡓ㸬㝖እᇶ‽ࡢ
ᑐ㇟࡜࡞ࡗࡓ 1 ྡࢆ㝖ࡃ㸪9 ྡࢆᑐ㇟࡜ࡋࡓ㸬
⾲ 1 ࡟ᝈ⪅ࡢᇶᮏᒓᛶࢆ♧ࡍ㸬
QOL ホ౯࡟ࡣᑐ㇟ࢆ㝈ᐃࡋ࡞࠸ໟᣓⓗ
QOL ᑻᗘ࡛࠶ࡿ SF-36 v2 Acute ∧ࢆ⏝࠸࡚
⮬ᕫグධᘧ࡛⾜࠸㸪⮬ᕫグධࡀᅔ㞴࡞⑕౛࡟
ࡣ⪺ࡁྲྀࡾᘧ࡛⾜ࡗࡓ㸬እ᮶࡛ࡢ࿧྾カ⦎ᣦ
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ୗ఩ᑻᗘࡈ࡜࡟ 0-100 Ⅼ࡛⟬ฟࡋࡓ㸬Acute
∧ࡣᅜẸᶆ‽್ࡀ⟬ฟࡉࢀ࡚࠸࡞࠸Ⅽ㸪ᶆ‽
∧ࡢᅜẸᶆ‽್ࢆཧ⪃್࡜ࡋ࡚⏝࠸㌟యⓗࢧ
࣐࣮ࣜࢫࢥ࢔㸪⢭⚄ⓗࢧ࣐࣮ࣜࢫࢥ࢔㸪ᙺ๭/
♫఍ⓗࢧ࣐࣮ࣜࢫࢥ࢔ࢆᅜẸᶆ‽೫ᕪ࡛⟬ฟ
ࡋࡓ㸬⤫ィゎᯒࡣࣇ࣮ࣜࢻ࣐ࣥ㡰఩࿴᳨ᐃᚋ㸪
࣎ࣥࣇ࢙࣮ࣟࢽ⿵ṇ࢘࢖ࣝࢥࢡࢯ᳨ࣥᐃࢆ⏝
࠸࡚ẚ㍑ࡋࡓ㸬᭷ពỈ‽ࡣ 5%ᮍ‶࡜ࡋࡓ㸬
࠙⤖ᯝࠚ
࿧྾カ⦎ᣦᑟ᫬㸪⾡๓㸪㏥㝔᫬ࡢኚ໬ࢆᑻ
ᗘࡈ࡜࡟⾲♧ࡍࡿ㸬㌟యᶵ⬟(௨ୗ PF)࡛ࡣ
87.5s12.0㸪86.3s15.2㸪73.1s12.0㸪᪥ᖖ
⏕άᙺ๭ᶵ⬟(㌟య)(௨ୗ RP)࡛ࡣ 89.1s16.6㸪
77.3s25.2㸪62.5s33.9㸪㌟యࡢ③ࡳ(௨ୗ
BP)࡛ࡣ 94.0s16.0㸪92.6s20.7㸪66.3s22.8㸪
඲యⓗ೺ᗣឤ(௨ୗ GH)࡛ࡣ 65.0s20.2㸪51.0
s17.1㸪42.3s17.0㸪άຊ(௨ୗ VT)࡛ࡣ 74.2
s19.5㸪61.7s29.6㸪46.9s20.8㸪♫఍⏕ά
ᶵ⬟(௨ୗ SF)࡛ࡣ 90.1s21.1㸪79.7s32.5㸪
67.2s35.4㸪᪥ᖖᙺ๭ᶵ⬟(⢭⚄)(௨ୗ RE)࡛
ࡣ 90.7s15.0㸪80.2s20.2㸪59.4s35.8㸪ᚰ
ࡢ೺ᗣ(௨ୗ MH)࡛ࡣ 71.9s21.5㸪60.6s28.6㸪
59.4s20.9 ࡛࠶ࡗࡓ㸬඲ୗ఩ᑻᗘ࡛࿧྾カ⦎
ᣦᑟ᫬㸪⾡๓㸪㏥㝔᫬࡜ᚎࠎ࡟ QOL ࡀపୗ
ࡍࡿഴྥ࡟࠶ࡗࡓ㸬
≉࡟ GH ࡢపୗࡣ኱ࡁࡃ㸪
࿧྾カ⦎ᣦᑟ᫬࠿ࡽ⾡๓㸪࿧྾カ⦎ᣦᑟ᫬࠿
ࡽ㏥㝔᫬࡛᭷ព࡟పୗࡀࡳࡽࢀࡓ㸬
㸫1㸫
― 56 ―
ࡲࡓ㸪㌟యⓗࢧ࣐࣮ࣜࢫࢥ࢔ࡣ 51.5s7.9㸪
51.6s7.9㸪41.6s5.2㸪⢭⚄ⓗࢧ࣐࣮ࣜࢫࢥ
࢔ࡣ 54.7s9.5㸪48.7s10.8㸪46.8s12.8㸪ᙺ
๭/♫఍ⓗࢧ࣐࣮ࣜࢫࢥ࢔ࡣ 48.9s7.3㸪44.0
s12.9㸪38.0s24.1 ࡜඲㡯┠࡛࿧྾カ⦎ᣦᑟ
᫬㸪⾡๓㸪㏥㝔᫬࡜ᚎࠎ࡟పୗࡍࡿഴྥ࡟࠶
ࡗࡓ㸬
⾲ 1. ᑐ㇟⪅ࡢᇶᮏᒓᛶ(n=9)
ᖺ㱋(ṓ)
70.6s6.9
ᛶู
⏨ᛶ 8 ྡࠊዪᛶ 1 ྡ
ධ㝔᪥ᩘ(᪥)
12.2s6.7
ᶵ⬟ホ౯
Barthel Index(Ⅼ)
PCF(l/min)
⾡๓
100.0 s
0.0
423.9
s145.4㻌
⾡ᚋ
98.3s2.5
323.9
s103.0
10m Ṍ⾜㏿ᗘ(⛊)
8.68s2.0
9.89s2.0
Timed Up & Go(⛊)
10.5s2.2
35.1
s11.5
33.2s9.0
11.3s2.6
ᥱຊ(kg)
⭸ఙᒎ➽ຊ(kg 㔜)
31.7s9.5
30.4s9.9
ᅗ 1.SF-36 ࡢኚ໬
࠙⪃ᐹࠚ
ᮏ◊✲࡛ࡣ㸪⫵⒴ᝈ⪅ࡢ࿘⾡ᮇ࡟࠾ࡅࡿ
QOL ࡢㄪᰝࢆ⾜࠸㸪እ᮶࡛ࡢ࿧྾カ⦎ᣦᑟ᫬㸪
⾡๓㸪㏥㝔᫬ࡢ QOL ࡢኚ໬ࢆ᳨ドࡋࡓ㸬
ࡑࡢ⤖ᯝ㸪඲ᑻᗘ࡛࿧྾カ⦎ᣦᑟ᫬࠿ࡽ⾡
๓㸪⾡๓࠿ࡽ㏥㝔᫬࡜ QOL ࡀపୗࡍࡿഴྥ
࡟࠶ࡗࡓ㸬≉࡟㸪඲యⓗ೺ᗣឤࡀ࿧྾カ⦎ᣦ
ᑟ᫬࠿ࡽ⾡๓㸪࿧྾カ⦎ᣦᑟ᫬࠿ࡽ㏥㝔᫬࡟
᭷ព࡟పୗࡋ࡚࠸ࡿࡇ࡜࠿ࡽ㸪ᡭ⾡๓ࡸ㏥㝔
᫬࡟࠾࠸࡚⌧ᅾࡢ೺ᗣ≧ែࡸ௒ᚋࡢ೺ᗣ≧ែ
࡟୙Ᏻࢆᢪ࠸࡚࠸ࡿࡇ࡜ࡀ♧၀ࡉࢀࡓ㸬
ࡲࡓ㸪㌟యⓗࢧ࣐࣮ࣜࢫࢥ࢔࡛ࡣ⾡๓ࡲ࡛
ࡣᅜẸᶆ‽್ࡼࡾୖᅇࡗ࡚࠾ࡾ㏥㝔᫬࡟ᅜẸ
ᶆ‽್ࢆୗᅇࡿഴྥ࡟࠶ࡾ㸪⢭⚄ⓗࢧ࣐࣮ࣜ
ࢫࢥ࢔ࡣ⾡๓࠿ࡽᅜẸᶆ‽್ࢆୗᅇࡗ࡚࠾ࡾ
㏥㝔᫬ࡣࡉࡽ࡟పୗࡍࡿഴྥ࡟࠶ࡗࡓ㸬ᙺ๭/
♫఍ⓗࢧ࣐࣮ࣜࢫࢥ࢔࡟࠾࠸࡚ࡣእ᮶࿧྾カ
⦎ᣦᑟ᫬࠿ࡽᅜẸᶆ‽್ࢆୗᅇࡗ࡚࠾ࡾ㸪⾡
ᚋ㸪㏥㝔᫬࡜᭦࡟పୗࡋ࡚࠸ࡃഴྥ࡟࠶ࡗࡓ㸬
ᮏ◊✲ࡢ⑕౛ࡣ㸪ࡑࢀࡲ࡛ࡢ⏕ά࡛⮬ぬ⑕
≧ࡀ↓ࡃ㸪೺ᗣデ᩿➼ࡢࣞࣥࢺࢤࣥ᧜ᙳ࡛⫵
⒴ࡀⓎぢࡉࢀࡓ౛ࡀከ࠿ࡗࡓ㸬ࡼࡗ࡚㸪࿧྾
カ⦎ᣦᑟ᫬ࡸ⾡๓ࡼࡾࡶ㸪ᡭ⾡࡟ࡼࡾ࿧྾ᶵ
⬟ࡸ㌟యᶵ⬟ࡢపୗࡀ࠶ࡿ㏥㝔᫬ࡢ᪉ࡀ
QOL ࡀపୗࡋࡓࡢ࡛ࡣ࡞࠸࠿࡜⪃࠼ࡽࢀࡿ㸬
௒ᅇ㸪⑕౛ᩘࡀᑡ࡞࠿ࡗࡓࡓࡵ㸪ࣀࣥࣃࣛ
࣓ࢺࣜࢵࢡࡢࣇ࣮ࣜࢻ࣐ࣥ㡰఩࿴᳨ᐃࢆ౑⏝
ࡋࡓࡀ㸪ࣇ࣮ࣜࢻ࣐ࣥ㡰఩࿴᳨ᐃᚋࡢ࣎ࣥࣇ
࢙࣮ࣟࢽ⿵ṇ࢘࢖ࣝࢥࢡࢯ᳨ࣥᐃࡣุᐃࡀཝ
ࡋࡃ㸪ᑐ㇟ࡀᑡ࡞࠸ሙྜࡣ᭷ពᕪࡀฟ࡟ࡃ࠸
ഴྥ࡟࠶ࡿࡇ࡜࠿ࡽ㸪௒ᚋࡣ⑕౛ᩘࢆቑࡸࡋ
᳨࡚ドࡍࡿᚲせࡀ࠶ࡿ㸬ࡲࡓ㸪㏥㝔ᚋࡢ⤒᫬
ⓗ࡞ QOL ࡢኚ໬ࡢㄪᰝࡶ௒ᚋࡢㄢ㢟࡜࡞ࡿ㸬
࠙ࡲ࡜ࡵࠚ
௒ᅇ㸪SF-36 ࢆ⏝࠸࡚࿘⾡ᮇ࡟࠾ࡅࡿ QOL
ࢆホ౯ࡋࡓ㸬ࡑࡢ⤖ᯝ㸪࿧྾カ⦎ᣦᑟ᫬㸪⾡
๓㸪㏥㝔᫬࡜ᚎࠎ࡟ QOL ࡀపୗࡋ࡚࠸ࡁ㸪
ᅜẸᶆ‽್ࢆୗᅇࡿഴྥ࡟࠶ࡗࡓ㸬
࠙ཧ⪃ᩥ⊩ࠚ
1) ㎷ဴஓ㸸ᐇ㊶ ࡀࢇࡢࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ㸬
ᰴᘧ఍♫࣓ࢴ࢝ࣝࣇࣞࣥࢻ♫㸪ᮾி㸪2007
2) ⚟ཎಇ୍㸪㕥㬞ࡼࡋࡳ㸸SF-36v2 ᪥ᮏㄒ∧
࣐ࢽࣗ࢔ࣝ➨ 3 ∧㸬≉ᐃ㠀Ⴀ฼άືἲே೺
ᗣ་⒪ホ౯◊✲ᶵᵓ 㸪2011
㸫2㸫
― 57 ―
19
⫵⒴ᝈ⪅࡟ᑐࡍࡿ⫵ษ㝖⾡๓ᚋࡢ㌟యᶵ⬟ኚ໬࡟ࡘ࠸࡚
⚟ᒣᕷẸ⑓㝔ࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ⛉
࠺ࡕࡔ
࠶ࡸ
࠿ࢃࡉࡁ
࠼ ࡾ ࡞
ࡁࡋ
ࡸࡍࡦࢁ
ࡩࡌ࠸
࡜ࡋࡦࢁ
‫ۑ‬ෆ⏣ ⥤㸪ᕝ㷂 ⱥ㔛ዉ㸪ᓊ Ὀᘯ㸪⸨஭ ಇᏹ
࠙ࡣࡌࡵ࡟ࠚ
࿘⾡ᮇࣜࣁࣅࣜࢸ࣮ࢩࣙࣥ㸦௨ୗࣜࣁࣅࣜ㸧
ࡢ┠ⓗࡣ⾡ᚋࡢ࿧྾ჾྜే⑕ࡢண㜵࡜᪩ᮇ㞳
ᗋ࡛࠶ࡾ㸪⾡๓࠿ࡽࡢ௓ධࡀ㔜せ࡛࠶ࡿ㸬ᙜ
㝔࡛ࡢ࿘⾡ᮇࣜࣁࣅࣜࡢὶࢀࡣ㸪እ᮶ཷデ᫬
࡟ᡭ⾡ࡀỴᐃࡍࡿ࡜ࣜࣁࣅࣜ⛉࡬⤂௓ࡉࢀ⾡
๓ホ౯㸦㌟యᶵ⬟㸪άື≧ἣ㸧࡞ࡽࡧ࡟⾡๓
ᣦᑟ㸦࿧྾ἲ㸪တႿἲ㸪࢖ࣥࢭࣥࢸ࢕ࣈࢫࣃ
࢖࣓ࣟࢺࣜࡢ౑⏝᪉ἲ㸪ධ㝔ࡲ࡛ࡢ⏕άᣦᑟ㸧
ࢆཷࡅࡿ㸬ධ㝔ࡲ࡛ࡢᮇ㛫ࡣᇶᮏⓗ࡟࣮࣒࣍
࢚ࢡࢧࢧ࢖ࢬࢆཎ๎࡜ࡋ㸪ᚲせ࡟ᛂࡌ࡚⾡๓
㏻㝔ࣜࣁࣅࣜࢆ⾜ࡗ࡚࠸ࡿ㸬⾡ᚋࡣ⾡⩣᪥࠿
ࡽࡢ᪩ᮇ௓ධࢆ⾜࠸㸪⾡ᚋ࿧྾ჾྜే⑕ࡢண
㜵࡜᪩ᮇ㞳ᗋ࡟ດࡵ㸪㏥㝔ࡲ࡛Ṍ⾜ࡸ⮬㌿㌴
࢚ࣝࢦ࣓࣮ࢱ࣮࡟ࡼࡿ᭷㓟⣲㐠ືࢆ୰ᚰ࡜ࡋ
ࡓ㐠ື⒪ἲࢆ⥅⥆ࡋ࡚࠸ࡿ㸬ࡲࡓ㏥㝔᫬࡟ࡣ
ྛ⑕౛࡟⾡๓࡜㏥㝔᫬ࡢ㌟యᶵ⬟ ᐃ⤖ᯝࢆ
༳ๅ㸪㏥㝔ᚋࡢ㐠ື࡜᪥ᖖ⏕άࡢᣦᑟࢆ⾜ࡗ
࡚࠸ࡿ㸬
࿘⾡ᮇࡢ㌟యᶵ⬟ࡢ≉ᚩࢆ᫂ࡽ࠿࡟ࡍࡿࡇ
࡜ࡀ㸪௒ᚋࡢᝈ⪅ᣦᑟ㸪ࣜࣁࣅࣜෆᐜࡢ᳨ウ
࡟᭷⏝࡛࠶ࡿ࡜⪃࠼ࡽࢀ㸪ᮏ◊✲࡛ࡣ㸪⫵ษ
㝖⾡๓ᚋࡢ㌟యᶵ⬟ࡢኚ໬ࢆ᳨ドࡋࡓ㸬
࠙ᑐ㇟࡜᪉ἲࠚ
ᑐ㇟⪅ࡣ 2012 ᖺ 2 ᭶࠿ࡽ 2012 ᖺ 10 ᭶ࡲ
࡛ࡢ㛫࡟ᙜ㝔࡟࡚⫵ษ㝖⾡ࢆ᪋⾜ࡋ㸪࿘⾡ᮇ
ࣜࣁࣅࣜࢆᐇ᪋ࡋࡓཎⓎᛶ⫵⒴ᝈ⪅࡛㸪⾡๓
ࡢ࢚࢜ࣜࣥࢸ࣮ࢩࣙࣥ᫬࡟ࡇࡢ ᐃࡢព⩏࡜
┠ⓗࢆㄝ᫂ࡋྠពࢆᚓࡓ 17 ྡࢆᑐ㇟࡜ࡋࡓ㸬
㝖እᇶ‽ࡣ⾡ᚋ࡟㔜⠜࡞ྜే⑕ࡀฟ⌧ࡋࡓ⑕
౛ࡸᨵゞ㛗㇂ᕝᘧ⡆᫆▱⬟ホ౯ࢫࢣ࣮ࣝ࡟࡚
ㄆ▱ᶵ⬟పୗࢆㄆࡵࡓ⑕౛࡜ࡋࡓ㸬㝖እᇶ‽
ࡢᑐ㇟࡜࡞ࡗࡓ㔜⠜࡞ᚠ⎔ჾ⣔ྜే⑕ࡀฟ⌧
ࡋࡓ 2 ྡ㸪ㄆ▱ᶵ⬟పୗ⑕౛ 2 ྡࢆ㝖ࡃ 13
ྡࢆᑐ㇟࡜ࡋࡓ㸬⾲ 1 ࡟ᑐ㇟⪅ࡢᇶᮏᒓᛶࢆ
♧ࡍ㸬
㌟యᶵ⬟ ᐃࡣ⾡๓࡜㏥㝔᫬ࡢ 2 ᅇᐇ᪋ࡋ
ࡓ㸬㌟యᶵ⬟ࡣတႿ᫬ࡢ᭱኱࿧Ẽὶ㔞㸦Peak
Cough Flow㸪௨ୗ PCF㸧
㸪ᥱຊ㸪᭱኱➼ᑻᛶ
⭸ఙᒎ➽ຊ㸪10m Ṍ⾜㏿ᗘࢆ ᐃࡋࡓ㸬PCF
ࡢ ᐃ࡟ࡣࣆ࣮ࢡࣇ࣮࣓࣮ࣟࢱ࣮㸦ࣇࢪ࣭ࣞ
ࢫࣆࣟࢽࢡࢫ♫〇㸪࢔ࢭࢫࣆ࣮ࢡࣇ࣮࣓࣮ࣟ
ࢱ࣮㸧ࢆ౑⏝ࡋࡓ㸬 ᐃయ఩ࡣ➃ᗙ఩࡜ࡋ㸪
ᗙ఩ࡢ୙Ᏻᐃ࡞⑕౛࡛ࡣ㌴᳔Ꮚ࠶ࡿ࠸ࡣ᳔Ꮚ
ᗙ఩࡜ࡋࡓ㸬PCF ᐃࡣᝈ⪅࡟ྍ⬟࡞㝈ࡾ῝
྾Ẽࢆࡋࡓᚋ࡟࣐࢘ࢫࣆ࣮ࢫࢆཱྀ၁࡛ᜥࡀ₃
ࢀ࡞࠸ࡼ࠺࡟ᐦ㛢ࡋᙉࡃ㏿ࡃᜥࢆྤࡃࡼ࠺࡟
ᣦ♧ࢆࡋ࡚ ᐃࡋࡓ㸬 ᐃࡣ⦎⩦ࡶྵࡵ 5 ᅇ
⾜࠸ࡑࡢ᭱㧗್ࢆ᥇⏝ࡋࡓ㸬ᥱຊࡢ ᐃ࡟ࡣ
ࢫ࣓ࢻ࣮ࣞᆺᥱຊィ㸦ᯇᐑ་⛉⢭ჾ〇సᡤ㸪
ᥱຊィࢫ࣓ࢻ࣮ࣞᘧ㸧ࢆ౑⏝ࡋ㸪᭱኱➼ᑻᛶ
⭸ఙᒎ➽ຊࡢ ᐃ࡟ࡣࣁࣥࢻ࣊ࣝࢻࢲ࢖ࢼࣔ
࣓࣮ࢱ࣮㸦࢔ࢽ࣐♫〇㸪ᚐᡭ➽ຊ ᐃჾȣ
TasF-1㸧ࢆ⏝࠸㸪ᕥྑྛ 2 ᅇ ᐃࡋ㸪ᕥྑࡢ
㧗್ࡢᖹᆒ್ࢆ ᐃ್࡜ࡋ࡚᥇⏝ࡋࡓ㸬ࡲࡓ
ᚋ㏙ࡢ⾡ഃᥱຊ㸪㠀⾡ഃᥱຊ࡜ࡋ࡚ࡣィ ഃ
ࡢ㧗್ࢆ᥇⏝ࡋࡓ㸬10㹫Ṍ⾜㏿ᗘࡣ 10m ࡢ
┤⥺Ṍ⾜㊰ࢆタࡅ㸪୧➃ 3m ࡢணഛ㊰ࢆタࡅ
ࡓ 16m ࢆ⏝࠸࡚㏻ᖖṌ⾜࡟࡚ 2 ᅇ ᐃࡋ᭱
㏿್ࢆ᥇⏝ࡋࡓ㸬
⤫ィゎᯒ࡟ࡣ࢘࢖ࣝࢥࢡࢯࣥ㡰఩࿴᳨ᐃࢆ
⏝࠸㸪᭷ពỈ‽ 5㸣ᮍ‶࡜ࡋࡓ㸬
࠙⤖ᯝࠚ
PCF ࡣ⾡๓ 405.4s100.5l/min(᭱ᑠ್ 230
㸫1㸫
― 58 ―
l/min㸧㏥㝔᫬ 328.8s75.4l/min㸦᭱ᑠ್ 225
l/min㸧㸦p㸺0.01㸧㸪⾡๓್ࡢ 81.1%࡛࠶ࡾ᭷
ពᕪࡀㄆࡵࡽࢀࡓ㸬ᥱຊࡣ⾡๓ 32.8s9.7kg㸪
㏥㝔᫬ࡣ 31.1s7.1kg㸪⾡๓್ࡢ 94.9㸣࡛᭷
ពᕪࢆㄆࡵ࡞࠿ࡗࡓ㸬⾡ഃ㸪㠀⾡ഃ᳨࡛ウࡍ
ࡿ࡜⾡ഃᥱຊࡣ⾡๓ 32.2s10.1kg㸪㏥㝔᫬
29.7s6.7kg㸦p㸺0.05㸧㸪⾡๓್ࡢ 92.3%࡛
࠶ࡾ᭷ពᕪࢆㄆࡵࡓࡀ㸪㠀⾡ഃᥱຊࡣ⾡๓
33.5s9.5kg㸪㏥㝔᫬ 32.6s8.2kg㸪⾡๓್ࡢ
97.4㸣࡛᭷ពᕪࢆㄆࡵ࡞࠿ࡗࡓ㸬᭱኱➼ᑻᛶ
⭸ఙᒎ➽ຊࡣ⾡๓ 31.6s7.8kgf㸪㏥㝔᫬ 29.9
s7.6kgf㸪⾡๓್ࡢ 94.6%࡛᭷ពᕪࢆㄆࡵ࡞
࠿ࡗࡓ㸬10m Ṍ⾜㏿ᗘࡣ⾡๓ 8.4s1.4 ⛊㸪
㏥㝔᫬ 8.6s1.3 ⛊㸪⾡๓್ࡢ 103.3%࡛Ṍ⾜
㏿ᗘࡢపୗࢆㄆࡵࡓࡀ᭷ពᕪࢆㄆࡵ࡞࠿ࡗࡓ㸬
Barthel Index ࡣ⾡๓ 99.6s1.3㸪⾡ᚋ 98.8
s2.1㸪⾡๓್ࡢ 99.2%࡛᭷ពᕪࢆㄆࡵ࡞࠿ࡗ
ࡓ㸬⾡ᚋ࿧྾ჾྜే⑕ࡢⓎ⑕ࡣ↓࠿ࡗࡓ㸬
⾲㸯 ᑐ㇟⪅ࡢᇶᮏᒓᛶ
ᖺ㱋㸦ṓ㸧
71.7s6.8
ᛶู
⏨ᛶ 11 ྡ
ዪᛶ㸰ྡ
BMI㸦kg/੍㸧
22.8s3.2
StageϨA㸸9 ྡ
Clinical Stage
StageϨB㸸2 ྡ
StageϩA㸸1 ྡ
StageϪA㸸1 ྡ
ษ㝖⠊ᅖ
㒊ศษ㝖㸸5 ྡ
༊ᇦษ㝖㸸2 ྡ
୍ⴥษ㝖㸸5 ྡ
஧ⴥษ㝖㸸1 ྡ
ᡭ⾡᫬㛫㸦ศ㸧
120.5s77.5
ฟ⾑㔞㸦g㸧
29.8s35.7
⾡๓௓ධᮇ㛫㸦᪥㸧
⾡ᚋᅾ㝔᪥ᩘ㸦᪥㸧
21.0s17.2
10.8s6.4
せ࡛࠶ࡿ㸬PCF ࡢ᭷ព࡞పୗࡣ⫵ษ㝖࡟క࠺
⫵ᐜ㔞ῶᑡ࡜࿧྾➽࡬ࡢᡭ⾡౵く࡟ࡼࡿ࡜⪃
࠼ࡽࢀࡓ㸬⾡ഃᥱຊࡢ᭷ព࡞పୗࡣ⾡ᚋࡢ⬚
⭍ࢻ࣮ࣞࣥࡢᤄධ࡟ࡼࡿ⑊③ࡸ⫪ࡢᣲୖ࡟క
࠸๰ࡀᘬࡁࡘࢀ࡚ㄏⓎࡉࢀࡿ⑊③࡟ࡼࡾ㸪ୖ
⫥ࡢ౑⏝ࡀไ㝈ࡉࢀࡓࡇ࡜࡟ࡼࡿ࡜⪃࠼ࡽࢀ
ࡓ㸬᭱኱➼ᑻᛶ⭸ఙᒎ➽ຊ࡜ 10㹫Ṍ⾜㏿ᗘ࡟
࠾࠸࡚᭷ព࡞పୗࢆㄆࡵ࡞࠿ࡗࡓࡇ࡜࡟ࡘ࠸
࡚ࡣ㸪⫵⒴ࡣ↓⑕≧ࡢࡲࡲ᳨デ᫬ࡢ⬚㒊⏬ീ
᳨ᰝ࡛Ⓨぢࡉࢀࡿࡇ࡜ࡀከࡃ⾡๓ࡢୗ⫥➽ຊ㸪
Ṍ⾜⬟ຊࡀ㧗࠸⑕౛ࡀከ࠸࡜⪃࠼ࡽࢀࡿ㸬ࡲ
ࡓ⾡ᚋࡶ⾡⩣᪥ࡼࡾ㞳ᗋࢆ୰ᚰ࡜ࡋࡓࣜࣁࣅ
ࣜࢆ⾜ࡗࡓࡇ࡜࡟ࡼࡾ⾡ᚋࡢ⮩ᗋ࡟ࡼࡿୗ⫥
➽ຊ㸪Ṍ⾜⬟ຊࡢపୗࢆ㜵ࡄࡇ࡜ࡀ࡛ࡁ㸪᪩
ᮇ㞳ᗋࡢຠᯝࡀ♧ࡉࢀࡓ࡜⪃࠼ࡿ㸬
ᮏ◊✲ࡼࡾ㏥㝔᫬࡟࠾࠸࡚ PCF㸪⾡ഃᥱຊ
ࡣపୗࡋࡓ≧ែ࡛࠶ࡾ㸪㏥㝔ᚋࡶ⮬୺ⓗ࡞㐠
ືࡢ⥅⥆ࡀᚲせ࡛࠶ࡿ࡜⪃࠼ࡽࢀࡿ㸬ᐈほⓗ
࡞ホ౯࡟ࡼࡾ⾡๓ᚋࡢ㌟యᶵ⬟ࢆㄆ㆑ࡉࡏ㐠
ືࡢ⥅⥆ࢆಁࡍᣦᑟࡣ᭷⏝࡜⪃࠼ࡽࢀࡓ㸬
ࡉࡽ࡟ PCF ࡟ࡘ࠸࡚ᒣᕝࡽ㸯㸧ࡣ୰㧗㱋ᝈ
⪅ࡢ☜ᐇ࡞⮬ᕫ᤼⑱ࡢྍྰࢆุูࡍࡿ PCF
Ỉ‽ࢆ 240l/min ࡜ᥦ♧ࡋ࡚࠾ࡾ㸪တႿຊ࡟
ὀពࢆせࡍࡿ⑕౛ࡀᏑᅾࡍࡿࡇ࡜ࡶᮏ◊✲ࡢ
ホ౯࡟࡚᫂ࡽ࠿࡜࡞ࡗࡓ㸬
௒ᚋࡣ㏥㝔ᚋࡢ㌟యᶵ⬟ࡢኚ໬࡟ࡘ࠸࡚⤒
㐣ࢆ㏣ࡗ࡚࠸ࡃࡇ࡜ࡀᚲせ࡛࠶ࡿ㸬
࠙ࡲ࡜ࡵࠚ
௒ᅇ㸪ཎⓎᛶ⫵⒴ࡢ⾡๓࡜㏥㝔᫬ࡢ㌟యᶵ
⬟ࡢኚ໬ࢆ᳨ウࡋ㸪PCF ࡜⾡ഃᥱຊ࡟࠾࠸࡚
᭷ព࡞పୗࢆㄆࡵ㸪㏥㝔᫬ᣦᑟࡢ᭷⏝ᛶ㸪㏥
㝔ᚋࡢ㐠ື⒪ἲࡢ⥅⥆ࡢᚲせᛶࡀ♧ࡉࢀࡓ㸬
࠙⪃ᐹࠚ
ຠᯝⓗ࡞တႿࡣ྾Ẽ㔞࡜㏿࠸࿧Ẽὶ㏿ࡀᚲ
࠙ཧ⪃ᩥ⊩ࠚ
1)ᒣᕝ᲍⤮㸪ᶓᒣோᚿ㸪Ώ㑓㝧௓㸪ᶓᒣ᭷
㔛㸪Ṋᕷᑦஓ㸪▼㜰ጼᏊ㸪ᒸ⏣୍㤿㸪➲
┈㞝㸸᤼⑱⬟ຊࢆุูࡍࡿ Cough Peak
Flow ࡢỈ‽㸫୰㧗㱋ᝈ⪅࡟࠾ࡅࡿ᳨ウ
㸫㸬ேᕤ࿧྾ 2012㸹27㸸260㸫266
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