著者

山田 剛 中西 健 鵜山 治 飯田 竜也 杉田 實

出版者

社団法人 日本腎臓学会

雑誌

日本腎臓学会誌 (ISSN:03852385)

巻号頁・発行日

vol.33, no.6, pp.581-586, 1991 (Released:2010-07-05)

参考文献数

19

---

We described a patient with the milk-alkali syndrome induced by the ingestion of small amount of milk (200 ml/day) and ice cream (145 g/day) and the administration of small dose of absorbable alkali (magnesium oxide 2.0 g/day) for the treatment of chronic constipation. The present case shows not only triads, i, e., hypercalcemia (s-Ca 14.3 mg/dl), metabolic alkalosis (s-HCO3- 37.4 mEq/L), and renal insufficiency (s-Cre 2.3 mg/dl) but also hypernatremia (s-Na 161 mEq/L) and hypertonic dehydration after the frequent episodes of elevated body temperature. The milk-alkali syndrome has been defined as the hypercalcemia with a metabolic alkalosis from a high amount of calcium intake and long term administration of absorbable alkali in any form, usually as calcium carbonate for the treatment of peptic ulcer. As the present case could be distinguished from any other cases previously reported with regard to the amount of calcium (0.4 g/day) and alkali (36 mEq/day) intake and the clinical situations that induced the syndrome, we compared the present case with the previous reports, calculating the amount of calcium and alkali intake from milk and absorbable alkali. After the introduction of the H2 blockers for peptic ulceration, the most cases with milk-alkali syndrome had provoked by the smaller amount of calcium than previously reported, which were associated with the treatment of relatively large amount of alkali (50-150 mEq/day), suggesting the role of sustained metabolic alkalosis for the development. In the present case the metabolic alkalosis induced by hypertonic dehydration and enhanced by absorbable alkali intake also could cause an increase of renal tubular reabsorption of calcium and a decrease of ionized calcium which might produce increased secretion of parathyroid hormone followed by vitamin D3 activation and increased Ca absorption from the gut. The metabolic alkalosis might be essential to the development of the milk-alkali syndrome without a high calcium and absorbable alkali intake.

著者

川口 孝泰 鵜山 治 西山 忠博 小河 幸次 飯田 健夫

出版者

一般社団法人 日本人間工学会

雑誌

人間工学 (ISSN:05494974)

巻号頁・発行日

vol.34, no.5, pp.261-270, 1998

被引用文献数

2

---

本研究は, head-up を伴う体位変換介助時において, 被介護者に変換を"事前予告"しておくことが循環調節にどのような影響をもたらすかを, 自律神経機能および脳循環の測定により検討した. 実験は, 健康成人12人 (男性6人, 女性6人) に対して, head-up と同時に声をかけながら70°head-up tilt (仰臥位から座位) を他動的に実施【事前予告なし】と, 5分前から1分ごとに体位変換を予告して70°head-up tilt を実施【事前予告あり】の2条件で行った. その結果,<br>1) head-up 後の平均RR間隔は"事前予告あり"のほうが短くなった (p<0.05).<br>2) head-up 前のLF/HF値は, 3分前頃から"事前予告あり"のほうが有意に高くなった (p<0.01).<br>3) 脳循環は head-up により, oxy-Hb および total-Hb が低下した. 特に"事前予告あり"では, head-up 前に oxy-Hb に上昇がみられた.<br>本研究により, head-up を伴う体位変換の前に"事前予告"を行うことで, head-up 後の循環調節の準備状態に入ることが明らかとなった.

著者

大島 理恵子 堀田 佐知子 近田 敬子 鵜山 治 Rieko OSHIMA Sachiko HORITA Keiko CHIKATA Osamu UYAMA 兵庫県立大学看護学部 実践基礎看護講座看護病態学 兵庫県立大学大学院看護学研究科修士課程看護病態学専攻 園田学園女子大学人間看護学科 兵庫県立大学看護学部 実践基礎看護講座看護病態学 Nursing Pathobiology College of Nursing Art and Science University of Hyogo Graduate School of Nursing Art and Science University of Hyogo Department of Human Nursing Sonoda Women's University Nursing Pathobiology College of Nursing Art and Science University of Hyogo

出版者

兵庫県立大学看護学部

雑誌

兵庫県立大学看護学部紀要 = University of Hyogo College of Nursing art and Science bulletin (ISSN:13498991)

巻号頁・発行日

vol.13, pp.51-61, 2006-03-15

---

本研究の目的は、「まちの保健室」を訪れる地域住民の睡眠の実態を調査するとともに、睡眠相談の活動方法を検討することである。研究協力者はH大学「まちの保健室」に来訪した男女102名(平均年齢55.9歳)で、質問紙調査を行った。また、個別睡眠相談を利用した女性17名(平均年齢60.9歳)には、アクチウォッチを用いた個別相談と介入を行いその反応について分析した。得られた結果は以下のとおりである。1)質問紙調査の判定で睡眠が良好だった人は49.0%、要注意の人は21.6%、不眠の疑いがある人は29.4%で、「まちの保健室」に来訪した人の約5割は、睡眠に関して何らかの問題や不満を抱えていた。2)個別睡眠相談来訪者の主な相談内容は、寝つきが悪い、中途覚醒がある、いびき、ほてり、自己の睡眠の測定などで、「不眠の悩みを相談しやすい状況をつくる」、「介入のきっかけの一つとしてアクチウォッチのデータを用いる」、「来訪者と共に生活の仕方を振り返る」、「眠れていることや良い生活習慣等できていることを認める」、「睡眠に関する知識・情報を提供する」などの介入を行った。3)個別睡眠相談を利用した17名のうち7名に、1ヶ月後以降の睡眠や生活の様子について聞き取り調査を行ったところ、「自分の睡眠を知ることによる安心感」、「自分の行動を認める」、「睡眠に対する関心の高まり」などの、視点や考え方の変化がみられた。また、7名中3名には睡眠が改善したという発言があった。睡眠相談は相談に来る人を待つスタイルであるが、今後は集団を対象とした睡眠衛生教育など、より積極的な介入も必要であると考える。「まちの保健室」睡眠相談で、アクチウォッチを用いながら個別の生活に合わせた介入を行うことにより、来訪者の睡眠に対する考え方や生活行動に変化が現れ、睡眠が改善する効果があることが示唆された。The purpose of this study was to investigate the sleep status of the local residents who visited the "Neighborhood Health Station" and to examine the action method used for sleep consultations. The study volunteers consisted of 102 persons (average age: 55.9 years) who visited the "Neighborhood Health Station" established by H University. The investigation was carried out using questionnaires. Seventeen females (average age: 60.9 years) received individual sleep consultations using an Actiwatch and interventions were made. The results were then analyzed. Results 1) According to the questionnaire data, 49.0% were classified as good sleepers; 21.6% as marginal; and 29.4% were suspected of being insomniacs. About 50% of those who visited the "Neighborhood Health Station" had some issues or dissatisfaction with their sleep. 2) The main topics raised by individuals during sleep consultations were their difficulty in falling asleep, waking up in the middle of the night, snoring, hot flashes and also how to get advice on how to monitor their own sleep patterns. We conducted interventions such as a) creating an environment where visitors can freely discuss their insomnia problems, b) making use of the Actigraph's data as one way of initiating intervention, c) examining clients' lifestyles and having them reflect on this with the support of the counselor, d) acknowledging that a good sleep and good life habits are being achieved, and e) providing knowledge and information about sleep". 3) Of 17 visitors who had individual sleep consultations, seven were chosen for further interviews regarding their sleep status and lives at more than one month after the initial consultation. We witnessed changes in the visitors' viewpoints and thinking, such as a) feeling assured by understanding their own sleep, b) acknowledging their own actions, and c) increased interest in sleep. Moreover, three out of the seven claimed that their sleep had improved. These sleep consultations were relied on waiting for clients to simply come in; however, in the future, we think that more active intervention will be necessary, such as conducting sleep health classes for groups. Intervening, in accordance with individual lifestyles by using the Actiwatch at the "Neighborhood Health Station" consultations, suggests that the clients' ideas about sleep and lifestyle were modified and such interventions were effective in improving sleep.