2 0 0 0 OA 病院全体の心電図スキルアップを目指した人材育成 ─心電図チームの取り組みを通して─
- 著者
- 石川 静香 椋本 泰生 西原 亜希子 清水 佳代子 船田 幸奈 岩部 彩加 毛利 洋久 広瀬 卓哉 綾井 健太 黒住 瑞紀 難波 経立 佐々木 英之 松元 一郎 高木 雄一郎
- 出版者
- 公益財団法人 日本心臓財団
- 雑誌
- 心臓 (ISSN:05864488)
- 巻号頁・発行日
- vol.52, no.10, pp.1130-1136, 2020-10-15 (Released:2021-10-25)
- 参考文献数
- 1
目的:当院ではメディカルスタッフが中心となり,循環器科疾患診療に従事する,多職種でチーム医療を行うCardiovascular Care Team(CCT)を立ち上げ,さまざまな取り組みを行っている.CCTではワーキングチームの1つとして心電図チームを組織し,職員の心電図関連のスキルアップを目指した. 方法:新入職の看護師に対しては入職時に12誘導心電図講習を行った.入職後1年以上経過した職員に対しては,当院独自の基準によるモニター心電図ライセンス制度を導入し,講習を受講したのち,資格試験合格によりライセンス取得とした.各講習の受講前後にはアンケートにより知識や意識の変化を調査した.ライセンス取得者らで全病棟のモニター心電図記録の回診を行い実務に還元した.モニター心電図回診導入後に重症不整脈の指摘状況や誤認率が変化したか調査した. 結果:講習終了後には講習前と比較して心電図に対する苦手意識や嫌悪感が減少していた.ライセンス取得者は年々増加し,モニター心電図回診導入後,年々重症不整脈の見落としや誤認が減少していた. 考察:心電図チームによる講習,ライセンス制度により職員の心電図に対する関心が高まり,苦手意識も減少していた.結果として病棟での重症不整脈などの見落としが減少し,リスクマネジメントの向上に寄与できた.専門的にみられがちな12誘導心電図記録,モニター心電図判読を病院内の多くの職員に広めていくことができた.今後もさらなる質的向上を目指した取り組みを行う予定である.
- 著者
- 森満 保 平島 直子 松元 一郎
- 出版者
- JIBI TO RINSHO KAI
- 雑誌
- 耳鼻と臨床 (ISSN:04477227)
- 巻号頁・発行日
- vol.19, no.1, pp.20-30, 1973
In 1971 Morimitsu et al reported on the effects of sodium chloride crystals administered on the round window membrane upon the cochlear microphonics which were recorded from the basal turn of the cochlea of guinea pigs with differential electrodes technique. The amplitude of CM after the administration of NaCl-crystals showed changes in a regular pattern which is composed of an initial overshoot, a primary decrease, a recovery and a secondary decrease. It was considered that the action of NaCl-crystals should be affected by the permeability of the round window membrane, the production and absorption of the inner ear fluids and the vulnerability of the organ of Corti by the biophysical changes of the fluids.<BR>In order to clarify the mechanism ofthese changes of CM and the effects of sympathomimetic and sympathoplegic drugs in the cochlea, the changes of CM modified by NaCl-crystals were observed after the intravenous injection of the following drugs; norepinephrine, isoproterenol, epinephrine, phenoxybenzamine and propranolol. The α-receptor stimulant (norepinephrine) prolonged the initial overshoot and depressed the grade of the primary decrease of CM, but did not influence the grade, of the secondary decrease. The β-receptor stimulant (isoproterenol) depressed the grades of both decreases and therefore the recovery after the primary decrease was complete. The α-receptor blockade (phenoxybenzamine) caused a slight decrease of CM prior to the initial overshoot, and depressed the grades of both decreases. The β-receptor blockade (propranolol) acted to depress the grade of the primary decrease of CM, but did not influence the grade of the secondary decrease. The α-β-receptor stimulant (epinephrine) caused a slight decrease of CM prior to the initial overshoot and influenced so as to depress the both decreases. The action of epinephrine showed a slight resemblance to that of the 13-receptor stimulant. The results obtained showed that the β-receptor stimulant and the α-receptor blockade have a favorable effect on the reactivation of the homeostatic processes govering the labyrinthine fluids and have a effect to minimize the irreversible damage of the organ of Corti occurring after the placement of NaCl-crystals. Considering different actions between α-receptor acting drugs and the β-receptor acting drugs, it is suspected that the sympathetic nerves in the cochlea also consist of the a and β-receptor which act in a sense antagonistic. As the several possible mechanisms of the actions of these drugs, an effect on the permeability of the blood vessels of the cochlea and of the round window membrane besides an effect on the cochlear blood flow was considered. Furthermore, an effect on the sympathetic nerve which was recognized in the basilar