ᒣ㝧ㄽྀ㻌 ➨ 㻝㻥 ᕳ㻌 㻔㻞㻜㻝㻞㻕㻌ㄽᩥ㧗㱋⪅䛾⬺Ỉ⑕ண㜵䛾䜿䜰䛻㛵䛩䜛ᩥ⊩ⓗ⪃ᐹ
A Literature Review To The Prevention Of The Dehydration OfThe Elderlyዟᒣ ┿⏤⨾*䚸す⏣ ┿ᑑ⨾**
Mayumi Okuyama and Masumi Nishida㻌䜻䞊䝽䞊䝗䠖㧗㱋⪅䠈⬺Ỉ⑕䠈䜿䜰䠈ᩥ⊩᳨ウ
Key Words: Elderly, Dehydration, Care, Literature Reviewせ᪨㻌 ᡃ䛜ᅜ䛻䛚䛡䜛㧗㱋⪅䛾⬺Ỉ⑕ண㜵䛾䜿䜰䛻㛵䛩䜛◊✲ㄽᩥ䛾䝺䝡䝳䞊䛛䜙䚸㧗㱋⪅䛾⬺Ỉ⑕䛾ᐇែ䛺䜙䜃䛻䜿䜰䛾⌧≧䜢᫂䜙䛛䛻䛧䚸௒ᚋ䛾ㄢ㢟䛻䛴䛔䛶᳨ウ䛧䛯䚹䛭䛾⤖ᯝ䚸ᡃ䛜ᅜ䛾㧗㱋⪅䛿䚸⏕ά䛾ሙ䛾㐪䛔䛻䛛䛛䜟䜙䛪⬺Ỉ⑕䛾䝸䝇䜽䛾㧗䛔⪅䛜ከ䛔䛣䛸䛜♧၀䛥䜜䛯䚹䜎䛯䚸⬺Ỉ⑕䛾䜰䝉䝇䝯䞁䝖䛻䛴䛔䛶䛿䚸 㧗㱋⪅≉᭷䛾䜰䝉䝇䝯䞁䝖ᣦᶆ䛾㛤Ⓨ䛻㛵䛩䜛◊✲䜒⾜䜟䜜䛶䛔䜛䛜䚸౫↛䛸䛧䛶䜰䝉䝇䝯䞁䝖䛾㞴䛧䛥䛜䛒䜛䛣䛸䛜䛖䛛䛜䛘䛯䚹䛥䜙䛻䚸⬺Ỉ⑕ண㜵䛿䚸Ỉศᦤྲྀ䛜➨୍㑅ᢥ䛾䜿䜰䛷䛒䜛䛜䚸䜰䝉䝇䝯䞁䝖䛺䜙䜃䛻䜿䜰䛾ホ౯䛜㞴䛧䛔䛯䜑䚸䛂㣧䜣䛷䜒䜙䜟䛺䛡䜜䜀䛺䜙䛺䛔䛃䛸䛔䛖ᙉ㏕ほᛕ䛜┳ㆤ⫋䚸௓ㆤ⫋䛸䜒䛻䛒䜛䛣䛸䛜᥎ 䛥䜜䛯䚹௨ୖ䜘䜚䚸௒ᚋ䛿䚸⬺Ỉ⑕ண㜵䛾䜿䜰䛾ᐇែ䜔䜿䜰䛩䜛ഃ䛾ᚰ⌮ⓗᙳ㡪䜢ྵ䜑䛶䛥䜙䛻ㄪᰝ䛩䜛ᚲせ䛜䛒䜛䚹䜎䛯䚸㧗㱋⪅䛾⬺Ỉ⑕䛾䝸䝇䜽ホ౯䜢⾜䛖䛯䜑䛾⡆౽䛺䜰䝉䝇䝯䞁䝖ᣦᶆ䛾㛤Ⓨ䛾ᚲせᛶ䛜♧၀䛥䜜䛯䚹䊠䠊䛿䛨䜑䛻㧗㱋⪅䛷䛿䚸ຍ㱋䛻䜘䜛⭈ᶵ⬟䜔ᚰ⫵ᶵ⬟䛾పୗ䚸Ῥ୰ᯡ䛾㜈್䛾ୖ᪼䚸⣽⬊ෆᾮ㔞䛾ῶᑡ䛺䛹䛻䜘䜚䚸ᵝ䚻䛺⎔ቃୗ䛻䛚䛡䜛ணഛ⬟ຊ䛜పୗ䛧䛶䛔䜛䠍䠅䚹䜎䛯㧗㱋⪅䛿䚸Ỉ䞉㟁ゎ㉁␗ᖖ
䜢᮶䛧䜔䛩䛔⑓ែ䠍䠅䜔⤒ཱྀⓗ䛻Ỉศᦤྲྀ䛜ᅔ㞴䛻䛺䜛⑓ែ䛾ቑຍ䠎䠅䚸䛒䜛䛔䛿ᇶ♏⑌ᝈ䛻㉳ᅉ䛧䛯⸆≀⒪ἲ䛾ᙳ㡪 䠏䠅䛺䛹䛻䜘䜚䚸ຍ㱋䜔೺ᗣ㞀ᐖ䛻క䛖⬺Ỉ⑕䝸䝇䜽䛜㧗䛟䛺䜛䚹䛥䜙䛻ᛴᛶ䛻⏕䛨䜛⬺Ỉ⑕䛰䛡䛷䛺䛟䚸⤒ཱྀᦤྲྀ㔞䛾పୗ➼䛻䜘䜛៏ᛶⓗ䛺⬺Ỉ⑕䛜䛒䜛⪅䜒ᑡ䛺䛟䛺䛔 䠍䠅䚹㧗㱋⪅䛿ⱝᖺ⪅䛻ẚ䜉䛶⬺Ỉ᫬䛾⮬ぬ⑕≧䛜⌧䜜䛻䛟䛟䚸≉䛻ㄆ▱ᶵ⬟䛾పୗ䜔 ADL 䛾పୗ䛺䛹䛛䜙䚸⬺Ỉ䛻㝗䛳䛶䜒⮬ຊ䛷Ỉศᦤྲྀ䜢⾜䛖䛣䛸䛜ᅔ㞴䛺⪅䜒ከ䛔䚹䜎䛯䚸ኪ㛫䛾᤼ᒀ䛾㈇ᢸ㍍ῶ䛾䛯䜑䛻⮬䜙䛒䜛䛔䛿௓ㆤ⪅䛜Ỉศᦤྲྀ䜢ไ㝈䛩䜛䛣䛸䛜䛒䜛䛸䜒ሗ࿌䛥䜜䛶䛔䜛䠎䠅䚹䛣䛾䜘䛖䛻䚸㧗㱋⪅䛿㌟యᶵ⬟䛰䛡䛷䛺䛟䚸௓ㆤ≧ἣ䜔㧗㱋⪅䛾⨨䛛䜜䛶䛔䜛♫఍ⓗ䛺せᅉ䠐䠅䛻䜘䛳䛶䜒*㻌 ᒣ㝧Ꮫᅬ኱Ꮫ┳ㆤᏛ㒊┳ㆤᏛ⛉**ᒸᒣ኱Ꮫ኱Ꮫ㝔ಖ೺Ꮫ◊✲⛉- 83 -ዟᒣ䞉す⏣㻌 㻦㻌 㧗㱋⪅䛾⬺Ỉ⑕ண㜵䛾䜿䜰䛻㛵䛩䜛ᩥ⊩ⓗ⪃ᐹ㻌ᐜ᫆䛻⬺Ỉ䜢㉳䛣䛧䜔䛩䛔䛸䛔䛖ၥ㢟䛜䛒䜛䚹㧗㱋⪅䛾⬺Ỉ⑕ண㜵䛾䜿䜰䛿䚸᪥㡭䛛䜙㧗㱋⪅䛾≧ែ䜢ほᐹ䛧䚸㐺ษ䛺Ỉศ䞉㟁ゎ㉁⿵⤥䛾᥼ຓ䛜ᚲせ䛷䛒䜛䛣䛸䠎䠅䜔䚸ᾏእ䛷䛿䠍᪥䛚䛚䜘䛭 1200䡚1700ml 䛾Ỉศᦤྲྀ䛾ᚲせᛶ䛜ሗ࿌䛥䜜䛶䛔䜛 5-8䠅䛜䚸䜟䛜ᅜ䛾㧗㱋⪅䜈䛾㐺⏝䛾᰿ᣐ䛿᫂☜䛷䛿䛺䛔䚹䜎䛯䚸ᆅᇦ䛷⏕ά䛩䜛㧗㱋⪅䜔᪋タ䛷⏕ά䛩䜛せ௓ㆤ㧗㱋⪅䛾⬺Ỉ䛻㛵䛩䜛ᐇែ䜔་⒪⚟♴ᑓ㛛⫋䛾ㄆ㆑䛚䜘䜃䜿䜰䛾ᐇែ䜒༑ศ䛻᫂䜙䛛䛻䛿䛥䜜䛶䛔䛺䛔䚹䛭䛣䛷䚸㧗㱋⪅䛾⬺Ỉ⑕ண㜵䜎䛯䛿⬺Ỉ⑕䛾䜿䜰䛻㛵䛩䜛◊✲ㄽᩥ䜢䝺䝡䝳䞊䛧䚸ᡃ䛜ᅜ䛻䛚䛡䜛㧗㱋⪅䛾⬺Ỉ⑕ண㜵䛺䜙䜃䛻䜿䜰䛾⌧≧䜢᫂䜙䛛䛻䛧䚸௒ᚋ䛾ㄢ㢟䛻䛴䛔䛶᳨ウ䛧䛯䚹䊡䠊◊✲᪉ἲᩥ⊩䛿䚸2002 ᖺ䛛䜙 2011 ᖺ䛻Ⓨ⾜䛥䜜䛯ᩥ⊩䛸䛧䚸་Ꮫ୰ኸ㞧ㄅ Web ∧䛚䜘䜃 CiNii䠄NIIㄽᩥ᝟ሗ䝘䝡䝀䞊䝍ᅜ❧᝟ሗᏛ◊✲ᡤ䠅䜢⏝䛔䚸⬺Ỉ⑕䚸㧗㱋⪅䚸䜿䜰䜢䜻䞊䝽䞊䝗䛸䛧䛶⤌䜏ྜ䜟䛫䛶᳨⣴䛧䛯䚹䛭䛾⤖ᯝ䚸་Ꮫ୰ኸ㞧ㄅ䛷䛿 107 ௳䚸CiNii 䛷䛿 3 ௳䛜ᢳฟ䛥䜜䛯䚹ḟ䛔䛷䚸᳨⣴䛥䜜䛯ᩥ⊩䛾䛺䛛䛛䜙ゎㄝ䛺䜙䜃䛻఍㆟㘓䜢㝖እ䛧䚸ṧ䛳䛯◊✲ㄽᩥ䛾䛺䛛䛛䜙䚸⬺Ỉ⑕ண㜵䛾䜿䜰䛻㛵䛩䜛 11 ௳䜢ᩥ⊩䝺䝡䝳䞊䛾ᑐ㇟䛸䛧䛯䚹௒ᚋ䛾ㄢ㢟䜢᳨ウ䛩䜛䛯䜑䛻䚸䛂㧗㱋⪅䛾⬺Ỉ⑕䛾ᐇែ䛻㛵䛩䜛䜒䛾䛃䛂㧗㱋⪅䛾⬺Ỉ⑕䛾䜰䝉䝇䝯䞁䝖᪉ἲ䛻㛵䛩䜛䜒䛾䛃䛂㧗㱋⪅䛾⬺Ỉ⑕ண㜵䛾䜿䜰䛾ᐇែ䛻㛵䛩䜛䜒䛾䠄䜿䜰䛸䛭䛾ホ౯䛾ᐇ㝿䠅䛃䛂㧗㱋⪅䛾⬺Ỉ⑕ண㜵䛾䜿䜰䛻䛴䛔䛶䛾┳ㆤ⫋䜔௓ㆤ⫋䛾ㄆ㆑䛻㛵䛩䜛䜒䛾䛃䛾䠐䛴
䛾どⅬ䛷䝺䝡䝳䞊䜢⾜䛳䛯䚹䊢䠊⤖ᯝ⬺Ỉ⑕ண㜵䛾䜿䜰䛻㛵䛩䜛 11 ᩥ⊩䛾䛖䛱䚸㧗㱋⪅䛾⬺Ỉ⑕䛾ᐇែ䛚䜘䜃⬺Ỉ⑕䛾䜰䝉䝇䝯䞁䝖᪉ἲ䛻㛵䛩䜛ᩥ⊩䛿 7 ௳䛷䛒䜚䚸⬺Ỉ⑕䛾ᣦᶆ䜢⏝䛔䛶◊✲䜢⾜䛳䛶䛔䛯䚹ྛᩥ⊩䛷౑⏝䛥䜜䛯ᣦᶆ䛸◊✲᪉ἲ䚸⤖ᯝ䛻䛴䛔䛶⾲䠍䛻♧䛧䛯䚹䛭䛾௚䛾 4 ᩥ⊩䛿䚸⬺Ỉ⑕ண㜵䛾䛯䜑䛾ලయⓗ䛺䜿䜰䛻㛵䛩䜛ෆᐜ䛷䛒䜚䚸⤖ᯝ䛾ศᯒ᫬䛻⬺Ỉ⑕䛾ᐃ⩏䛒䜛䛔䛿ᣦᶆ䜢ᚲせ䛸䛧䛺䛔◊✲䛷䛒䛳䛯䚹௨ୗ䛻䚸4 䛴䛾どⅬ䛤䛸䛻䝺䝡䝳䞊䜢⾜䛳䛯䚹䠍䠊㧗㱋⪅䛾⬺Ỉ⑕䛾ᐇែ䛻㛵䛩䜛䜒䛾೺ᗣ䛺㧗㱋⪅䛾⬺Ỉ≧ែ䛾᭷↓䛻䛴䛔䛶ᮡᒣ䜙䠕䠅䛜ㄪᰝ䛧䛶䛔䜛䚹㧗㱋⪅䛻ከ䛔㧗ᙇᛶ⬺Ỉ䛾ᐃ⩏䜢㧗 Na ⾑⑕䠄⾑Ύ Na ್ 145mEq/dl ௨ୖ䠅䛛䛴㧗ᾐ㏱ᅽ⾑⑕䠄⾑Ύᾐ㏱ᅽ್
300mOsm/l ௨ୖ䠅䛾≉ᛶ䜢᭷䛩䜛䛣䛸䛸䛧䚸೺ᗣ䛺㧗㱋⪅ 117 ྡ䛸᪋タ䛻ධᒃ䛧䛶䛔䜛㧗㱋⪅
387 ྡ䛾⬺Ỉ≧ែ䛾᭷↓䛻䛴䛔䛶ㄪᰝ䛧䛶䛔䜛䚹䛭䛾⤖ᯝ䚸⾑Ύ Na ್䛿೺ᗣ㧗㱋⪅䛺䜙䜃䛻᪋タ㧗㱋⪅䜒䛸䜒䛻 140.8mEq/l 䛷䛒䛳䛯䛜䚸೺ᗣ㧗㱋⪅䛿ᡂே䛾ᇶ‽್(135-145 mEq/l)䛾
⠊ᅖ䛻ྵ䜎䜜䛶䛔䛯䚹䛧䛛䛧䚸᪋タ㧗㱋⪅䛿ప್䛛䜙㧗್䜎䛷ศᕸ䛧䛶䛔䛯䚹⾑Ύᾐ㏱ᅽ್
䠄Osm䠅䛿䚸೺ᗣ㧗㱋⪅䛿 299 mOsm/l䚸᪋タ㧗㱋⪅䛿 295 mOsm/l 䛷䛒䛳䛯䚹೺ᗣ㧗㱋⪅䛿
295 mOsm/l ௨ୖ䛜඲య䛾 60%䚸300 mOsm/l ௨ୖ䛾⪅䛜඲య䛾 50%䛷䛒䛳䛯䛣䛸䛛䜙䚸೺ᗣ㧗㱋⪅䛿⾑Ύᾐ㏱ᅽ್䛜㧗䛔ഴྥ䛷䛒䜛䛸䛔䛘䛯䚹䛭䛾௚䚸⾑Ύ Na ್䛸⾑Ύᾐ㏱ᅽ್䛻┦㛵䛜䛒䜛䛣䛸䛜ሗ࿌䛥䜜䛶䛔䜛䚹䜎䛯䚸䛂⯉䛾஝⇱䞉ட⿣䛾䛒䜛䛃䛸䛔䛖ᚩೃ䛸⾑Ύᾐ㏱ᅽ䛸䛾㛵㐃䛜䛒䜚䚸䛥䜙䛻䛿䚸⾑⢾ୗ㝆๣䜢㣧䜣䛷䛔䜛ே䛿⾑Ύᾐ㏱ᅽ್䛜㧗್䛾ഴྥ䛻䛒䛳䛯䚹Ỉศᦤྲྀ≧ἣ䛷䛿䚸᫨㣗᫬䛾Ỉศᦤྲྀ≧ἣ䛸⾑Ύᾐ㏱ᅽ್䛻㛵㐃䛜䛒䜛䛣䛸䛜ሗ࿌䛥䜜䛶䛔䜛䚹- 84 -ᒣ㝧ㄽྀ㻌 ➨ 㻝㻥 ᕳ㻌 㻔㻞㻜㻝㻞㻕㻌⾲䠍䚷ྛㄽᩥ䛷౑⏝䛥䜜䛯⬺Ỉ⑕䛾ᣦᶆ䛸◊✲᪉ἲ䚸⤖ᯝ䝔䞊䝬ⴭ⪅Ⓨ⾜ᖺ⬺Ỉ⑕䛾ᣦᶆ◊✲᪉ἲ⤖ᯝ⾑ᾮ᳨ᰝ䛚䜘䜃⮫ᗋୖ䛾ᚩ 䠍䠊⾑Ύ㻺㼍್䛿೺ᗣ㧗㱋⪅䚸᪋タ㧗㱋⪅䜒㻝㻠㻜㻚㻤㼙㻱㼝㻛㼘䛷䛒䛳䛯䚹೺ᗣ⪅䛿ᡂே䛾ᇶ㧗㻺㼍⾑⑕䠄⾑Ύ㻺㼍್䛂᪂⪁ே䛾఍䛃䛾⬺Ỉ≧ ᮡᒣ䜏䛱Ꮚ㻘Ლ஭ᩥᏊ‽್䛾⠊ᅖ䛻ྵ䜎䜜䛶䛔䛯䛜䚸᪋タ⪅䛿ప್䛛䜙㧗್䜎䛷ศᕸ䛧䛶䛔䛯䚹㻝㻠㻡㼙㻱㼝㻛㼐㼘௨ୖ䠅䛛䛴㧗ᾐ ೃ䞉⑕≧㡯┠䛾ㄪᰝែ䛻㛵䛩䜛ㄪᰝ䠕䠅䠎䠊⾑Ύᾐ㏱ᅽ䠄㻻㼟㼙䠅䛿䚸೺ᗣ㧗㱋⪅䛿㻞㻥㻥㼙㻻㼟㼙㻛㼘䚸᪋タ⪅䛿㻞㻥㻡㼙㻻㼟㼙㻛㼘䛷䛒䛳㏱ᅽ⾑⑕䠄⾑Ύᾐ㏱ᅽ್䛯䚹೺ᗣ⪅䛿㻞㻥㻡㼙㻻㼟㼙㻛㼘௨ୖ䛜㻢㻜㻑䛰䛳䛯䚹㻟㻜㻜㼙㻻㼟㼙㻛㼘௨ୖ䠅䛾≉ᛶ䜢䠏䠊⾑Ύ㻺㼍್䛸⾑Ύᾐ㏱ᅽ䛾್䛻┦㛵䛜䛒䛳䛯䚹᭷䛩䜛䛣䛸䠐䠊㻮㼁㻺䚸㻯㼞䚸㻮㻿䚸㻴㼎䚸㻴㼠䛿೺ᗣ⪅䛾᪉䛜㧗䛛䛳䛯䚹㻞㻜㻜㻞䠑䠊⬺Ỉ⑕≧䠄ཱྀῬ䛺䛹䠅䛿䚸⾑Ύ㻺㼍್䛸⾑Ύᾐ㏱ᅽ䛾್䛻┦㛵䛿䛺䛛䛳䛯䚹䠒䠊⯉䛾஝⇱䞉ட⿣䛾䛒䜛ே䛿⾑Ύᾐ㏱ᅽ䛜㧗䛛䛳䛯䚹䠓䠊⢾ᒀ⑓䛜䛒䜚䚸⾑⢾ୗ㝆๣䜢㣧䜣䛷䛔䜛ே䛿㧗್䛾ഴྥ䛻䛒䛳䛯䚹䠔䠊᫨㣗᫬䛾Ỉศᦤྲྀ≧ἣ䛜⾑Ύᾐ㏱ᅽ್䛻㛵㐃䛜䛒䛳䛯䚹೺ᗣ㧗㱋⪅䛾⬺Ỉ≧ែ Ლ஭ᩥᏊ䛾᪩ᮇⓎぢ䛾䛯䜑䛾䜰䝉䝇䝯䞁䝖㡯┠䛾㛤Ⓨ䛻㛵䛩䜛◊✲㻝㻜㻕㧗㻺㼍⾑⑕䠄⾑Ύ㻺㼍್⾑ᾮ᳨ᰝ䛚䜘䜃⮫ᗋୖ䛾ᚩ 䠍䠊⾑Ύ㻺㼍್䛿䚸೺ᗣ㧗㱋⪅䛷㻝㻠㻜㻚㻤㼼㻝㻚㻤㼙㻱㼝㻛㼘䛷䛒䛳䛯䚹᪋タ㧗㱋ᝈ⪅䛿㻝㻠㻜㻚㻞㼼㻝㻠㻡㼙㻱㼝㻛㼐㼘௨ୖ䠅䛛䛴㧗ᾐ ೃ䞉⑕≧㡯┠䛾ㄪᰝ㻠㻚㻟㼙㻱㼝㻛㼘䛷䛒䛳䛯䚹㻺㼍್䛜㻝㻠㻡㼙㻱㼝㻛㼘௨ୖ䛾⪅䛿䚸೺ᗣ㧗㱋⪅䛷㻝ྡ䠄㻜㻚㻥䠂䠅䚸᪋タ㧗
㏱ᅽ⾑⑕䠄⾑Ύᾐ㏱ᅽ್㱋⪅䛷㻝㻜ྡ䠄㻟㻚㻤䠂䠅䛷䛒䛳䛯䚹㏫䛻㻺㼍್䛜㻝㻟㻡ᮍ‶䛾⪅䛿೺ᗣ㧗㱋⪅䛷㻝ྡ㻟㻜㻜㼙㻻㼟㼙㻛㼘௨ୖ䠅䛾≉ᛶ䜢䠄㻜㻚㻥䠂䠅䚸᪋タ㧗㱋⪅䛷㻞㻠ྡ䠄㻥㻚㻜䠂䠅䛷䛒䛳䛯䚹᭷䛩䜛䛣䛸䠎䠊⾑Ύᾐ㏱ᅽ್䛿䚸೺ᗣ㧗㱋⪅䛿㻞㻥㻥㻚㻜㼼㻠㻚㻤㼙㻻㼟㼙㻛㼘䛷䚸᪋タ㧗㱋⪅䛿㻞㻥㻡㼼㻝㻝㻚㻡㼙㻻㼟㼙㻛㼘䛷䛒䛳䛯䚹㻞㻜㻜㻟䠏䠊೺ᗣ㧗㱋⪅䛿᪋タ㧗㱋⪅䛸ྠᵝ䛻⾑Ύᾐ㏱ᅽ್䛜㧗䛔ഴྥ䛻䛒䛳䛯䚹㛵㐃せᅉ䛸䛧䛶⢾ᒀ⑓䜚ᝈ䛸⾑⢾㝆ୗ๣䛾ෆ᭹ഴྥ䛜䛒䛳䛯䚹䠐䠊೺ᗣ㧗㱋⪅䛾㧗ᾐ㏱ᅽ⾑⑕䛾ᚩೃ䞉⑕≧䛸䛧䛶䛂⭆❐䛾஝⇱䛃䛂⯉䛾஝⇱䞉ட⿣䛃䛜᫂䜙䛛䛻䛺䛳䛯䚹ᅾᏯ⹫ᙅ㧗㱋⪅䛻䛚䛡䜛 Ლ஭ᩥᏊ㻘ᮡᒣ䜏䛱Ꮚ㻘⬺Ỉ≧ែ䛸Ỉศᦤྲྀ≧ἣ ஬࿡㑳Ꮚ㧗㻺㼍⾑⑕䠄⾑Ύ㻺㼍್⾑ᾮ᳨ᰝ䛚䜘䜃⬺Ỉ≧ែ䛻 䠍䠊⬺Ỉ⑕䛾䝸䝇䜽䛒䜚⩌㻥ྡ䛸䝸䝇䜽䛺䛧⩌㻢㻞ྡ䛾㻞⩌㛫䛷䛿䚸᪥ᖖ䛻䛚䛡䜛㻝᪥䛾Ỉ㻝㻠㻡㼙㻱㼝㻛㼐㼘௨ୖ䠅䛛䛴㧗ᾐ 㛵㐃䛩䜛䝸䝇䜽㡯┠䚸᪥ᖖ ศᦤྲྀ㢖ᗘ䛻᫂䜙䛛䛻㐪䛔䛜ぢ䜙䜜䛯䚹㏱ᅽ⾑⑕䠄⾑Ύᾐ㏱ᅽ್ 䛾Ỉศᦤྲྀ㢖ᗘ䚸⮬ぬ䛥䜜 䠎䠊୧⩌㛫䛷⬺Ỉ⑕≧䛻㛵㐃䛩䜛⮬ぬ⑕≧䛻䛿㐪䛔䛜ㄆ䜑䜙䜜䛺䛛䛳䛯䚹㻞㻜㻜㻢㻟㻜㻜㼙㻻㼟㼙㻛㼘௨ୖ䠅䛾≉ᛶ䜢 䜛⑕≧䛾ㄪᰝ᭷䛩䜛䛣䛸㻝㻝㻕䝞䜲䜸䜲䞁䝢䞊䝎䞁䝇ἲ䜢 ሐ㞞ᜨ㻘ᑠᯘ㻌ᩄ⏕㻘ᑠ⏝䛔䛯㧗㱋⪅䛾యෆỈศ ᕝ㻌ᬒᏊ㻘௚㔞 ᐃ㻦䜿䜰䝝䜴䝇ධᡤ⪅䛸≉ู㣴ㆤ⪁ே䝩䞊䝮ධᡤ⪅䜢ᑐ㇟䛸䛧䛶㻝㻞㻕䜿䜰䝝䜴䝇ධᡤ㧗㱋⪅䛻 ሐ㞞ᜨ㻘బ⸨㻌⨾ᖾ㻌㻘ᑠ䛚䛡䜛యෆỈศ㔞䛾Ꮨ⠇ ᯘ㻌ᩄ⏕ኚື䠉䝞䜲䜸䜲䞁䝢䞊䝎䞁䝇ἲ䜢⏝䛔䛯ኟᏘ䛸෤Ꮨ䛾ẚ㍑᳨ウሐ㞞ᜨ㻝㻟㻕ᅾᏯせ௓ㆤ㧗㱋⪅䛾ኟ 㛗἟⌮ᜨ㻘⾲ᚿὠᏊ㻘ሯᏘ䛻䛚䛡䜛⬺ỈⓎ⏕䛻㛵 ᓮ㻌ᜨᏊ䛩䜛ᐇែㄪᰝ䠉䝕䜲䝃䞊䝡䝇฼⏝⪅䜢ᑐ㇟䛻䠉㻝㻠㻕㧗㱋ධ㝔ᝈ⪅䛾⬺Ỉ≧ Ლ஭ᩥᏊែ䛾᪩ᮇⓎぢ䛾䛯䜑䛾┳ㆤ䜰䝉䝇䝯䞁䝖䠉㧗ᙇᛶ⬺Ỉ䛾⾑ᾮ᳨ᰝᣦᶆ䛸ほᐹᡤぢ䛛䜙䛾ศᯒ䠉㻝㻡㻕యෆỈศ㔞䛾ῶᑡయෆỈศ㔞䛾 ᐃ䛚䜘䜃⮬ 䠍䠊䜿䜰䝝䜴䝇ධᡤ⪅䛚䜘䜃≉㣴ධᡤ⪅䛾యෆỈศ㔞䛿䚸⣽⬊ෆ䞉⣽⬊እỈศ㔞䛜ぬ⑕≧䚸ཱྀ⭍ෆ䛾஝⇱≧ែ 䜋䜌ྠ⋡䛷䛒䜚䚸ᕪ䛜䛺䛛䛳䛯䚹䜎䛯䚸䠝䠠䠨䛸యෆỈศ㔞䛸䛾㛵㐃䛜䛺䛛䛳䛯䚹䜔⭆❐䛾஝⇱䛺䛹䛾௚ぬ⑕ 䠎䠊ព㆑㞀ᐖ䛚䜘䜃⮬ぬ⑕≧䞉௚ぬ⑕≧䛿䚸యෆỈศ㔞䛾ῶᑡ䜢♧䛩☜ᐇ䛺ᣦᶆ䛷䛿䛺䛛䛳䛯䚹≧䛾ほᐹయෆỈศ㔞䛾ῶᑡయෆỈศ㔞䛾 ᐃ䛚䜘䜃⮬ 䠍䠊㻞㻟ྡ䛾ኟᏘ䞉෤Ꮨ䛻䛚䛡䜛㌟㛗䞉య㔜䞉㻮㻹㻵䚸య 䚸⬦ᢿ䚸⾑ᅽ䛿ᕪ䛿䛺䛛䛳䛯䚹ぬ⑕≧䛾ㄪᰝ䠎䠊య⬡⫫⋡䛜෤Ꮨ䛻㧗䛛䛳䛯䚹䠏䠊యෆỈศ㔞䛿䚸⥲Ỉศ㔞䛾య㔜䛻༨䜑䜛๭ྜ䛿䚸ኟᏘ㻠㻥㻚㻡䚸෤Ꮨ㻠㻡㻚㻜䛷᭷ព䛥䛜䛒䛳䛯䚹⣽⬊ෆ䚸⣽⬊እỈศ㔞䜒෤Ꮨ䛾᪉䛜᭷ព䛻ప䛛䛳䛯䚹䠐䠊⓶⭵஝⇱䛾⮬ぬ⑕≧䛾䛒䜛ே䛿෤Ꮨ䛻䛚䛔䛶䛂䛒䜛䛃䛸⟅䛘䛯ே䛜᭷ព䛻ከ䛛䛳䛯䚹㻞㻜㻜㻟㻞㻜㻜㻟Ỉศฟ⣡䝞䝷䞁䝇⬺Ỉ⑕䛜␲䜟䜜䜛⑕≧䞉ㄏ 䠍䠊ㄪᰝ᪥䛾⬺Ỉ⑕䛾␲䛔䛿㻝㻤㻚㻠㻑䛚䜚䚸䝕䜲䝃䞊䝡䝇䜢฼⏝䛧䛶䛔䛯ẚ㍑ⓗ೺ᗣ≧ᅉ䛻䛴䛔䛶䛾⪺䛝ྲྀ䜚䛸䜰䝉 ែ䛜Ᏻᐃ䛧䛶䛔䛯ᅾᏯせ௓ㆤ㧗㱋⪅䛻䛚䛔䛶䚸⬺Ỉ⑕䛜Ⓨ⑕䛩䜛༴㝤ᛶ䛾䛒䜛⪅䝇䝯䞁䝖䛜䛔䛯䚹䠎䠊ཱྀ⭍஝⇱䛜䛒䜛䛜䚸ཱྀῬឤ䛜䛺䛔⪅䛜㻟㻝㻚㻢㻑䛚䜚䚸ཱྀ⭍ෆ䛾஝⇱ᗘ䛸ཱྀῬឤ䛻䛪㻞㻜㻜㻡䜜䛜䛒䜛⪅䛜䛔䛯䚹䠏䠊⬺Ỉ⑕䛻㛵ಀ䛩䜛ㄏᅉ䛸䛧䛶ከ䛛䛳䛯䛾䛿䚸ᬬ䛔᫬䛻Ỉศᦤྲྀ䜢ቑ䜔䛥䛺䛔⪅䛜㻡㻜㻑䚸Ỉศฟ⣡䝞䝷䞁䝇䛜䝬䜲䝘䝇䛾⪅䛜㻟㻢㻚㻤㻑䚸୺䛻᤼ἥ䜢ព㆑䛧䛶⮬䜙Ỉศ䜢ไ㝈䛧䛶䛔䛯⪅䛜㻞㻝㻚㻝㻑䛔䛯䚹㧗㻺㼍⾑⑕䠄⾑Ύ㻺㼍್⾑ᾮ᳨ᰝ䛚䜘䜃⮫ᗋୖ䛾ᚩ 䠍䠊⬺Ỉ⑕䛾せᅉ㡯┠䛷䛿䚸⾑Ύ䝘䝖䝸䜴䝮㧗್㻔㼚㻩㻝㻞㻕䛸䛂฼ᒀ⸆䜢౑⏝䛃䛂ཱྀ⭍ෆ䛜㻝㻠㻡㼙㻱㼝㻛㼐㼘௨ୖ䠅䛛䛴㧗ᾐ ೃ䞉⑕≧㡯┠䛾ㄪᰝở䛔䛃䛸䛻㛵㐃䛜䛒䛳䛯䚹䜎䛯䚸⾑Ύᾐ㏱ᅽ㻞㻥㻡㻻㼟㼙㻛䡈䜘䜚㧗್㻔㼚㻩㻝㻢㻝㻕䛸䛂ዪᛶ䛃䛂ୗ㏱ᅽ⾑⑕䠄⾑Ύᾐ㏱ᅽ್๣䞉ᾃ⭠䜢฼⏝䛃䛂㻰㻹䛜䛒䜛䛃㼇㻮㼍㼞㼏㼔㼑㼘䚷㻵㼚㼐㼑㼤䛜㻣㻜Ⅼ௨ୖ䛃䛸䛾㛵㐃䛜䛒䛳䛯䚹䛥䜙㻟㻜㻜㼙㻻㼟㼙㻛㼘௨ୖ䠅䛾≉ᛶ䜢䛻䚸⾑Ύᾐ㏱ᅽ㻟㻜㻜㻻㼟㼙㻛䡈䜘䜚㧗್㻔㼚㻩㻤㻞㻕䛸䛂㻤㻡ṓ௨ୖ䛷䛒䜛䛃䛂⤒ཱྀᰤ㣴ἲ䛷䛒䜛䛃᭷䛩䜛䛣䛸䛸䛻㛵㐃䛜䛒䛳䛯䚹㻞㻜㻜㻞䠎䠊⬺Ỉ䛾ᚩೃ䞉⑕≧䛷䛿䚸⾑Ύ䝘䝖䝸䜴䝮㧗್䛸䛂ཱྀ၁䛾஝⇱䛃䛂⯉䛾஝⇱䞉ட⿣䛃䛂⓶⭵䛾஝⇱䛃䛂⓶⭵䛾⥭ᙇ䛾పୗ䛃䛜㛵㐃䛧䛯䚹䜎䛯䚸⾑Ύᾐ㏱ᅽ㧗್䛸䛂⓶⭵䛾஝⇱䛃䛂ཱྀ၁䛾஝⇱䛃䛂⓶⭵䛾෭ឤ䛃䛂ᚤᙅ䛺⬦ᢿ䛃䛂࿧྾ᩘ䛾ୖ᪼䛃䛻㛵㐃䛜䛒䛳䛯䚹- 85 -ዟᒣ䞉す⏣㻌 㻦㻌 㧗㱋⪅䛾⬺Ỉ⑕ண㜵䛾䜿䜰䛻㛵䛩䜛ᩥ⊩ⓗ⪃ᐹ㻌ᮡᒣ䜙䛿䚸◊✲䜢㏻䛧䛶䚸㧗㱋⪅䛾⾑Ύᾐ㏱ᅽ್䛾ᇶ‽್䜔ຍ㱋䛻䜘䜛ᙳ㡪䜢᫂䜙䛛䛻䛩䜛ᚲせᛶ䛸䜰䝉䝇䝯䞁䝖㡯┠䛾᳨ド䛾ᚲせᛶ䜢ㄢ㢟䛸䛧䛶䛒䛢䛶䛔䜛䚹Ლ஭䜙 10䠅䛿䚸⒪㣴⑓ᗋ䛻ධ㝔୰䛾㧗㱋⪅ 267 ྡ䛻ᑐ䛩䜛⾑ᾮ᳨ᰝ䜢ᐇ᪋䛧䚸ᮡᒣ䜙䠕䠅䛾⤖ᯝ䛸ẚ㍑䛧䛯䛸䛣䜝䚸ᆅᇦ䛷⮬❧䛧䛯㧗㱋⪅䛷㧗ᙇᛶ⬺Ỉ䛾⪅䛿䠍ྡ䠄0.9%䠅䚸⒪㣴⑓ᗋ䛾㧗㱋⪅䛷䛿 8 ྡ䠄3.2%䠅䛷䛒䛳䛯䚹⒪㣴⑓ᗋ䛾㧗㱋⪅䛾⾑Ύ Na ್䛾ᖹᆒ䛿 140.2㼼4.3mEq/dl 䛷䚸⾑Ύᾐ㏱ᅽ್䛿 295.0㼼11.5mOsm/l 䛷䛒䜚䚸300 mOsm/l ௨ୖ䛾⪅䛜 87 ྡ䠄29.0%䠅䛷䛒䛳䛯䛸ሗ࿌䛧䛯䚹䜎䛯䚸Ლ஭䜙 11䠅䛿䚸ᅾᏯ⹫ᙅ㧗㱋⪅ 71 ྡ䛾⬺Ỉ≧ែ䛸Ỉศᦤྲྀ≧ἣ䜢ㄪᰝ䛧䛯䚹㧗ᙇᛶ⬺Ỉ䛾⪅䛿䠍ྡ䛾䜏䛷䛒䜚䚸㧗 Na ⾑⑕䛾⪅ 7 ྡ䚸⾑Ύᾐ㏱ᅽ 300 mOsm/l ௨ୖ䛾⪅䛜䠏ྡ䛷䛒䜚䚸䝸䝇䜽⩌ 9 ྡ䛸䛧䚸䝸䝇䜽䛺䛧⩌䛸Ỉศᦤྲྀ≧ἣ䜢ẚ㍑䛧䛯䛸䛣䜝䚸䝸䝇䜽䛒䜚⩌䛿Ỉศᦤྲྀ㔞䛜 2.7㼼1.5 ᮼ䚸䛺䛧⩌䛿 4.4㼼2.1 ᮼ䛷᭷ពᕪ䛜䛒䛳䛯䚹⬺Ỉ䛾⮬ぬ⑕≧䛻䛿᭷ពᕪ䛜䛺䛛䛳䛯䛸ሗ࿌䛧䛯䚹㧗㱋⪅䛾యෆỈศ㔞䛻╔┠䛧䛯◊✲䛷䛿䚸ሐ䜙 12䠅䛜䚸䝞䜲䜸䜲䞁䝢䞊䝎䞁䝇ἲ䜢⏝䛔䛶䜿䜰䝝䜴䝇ධᒃ⪅ 43 ྡ䛸≉㣴ධᒃ⪅ 20 ྡ䛾ẚ㍑䜢⾜䛳䛶䛔䜛䚹䜿䜰䝝䜴䝇ධᒃ⪅䛿⥲Ỉศ㔞 50.1䠂䚸
⣽⬊ෆᾮ㔞䠖⣽⬊እᾮ㔞䠙䠍䠖䠍䛷䛒䛳䛯䚹≉㣴ධᒃ⪅䛿䚸⥲Ỉศ㔞 48.6䠂䚸⣽⬊ෆᾮ㔞䠖⣽⬊እᾮ㔞䠙䠍䠖䠍䛷䛒䛳䛯䚹䜎䛯䚸䛭䛾ᚋ䚸ሐ䜙 13䠅䛿䜿䜰䝝䜴䝇ධᒃ⪅ 23 ྡ䛾యෆỈศ㔞䛾Ꮨ⠇ኚື䜢ㄪᰝ䛧䛯䚹䛭䛾⤖ᯝ䚸⥲Ỉศ㔞䚸⣽⬊ෆỈศ㔞䚸⣽⬊እỈศ㔞䛾䛩䜉䛶䛷ኟᏘ䛻ᑐ䛧䛶෤Ꮨ䛻䛚䛡䜛ῶᑡ䛜ㄆ䜑䜙䜜䛯䚹䜎䛯䚸⮬ぬ⑕≧䛸ᑐෆỈศ㔞䛸䛾㛵ಀ䛿䜏䜙䜜䛪䚸⮬ぬ⑕≧䛾᭷↓䛿యෆỈศ㔞䛾☜ᐇ䛺ᣦᶆ䛸䛿䛺䜙䛺䛔䛸ሗ࿌䛧䛯䚹௒ᚋ䛾ㄢ㢟䛸䛧䛶䛿䚸ᑐ㇟⪅ᩘ䜢ቑ䜔䛩䛣䛸䜔ᖺ㛫䜢㏻䛧䛶䛾ㄪᰝ䛾ᚲせᛶ䜢䛒䛢䛶䛔䜛䚹㛗἟䜙 14䠅䛾◊✲䛷䛿䚸ᅾᏯせ௓ㆤ㧗㱋⪅ 152 ྡ䛾ኟᏘ䛻䛚䛡䜛Ỉศฟ⣡䝞䝷䞁䝇䜢ㄪᰝ䛧䛯䛸䛣䜝䚸Ỉศฟ⣡䛾䝞䝷䞁䝇䛜䝬䜲䝘䝇䛾⪅䛿 18.2䠂䛷䛒䛳䛯䚹ཱྀ⭍ෆ஝⇱䛜䛒䛳䛶䜒ཱྀῬឤ䛾䛺䛔⪅䛜ከ䛟䚸ᬬ䛔᪥䛷䜒Ỉศᦤྲྀ䜢ቑ䜔䛥䛺䛔⪅䛜༙ᩘ䛔䛯䛣䛸䜢ሗ࿌䛧䛯䚹䠎䠊㧗㱋⪅䛾⬺Ỉ≧ែ䛾䜰䝉䝇䝯䞁䝖᪉ἲ䛻㛵䛩䜛◊✲Ლ஭䜙 15)䛾◊✲䛷䛿䚸௓ㆤ⒪㣴ᆺ་⒪᪋タ䛾㧗㱋⪅䛻䛚䛡䜛⬺Ỉ䛾᪩ᮇⓎぢ䛾䛯䜑䛾ලయⓗ䛺┳ㆤ䜰䝉䝇䝯䞁䝖㡯┠䜢᫂☜䛻䛩䜛䛯䜑䛻䚸274 ྡ䛾㧗㱋⪅䛻ᑐ䛧䛶䚸⾑ᾮ᳨ᰝᣦᶆ䛸ᝈ⪅≉ᛶ䜔೺ᗣ≧ែ䛺䛹䛾せᅉ䚸ᚩೃ䞉⑕≧㡯┠䛸䛾㛵㐃䜢᳨ウ䛧䛯䚹⬺Ỉ䛾せᅉ㡯┠䛷䛿䚸⾑ΎNa 㧗್䛸䛂฼ᒀ๣฼⏝䛃䛂ཱྀ⭍ෆ䛾⾨⏕≧ែ䛻ၥ㢟䛒䜚䛃䛾㛵㐃䛜䛒䛳䛯䚹⾑Ύᾐ㏱ᅽ㧗್䛸䛂ዪᛶ䛃䛂ୗ๣䞉ᾃ⭠䛾౑⏝䛃䛂⢾ᒀ⑓䛃䛂barthel Index score ᚓⅬ䛜㧗䛔䛃䛂85 ṓ௨ୖ䛃䛂⤒ཱྀ⒪ἲ䛷䛒䜛䛃䛸䛾㛵㐃䛜䛒䛳䛯䚹඙ೃ䞉⑕≧㡯┠䛷䛿䚸⾑Ύ Na 㧗್䛸䛂ཱྀ၁䛾஝⇱䛃䛂⯉䛾஝⇱䞉ட⿣䛃䛂⓶⭵஝⇱䛃䛂⓶⭵⥭ᙇ䛾పୗ䛃䛸䛾㛵㐃䛜䛒䛳䛯䚹⾑Ύᾐ㏱ᅽ㧗್䛸䛂⓶⭵஝⇱䛃䛂ཱྀ၁䛾஝⇱䛃䛂⓶⭵䛾෭ឤ䛃䛂ᚤᙅ䛺⬦ᢿ䛃䛂࿧྾ᩘ䛾ୖ᪼䛃䛸䛾㛵㐃䛜䛒䛳䛯䚹㧗㱋⪅䜿䜰䛷䛾⬺Ỉ䛾᪩ᮇⓎぢ䛻᭷ຠ䛺┳ㆤ䜰䝉䝇䝯䞁䝖㡯┠䛜᫂䜙䛛䛻䛺䛳䛯䛸䛧䛶䛔䜛䚹䜎䛯䚸Ლ஭䜙 10䠅䛿䚸೺ᗣ㧗㱋⪅䛾⬺Ỉ≧ែ䜢᪩ᮇⓎぢ䛩䜛䛯䜑䛾䜰䝉䝇䝯䞁䝖㡯┠䜢᫂☜䛻䛩䜛䛯䜑䛻䚸70 ṓ௨ୖ䛾೺ᗣ㧗㱋⪅ 117 ྡ䚸ᑐ↷⩌䛸䛧䛶⒪㣴⑓㝔ධ㝔୰䛾ᝈ⪅ 267 ྡ䛻ᑐ䛧䚸⾑ᾮ᳨ᰝ䛸㛵㐃せᅉ䚸24 㡯┠䛾඙ೃ䞉⑕≧䜢ㄪᰝ䛧䛯䚹䛭䛾⤖ᯝ䚸೺ᗣ㧗㱋⪅䛿᪋タ㧗㱋⪅䛸ྠᵝ䛻⾑Ύᾐ㏱ᅽ್䛜㧗䛔⪅䛜⣙ 3 ๭䛷䛒䛳䛯䚹㧗⾑Ύᾐ㏱ᅽ⑕䛾㛵㐃せᅉ䛸䛧䛶䛂⢾ᒀ⑓䛃䛸䛂⾑⢾ୗ㝆๣౑⏝䛃䛜䛒䛢䜙䜜䛯䚹䜎䛯䚸೺ᗣ㧗㱋⪅䛾㧗ᾐ㏱ᅽ⾑⑕䛾඙ೃ䞉⑕≧䛸䛧䛶䛂⭆❐䛾஝⇱䛃䛂⯉䛾஝⇱䞉ட⿣䛃䛜᫂䜙䛛䛻䛺䛳䛯䛸ሗ࿌䛧䛶䛔䜛䚹䠏䠊㧗㱋⪅䛾⬺Ỉ⑕ண㜵䛾䜿䜰䠄Ỉศᦤྲྀ䛻㛵䛩䜛䜿䜰䠅䛾ᐇែ䛸䛭䛾ホ౯䛻㛵䛩䜛◊✲ᑠᯇ䜙 16)䛿䚸ᅾᏯせ௓ㆤ㧗㱋⪅䛾⬺Ỉ⑕䜢ண㜵䛩䜛䛯䜑䛻䚸ኟᮇ䛻䛚䛡䜛Ỉศฟ⣡䛸㣧Ỉ᥼

- 86 -ᒣ㝧ㄽྀ㻌 ➨ 㻝㻥 ᕳ㻌 㻔㻞㻜㻝㻞㻕㻌ຓ䛾ᐇែ䜢ㄪᰝ䛧䛶䛔䜛䚹㧗㱋⪅ 14 ྡ䜢ᑐ㇟䛻ㄪᰝ䛧䛯⤖ᯝ䚸Ỉศ⥲ᦤྲྀ㔞䛿ᖹᆒ 198ml䚸㣧⏝Ỉ 996.9ml䚸㣗஦䛛䜙ᦤྲྀ 876.9ml 䛷䛒䛳䛯䚹య㔜䠍kg ᙜ䛯䜚䛾⥲ᦤྲྀ㔞䛿 45.7ml䚸㣧⏝Ỉ䛜 22.7ml 䛷䛒䛳䛯䛜䚸㣧⏝Ỉ䛾㔞䛿ಶேᕪ䛜኱䛝䛟䚸ᖹᆒᦤྲྀᅇᩘ䛿 6.5 ᅇ䛷䚸✀㢮䛿⥳Ⲕ䛜᭱䜒ከ䛟ḟ䛔䛷㯏Ⲕ䚸∵ங䛷䛒䜛䛣䛸䜢ሗ࿌䛧䛯䚹䜎䛯䚸௓ㆤ⪅䛿඲ဨ䛜㣧Ỉᦤྲྀ㔞䚸ᦤྲྀ᪉ἲ䚸㣧⏝Ỉ✀㢮䛺䛹䜢ព㆑䛧䛶䛚䜚䚸㣧Ỉ䛾┠Ᏻ䛿 910.0ml/᪥䛷䛒䜛䛣䛸䜔▱㆑㠃䛷䛿㣧Ỉ䛾┠Ᏻ㔞䚸⬺Ỉ⑕䚸㧗㱋⪅䛾㢖ᒀ䛾⌮ゎ䛜䛒䛳䛯䛣䛸䜢ሗ࿌䛧䛯䚹䛭䛾ᚋ䚸ᒸᒣ䜙 17)䛿㧗㱋⪅䛾⬺Ỉண㜵䛾䛯䜑䛾㣧Ỉ᥼ຓ䜢ᐇ㊶䛩䜛ୖ䛷ᚲせ䛺ᐈほⓗ㈨ᩱ
䜢ᚓ䜛┠ⓗ䛷䚸ᵝ䚻䛺⎔ቃୗ䛻䛔䜛㧗㱋⪅䛾ᐇែ䜢ㄪᰝ䛧䛶䛔䜛䚹䜎䛪䚸೺ᗣ䛺㧗㱋⪅䜢ᑐ㇟䛻䚸ኟᏘ䛸෤Ꮨ䛾㣧Ỉ㔞䛾ᕪ䛻䛴䛔䛶䛾ㄪᰝ䜔ᬬ⇕㡰໬䛻䜘䜛⥲Ỉศᦤྲྀ㔞䛾᳨ウ䜢⾜䛔䚸䛥䜙䛻䚸㐠ື᫬䛾Ỉศฟ⣡䛸㣧Ỉ⾜ື䚸ኪ㛫䛾╧╀୰䛾Ⓨờ㔞䛾㧗㱋⪅䛸ⱝ⪅䛾┦㐪䚸せ௓ㆤ㧗㱋⪅䛾Ỉศᦤྲྀ㔞䛾䠍㐌㛫䛾᥎⛣䛺䛹䜢ᐃ䛧䛶䛔䜛䚹䛭䛾⤖ᯝ䚸ᖺ㱋䜔య᱁䚸Ỉศᦤྲྀᅇᩘ䜢㓄៖䛧䛯ᣦᑟ䜢䛩䜛ᚲせᛶ䜔✚ᴟⓗ䛺Ỉศ⿵⤥䜢່䜑䜛ᚲせᛶ䚸⏕άୖ䛾㓄៖䚸㐠ືᚋ䛾✚ᴟⓗ䛺㣧Ỉ䜢ಁ䛩ᚲせᛶ䚸ᑵᐷ๓䛾㣧Ỉ䚸ᐷ䛦䜑䛾㣧Ỉ䛾ᚲせᛶ䚸௓ㆤ⪅䛜ṇ䛧䛔㣧Ỉ▱㆑䜢ᣢ䛴䛣䛸䚸㣧Ỉ䜿䜰䛾ᐇ㊶ຊ䜢ᣢ䛴䛣䛸䛾ᚲせᛶ䛺䛹䜢ሗ࿌䛧䛶䛔䜛䚹ᑠᯇ䜙 18䠅䛿䚸᪥ᖖ⏕ά⾜ື䛾⮬❧䛧䛯ᅾᏯ㧗㱋⪅䛻䛚䛡䜛㣧Ỉ㔞䛾ᐇែ䜢ᢕᥱ䛩䜛䛣䛸䛻ຍ䛘䚸⏕άせᅉ䚸ཱྀῬឤ䛺䛹䛾⏕⌮ⓗ⮬ぬ䜔㣧Ỉ▱㆑䛺䛹䛛䜙㣧Ỉ⾜ື䛻㛵㐃䛩䜛せᅉ䛻䛴䛔䛶䚸᪥ᖖ⏕ά䛾⮬❧䛧䛯㧗㱋⪅ 178 ྡ䜢ᑐ㇟䛸䛧䛶ㄪᰝ䛧䛯䚹䛭䛾⤖ᯝ䚸䠍᪥䛾㣧Ỉ㔞䛿ᖹᆒ 1.3㼼
0.6l 䛷䛒䜚䚸ዪᛶ䛜⏨ᛶ䜘䜚᭷ព䛻ከ䛟㣧Ỉ䛧䚸㣧Ỉᅇᩘ䛿⏨ዪ䛸䜒䛻 7 ᅇ䛰䛳䛯䛣䛸䚸㣧Ỉ㔞䛿ྠᒃ䜘䜚⊂ᒃ䛻ከ䛟䚸᤼ᒀᅇᩘ䛾ቑຍ䜢⮬ぬ䛩䜛ዪᛶ䚸䛚䜘䜃㣧Ỉ䜢᥍䛘䛺䛔⪅䛜䛭䛾௚䜘䜚䜒ከ䛛䛳䛯䛣䛸䚸ᚲせ䛸⪃䛘䜛㣧Ỉ㔞䛸ᐇ㝿䛾ᦤྲྀ㔞䛿䜋䜌୍⮴䛧䛶䛔䛯䛣䛸䜢ሗ࿌䛧䛯䚹䜎䛯䚸㧗㱋䛻䛺䜛䛸⬺Ỉ䛻䛺䜚䜔䛩䛔䛸⪃䛘䜛⪅䛿䛭䛖䛷䛺䛔䜒䛾䜘䜚䜒ከ䛟㣧Ỉ䛧䛶䛔䛯䛣䛸䜒᫂䜙䛛䛻䛧䛶䛚䜚䚸ṇ䛧䛔▱㆑䜢ᣢ䛱䚸ពᅗⓗ䛺Ỉศ⿵⤥䛾䛷䛝䜛⩦័䛾☜❧䜢ಁ䛩䛣䛸䛾ᚲせᛶ䜢㏙䜉䛶䛔䜛䚹Ლ஭䜙 19) 䛿䚸௓ㆤಖ㝤᪋タ䛻䛚䛡䜛せ௓ㆤ㧗㱋⪅䛾⬺Ỉண㜵䛾䛯䜑䛾ලయⓗ䛺᥼ຓ䛾ᐇ㝿䛸ㄢ㢟䜢᫂䜙䛛䛻䛩䜛䛯䜑䛻䚸┳ㆤ⫋䚸௓ㆤ⫋䚸ᰤ㣴ኈ䛾ィ 420 ྡ䜢ᑐ㇟䛻ㄪᰝ䜢⾜䛳䛶䛔䜛䚹⬺Ỉ䛾䜰䝉䝇䝯䞁䝖᪉ἲ䜢 25 㡯┠タᐃ䛧䚸㣗ḧ䚸㣗஦ᦤྲྀ㔞䚸ᦤ㣗䞉ᄟୗᶵ⬟䛾ኚ໬䚸ඖẼ䛾᭷↓䚸୙Ᏻ䜔ⱞ③䛾᭷↓䛾㡯┠䛷┳ㆤ⫋䛸௓ㆤ⫋䛾 9 ๭䛜⾜䛳䛶䛔䛯䚹㐌䠍䚸2 ᅇ䛿⾑ᅽ䠍ᅇ௨ୗ䛿య㔜ᐃ䚸᭶ᐃ䛷䛒䛳䛯䚹Ỉศᦤྲྀ䛿䚸3 㣗௨እ䛻᭱ప 3 ᅇ௨ୖ䛾Ỉศᦤྲྀ䜢䛧䛶䛔䜛䛣䛸䛜᫂䜙䛛䛻䛺䛳䛯䚹䜿䜰䛾ㄢ㢟䛿䚸㣧䜐䛣䛸䜔㣗䜉䜛䛣䛸䜈䛾ពḧపୗ䛜䛒䜛ሙྜ䚸ᄟୗᶵ⬟పୗ䛜䛒䜛ሙྜ䛻ᅔ䛳䛶䛚䜚䚸ၥ㢟ゎỴ䛜㞴䛧䛔䛣䛸䚸䜎䛯䚸䜿䜰䛩䜛ഃ䛾㧗㱋⪅䜈䛾ಶูᛶ䛸ᑛཝ䛒䜛᥼ຓ᪉ἲ䛻䛴䛔䛶䛾ㄢ㢟䛻䛴䛔䛶ゝཬ䛧䛶䛔䜛䚹䠐䠊㧗㱋⪅䛾⬺Ỉண㜵䛾䜿䜰䛻䛴䛔䛶䛾┳ㆤ⫋䜔௓ㆤ⫋䛾ㄆ㆑Ლ஭䜙19)䛿䚸⬺Ỉண㜵䛾䛯䜑䛻䜿䜰䛩䜛᥼ຓഃ䛾㧗㱋⪅䜈䛾ಶูᛶ䜔ᑛཝ䛒䜛᥼ຓ᪉ἲ䛻䛴䛔䛶ㄢ㢟䛜䛒䜛䛣䛸䛜㏙䜉䛶䛚䜚䚸᪋タෆ䛾᪂ே䝇䝍䝑䝣䜈䛾ᩍ⫱䞉◊ಟ䛾ᚲせᛶ䛜䛒䜛䛸ሗ࿌䛧䛶䛔䜛䚹䊣䠊⪃ᐹ䠍䠊㧗㱋⪅䛾⬺Ỉ⑕䛾ᐇែ䛻㛵䛩䜛䜒䛾ᡃ䛜ᅜ䛻䛚䛡䜛㧗㱋⪅䛾⬺Ỉ⑕䛾⌧≧䛸䛧䛶䛿䚸ㅖእᅜ䛷ከ䛟౑⏝䛥䜜䛶䛔䜛ᇶ‽ 20)䛷䛒䜛
㧗㱋⪅䛻ከ䛔㧗ᙇᛶ⬺Ỉ䛾ᐃ⩏䜢㧗 Na ⾑⑕䠄⾑Ύ Na ್ 145mEq/dl ௨ୖ䠅䛛䛴㧗ᾐ㏱ᅽ⾑- 87 -ዟᒣ䞉す⏣㻌 㻦㻌 㧗㱋⪅䛾⬺Ỉ⑕ண㜵䛾䜿䜰䛻㛵䛩䜛ᩥ⊩ⓗ⪃ᐹ㻌⑕䠄⾑Ύᾐ㏱ᅽ್ 300mOsm/l ௨ୖ䠅䛾≉ᛶ䜢᭷䛩䜛䛣䛸䛸䛧䛯ሙྜ䚸ᆅᇦᅾఫ䛾೺ᗣ䛺㧗㱋⪅䜒⒪㣴⑓ᗋ䛻ධ㝔䛧䛶䛔䜛㧗㱋⪅䜒㧗ᙇᛶ⬺Ỉ䛾⪅䛿ᑡ䛺䛔䛸䛔䛖䛣䛸䛜䛖䛛䛜䛘䜛䚹䛧䛛䛧䚸⾑Ύᾐ㏱ᅽ್䠄Osm䠅䛾䜏䛷䜏䜛䛸䚸೺ᗣ㧗㱋⪅䛿 299 mOsm/l䚸᪋タ㧗㱋⪅䛿 295 mOsm/l 䛷䛒䜚䚸䛭䛾䛖䛱೺ᗣ㧗㱋⪅䛿 295 mOsm/l ௨ୖ䛜 60%䛰䛳䛯䛣䛸䛛䜙䚸೺ᗣ㧗㱋⪅䜒᪋タ㧗㱋⪅䜒⬺Ỉ⑕䛾䝸䝇䜽䛿䛒䜚䚸≉䛻䚸᪋タ㧗㱋⪅䜘䜚䜒೺ᗣ䛺㧗㱋⪅䛾᪉䛜䝸䝇䜽䛜㧗䛔⪅䛜ከ䛔䛸䛔䛘䜛䚹䛣䛾䛣䛸䛿䚸᪋タ㧗㱋⪅䛾ሙྜ䚸せ௓ㆤ≧ែ䛾㧗㱋⪅䛜ከ䛔䛣䛸䛜᥎ᐹ䛥䜜䚸⬺Ỉ⑕ண㜵䛾䛯䜑䛾Ỉศᦤྲྀ䛾䜿䜰䜢ཷ䛡䛶䛔䜛≧ἣ䛜䛒䜛䛸⪃䛘䜛䚹䛧䛛䛧䚸೺ᗣ䛺㧗㱋⪅䛾ሙྜ䛻䛿䚸Ỉศᦤྲྀ䜢ྵ䜑䛯೺ᗣ⟶⌮䛿ಶே䛻䜎䛛䛫䜙䜜䛶䛚䜚䚸ຍ㱋䛻క䛖యෆỈศ㔞䛾ῶᑡ䛻ຍ䛘䛶䚸ཱྀῬឤ䛾ῶᑡ䛻క䛖Ỉศᦤྲྀ㔞䛾䝁䞁䝖䝻䞊䝹䛜⮬ຊ䛷༑ศ䛻⾜䛖䛣䛸䛜䛷䛝䛺䛔≧ἣ䜒䛒䜛䛣䛸䛜⪃䛘䜙䜜䜛䚹䜿䜰䝝䜴䝇ධᒃ⪅䛾యෆỈศ㔞䛾Ꮨ⠇䛻䜘䜛㐪䛔䜢᳨ウ䛧䛯ሗ࿌ 13䠅䛷䛿䚸ኟᏘ䛿 49.5䠂䚸෤Ꮨ 45.0䠂䛷᭷ពᕪ䛜䛒䛳䛯䛣䛸䛛䜙䚸ኟᏘ䜘䜚䜒෤Ꮨ䛾᪉䛜⬺Ỉ⑕䛾䝸䝇䜽䛜㧗䛔䛣䛸䛜䛖䛛䛜䛘䜛䚹䜎䛯䚸Ỉศฟ⣡䛛䜙᳨ウ䛧䛯◊✲ 14䠅䛷䛿䚸඲య䛾⣙ 2 ๭ᙅ䛾㧗㱋⪅䛜⬺Ỉ⑕䛾䝸䝇䜽䛜㧗䛔䛸䛔䛘䜛䚹⌧ᅾ䜎䛷䛻䚸ᡃ䛜ᅜ䛷䛿䚸⬺Ỉ⑕䛾䝸䝇䜽䛾㧗䛔㧗㱋⪅䛾≉ᚩ䜢᫂☜໬䛧䛯◊✲䛿ᑡ䛺䛔䚹ᾏእ䛾◊✲ 21)䛷䛿䚸⬺Ỉ⑕䛾䝸䝇䜽䝣䜯䜽䝍䞊䛸䛺䜛≉ᐃ䛾⑌ᝈ䛸䛧䛶䚸ㄆ▱⑕䚸៏ᛶᚰ⑌ᝈ䚸៏ᛶ⭈୙඲䚸ᰤ㣴୙Ⰻ䚸䛖䛴䚸⬻⾑⟶㞀ᐖ䚸⢾ᒀ⑓䛺䛹䛜䛒䛢䜙䜜䛶䛔䜛䚹ᡃ䛜ᅜ䛷䜒௒ᚋ䚸ㄪᰝ䜢⾜䛖ᚲせ䛜䛒䜛䚹௨ୖ䛾䛣䛸䛛䜙䚸ᡃ䛜ᅜ䛾㧗㱋⪅䛿䚸⏕ά䛾ሙ䛜ᆅᇦ䚸ᅾᏯ䚸᪋タ䛾䛔䛪䜜䛷䛒䛳䛯䛸䛧䛶䜒䚸⬺Ỉ⑕䛾䝸䝇䜽䛜㧗䛔䛣䛸䛜♧၀䛥䜜䚸≉䛻せ௓ㆤ≧ែ䛷௓ㆤ䜢ཷ䛡䛶䛔䜛⪅䜘䜚䜒䚸ᆅᇦ䛷⏕ά䛩䜛㧗㱋⪅䛾᪉䛜䜘䜚䝸䝇䜽䛜㧗䛔䛸⪃䛘䜙䜜䛯䚹䠎䠊㧗㱋⪅䛾⬺Ỉ≧ែ䛾䜰䝉䝇䝯䞁䝖᪉ἲ䛻㛵䛩䜛◊✲䜿䜰䝝䜴䝇ධᒃ⪅䛾యෆỈศ㔞䛾Ꮨ⠇ኚື䛾ㄪᰝ 13䠅䛛䜙䚸⮬ぬ⑕≧䛸ᑐෆỈศ㔞䛸䛾㛵ಀ䛿䜏䜙䜜䛪䚸⮬ぬ⑕≧䛾᭷↓䛿యෆỈศ㔞䛾☜ᐇ䛺ᣦᶆ䛸䛿䛺䜙䛺䛔䛣䛸䛜♧䛥䜜䛯䚹䛣䜜䛿䚸㧗㱋⪅䛾ሙྜ䚸⮫ᗋ⑕≧䛸᳨ᰝᡤぢ䛜୍⮴䛧䛺䛔䛣䛸䛜ከ䛔 2䠅䛸䛔䛖䛣䛸䛛䜙䜒䛔䛘䜛䚹Ლ஭䜙 10,19) 䛾ㄪᰝ䛛䜙䚸⾑ᾮ䝕䞊䝍䛸⑕≧䛺䛹䛸䛾㛵㐃䛛䜙䚸⬺Ỉ䛻㛵䛩䜛ᚩೃ䞉⑕≧㡯┠䛺䜙䜃䛻ุ᩿ෆᐜ䛜᫂䜙䛛䛻䛥䜜䛶䛔䜛䚹⓶⭵䚸ཱྀ⭍⢓⭷䚸║䚸඲㌟≧ែ䚸⚄⤒䚸䝞䜲䝍䝹䝃䜲䞁䛺䛹䛾኱㡯┠䛸䛭䜜䛮䜜䛻䚸୰㡯┠䚸ᑠ㡯┠䚸ุ᩿ෆᐜ䛜䛒䛢䜙䜜䚸ィ 25 㡯┠䛜♧䛥䜜䛶䛔䜛䚹䛣䜜䜙䛾㡯┠䛿䚸⬺Ỉ⑕䜢᪩ᮇⓎぢ䛩䜛䛯䜑䛾䜰䝉䝇䝯䞁䝖㡯┠䜢᫂☜䛻䛧䛯䜒䛾䛷䛿䛒䜛䛜䚸ྠ᫬䛻䚸⬺Ỉ⑕䛾䝸䝇䜽≧ែ䛻䛒䜛㧗㱋⪅䜢᪩ᮇⓎぢ䛩䜛䛯䜑䛻䜒᭷⏝䛷䛒䜛䛸ᛮ䜟䜜䜛䚹䛧䛛䛧䚸䛣䜜䜙䛾ᚩೃ䚸⑕≧㡯┠䛿䚸┳ㆤ⫋䜔௓ㆤ⫋䛻䜘䜛୺ほⓗ䛺ホ౯䛻䜘䜛㡯┠䜒ከ䛟䚸䛒䜟䛫䛶ㄆ▱⑕䛺䛹௚䛾೺ᗣ㞀ᐖ䛻䜘䜛⑕≧䛸䛾༊ู䛺䛹䛜䛴䛝䛻䛟䛔㡯┠䛺䛹䜒䛒䜚䚸ྛ㡯┠䜢⥲ྜⓗ䛻ุ᩿䛩䜛ຊ䛜䜿䜰䛩䜛ഃ䛻ᚲせ䛸䛺䜛䚹䛭䛾䛯䜑䚸䜰䝉䝇䝯䞁䝖㡯┠䛿᫂☜໬䛥䜜䛯䛜䚸䜰䝉䝇䝯䞁䝖䛾㞴䛧䛥䛿౫↛䛸䛧䛶ṧ䜛䜒䛾䛸⪃䛘䜛䚹䛧䛛䛧䚸䛣䜜䜙䛾ㄽᩥ䛛䜙䚸㧗㱋⪅≉᭷䛾⬺Ỉ⑕䛾䜰䝉䝇䝯䞁䝖ᣦᶆ䛸䛧䛶䚸ཱྀ၁䜔⯉䚸ཱྀ⭍䛾஝⇱≧ែ䚸⭆❐䛾஝⇱䛺䛹䛜᪂䛯䛻ά⏝䛷䛝䜛䛣䛸䛜♧䛥䜜䛶䛚䜚䚸䛣䜜䜙䛾ᣦᶆ䛜ᐈほⓗ䝕䞊䝍䛸䛧䛶㎿㏿䛻ᚓ䜛䛣䛸䛜ྍ⬟䛸䛺䜜䜀䚸䜰䝉䝇䝯䞁䝖䛾ᅔ㞴䛥䜒㍍ῶ䛥䜜䜛䛷䛒䜝䛖䛸ᛮ䜟䜜䜛䚹䠏䠊㧗㱋⪅䛾⬺Ỉ⑕ண㜵䛾䜿䜰䛾ᐇែ䛸䛭䛾ホ౯䛻㛵䛩䜛◊✲㧗㱋⪅䛾⬺Ỉ⑕䜢ண㜵䛩䜛䛯䜑䛾௦⾲ⓗ䛺䜿䜰䛿Ỉศᦤྲྀ䛷䛒䜚䚸䛭䜜௨እ䛾䜿䜰䛿ඛ⾜◊✲䛛䜙䛿ぢฟ䛩䛣䛸䛜䛷䛝䛺䛛䛳䛯䚹೺ᗣ䛺㧗㱋⪅䜢ᑐ㇟䛸䛧䛯ㄪᰝ⤖ᯝ 18)䛛䜙䚸ಶே䛷⬺Ỉ⑕

- 88 -ᒣ㝧ㄽྀ㻌 ➨ 㻝㻥 ᕳ㻌 㻔㻞㻜㻝㻞㻕㻌䜢ண㜵䛧䛶䛔䛟䛯䜑䛻䛿䚸ᵝ䚻䛺⎔ቃୗ䛻䛚䛔䛶䚸Ỉศᦤྲྀᅇᩘ䜢⪃៖䛧䛺䛜䜙䚸Ỉศᦤྲྀ䜢✚ᴟⓗ䛻⾜䛖ᚲせᛶ䛜䛒䜛䛸䛔䛘䜛䚹ᑠᯇ䜙 17䠅䛾◊✲⤖ᯝ䛛䜙䜒䚸㧗㱋⪅⮬㌟䛜⬺Ỉ⑕ண㜵䛻ᑐ䛩䜛ṇ䛧䛔▱㆑䜢ᣢ䛱䚸ពᅗⓗ䛺Ỉศ⿵⤥䛾䛷䛝䜛⩦័䛾☜❧䜢ಁ䛩䛣䛸䛾ᚲせᛶ䛜♧䛥䜜䛶䛔䜛䚹䜎䛯᭱㏆䛷䛿䚸㐺ษ䛺Ỉ䞉㟁ゎ㉁⿵⤥䛾᥼ຓ䛸䛧䛶䚸ᾏእ䛷ᬑཬ䛧䛶䛔䜛⤒ཱྀ⿵Ỉ⒪ἲ䠄Oral
Rehydration Solution :ORT䠅䛾㧗㱋⪅䛻ᑐ䛩䜛౑⏝䛾ྍ⬟ᛶ䠍 䛻䛴䛔䛶䜒䛔䜟䜜䜛䜘䛖䛻䛺䛳䛯䚹㧗㱋⪅᪋タ䛺䛹䛷䛾ά⏝䜒ᮇᚅ䛥䜜䛶䛚䜚䚸ຠᯝ䛾᳨ド䜢⾜䛳䛶䛔䛟ᚲせ䛜䛒䜛䛸ᛮ䜟䜜䜛䚹䛥䜙䛻䚸ᅾᏯ䛾せ௓ㆤ㧗㱋⪅䜔௓ㆤ᪋タ䛻ධᒃ䛧䛶䛔䜛㧗㱋⪅䛾䜿䜰䛻㛵䛩䜛ㄪᰝ⤖ᯝ11,13)䛛
䜙䚸௓ㆤ䛩䜛ഃ䛾⬺Ỉ⑕ண㜵䛾䛯䜑䛾▱㆑䛾ᚲせᛶ䜔✚ᴟⓗ䛺Ỉศᦤྲྀ䛾ᚲせᛶ䛜♧䛥䜜䛶䛔䜛䚹௨ୖ䜘䜚䚸೺ᗣ䛺㧗㱋⪅䛒䜛䛔䛿せ௓ㆤ≧ែ䛾㧗㱋⪅䛾䛔䛪䜜䛻䛚䛔䛶䜒䚸⬺Ỉ⑕ண㜵䛾䛯䜑䛻䛿✚ᴟⓗ䛺Ỉศᦤྲྀ䛜㔜せ䛷䛒䜛䛣䛸䛜᫂☜໬䛥䜜䛶䛔䜛䚹䠐䠊㧗㱋⪅䛾⬺Ỉண㜵䛾䜿䜰䛻䛴䛔䛶䛾┳ㆤ⫋䜔௓ㆤ⫋䛾ㄆ㆑⬺Ỉண㜵䛾䜿䜰䛻䛴䛔䛶┳ㆤ⫋䜔௓ㆤ⫋䛾ㄆ㆑䜢ㄪᰝ䛧䛯◊✲䛿䜋䛸䜣䛹䜏䜙䜜䛺䛛䛳䛯䚹Ლ஭䜙 19)䛾◊✲䛛䜙䚸⬺Ỉ⑕ண㜵䛾䛯䜑䛾䜿䜰䜢⾜䛖ୖ䛷䚸ᑛཝ䛒䜛᥼ຓ᪉ἲ䛜ㄢ㢟䛸䛧䛶䛒䛜䛳䛶䛔䜛䛜䚸䛭䛾᰿ᣐ䛿୙᫂☜䛷䛒䜛䚹⬺Ỉ⑕ண㜵䛾䜿䜰䛸䛧䛶➨୍䛻䛒䛢䜙䜜䜛䛾䛿Ỉศᦤྲྀ䛾䜿䜰䛷䛒䜛䚹᪥ᮏ⪁ᖺ་Ꮫ఍䛷䛿䚸㧗㱋⪅䜿䜰䛾ពᛮỴᐃ䝥䝻䝉䝇䛻㛵䛩䜛䜺䜲䝗䝷䜲䞁䜢♧䛧䛯 22)䚹≉䛻䚸ேᕤⓗỈศ䛸ᰤ㣴⿵⤥䛾ᑟධ䛻㛵䛩䜛་⒪䞉௓ㆤ䞉⚟♴ᑓ㛛⫋䛾ពᛮỴᐃ䛻↔Ⅼ䜢䛒䛶䛶䛔䜛䚹⤒ཱྀᦤྲྀ䛜ᅔ㞴䛻䛺䜚ᚲせ㔞䜢ᦤྲྀ䛷䛝䛺䛟䛺䛳䛯㝿䛻䛿䚸䝏䞊䝮䛷ᑐᛂ䛧䚸ᮏே䞉ᐙ᪘䛸䛾䝁䝭䝳䝙䜿䞊䝅䝵䞁䜢㏻䛧䛶䛾ྜព䜢┠ᣦ䛩䛣䛸䜢ᇶ┙䛸䛧䚸ពᛮỴᐃ䝥䝻䝉䝇䛾䝣䝻䞊䝏䝱䞊䝖䛷⾲䛧䛯䚹䛣䛾䛺䛛䛷䛿䚸ᮏே䛾ពྥ䜔 QOL 䛾⥔ᣢ䞉ྥୖ䛾どⅬ䛷᳨ウ䛩䜛䛣䛸䛜♧䛥䜜䛶䛔䜛䚹䛣䛾䜘䛖䛺ᣦ㔪䛜♧䛥䜜䛯⫼ᬒ䛻䛿䚸ຍ㱋䜔೺ᗣ㞀ᐖ䛻క䛖⤒ཱྀᦤྲྀ䛜ᅔ㞴䛸䛺䛳䛯㧗㱋⪅䛜ቑຍ䛧䛶䛔䜛୰䛷䚸⤊ᮎᮇ䛾䜿䜰䛾䛒䜚᪉䜢ᝎ䜐་⒪䞉௓ㆤᚑ஦⪅䛜ቑຍ䛧䛶䛔䜛䛸䛔䛖⌧≧䛜䛒䜛 22) 䚹⤒ཱྀᦤྲྀ䛜ᅔ㞴䛺㧗㱋⪅䛻䛔䛛䛻ᦤྲྀ䛧䛶䜒䜙䛖䛛䛿䚸㧗㱋⪅䛾⏕࿨䜔
QOL 䜢⪃䛘䜛ୖ䛷䛿㠀ᖖ䛻㔜せ䛺ㄢ㢟䛸䛺䜛䚹ேᕤⓗỈศ䞉ᰤ㣴⿵⤥䛾ᑟධ䛾ពᛮỴᐃ䜢⾜䛖๓䛻䚸ከ䛟䛾┳ㆤ⫋䜔௓ㆤ⫋䛜䚸⤒ཱྀᦤྲྀ䜢ಁ䛩ດຊ䜢䛧䛶䛔䜛䛣䛸䛜䛖䛛䛜䛘䜛䚹䛣䛾䜘䛖䛺≧ἣ䛾୰䛷䚸䜿䜰䛩䜛ഃ䛾ㄆ㆑䛸䛧䛶⬺Ỉ⑕䜢ண㜵䛩䜛䛯䜑䛻䛿䚸䛂㣧䜣䛷䜒䜙䜟䛺䛡䜜䜀䛺䜙䛺䛔䛃䛸䛔䛖ᙉ䛔ᛮ䛔䛜䛒䜛䛾䛷䛿䛺䛔䛛䛸ண᝿䛥䜜䜛䚹䛭䛾䛯䜑䚸௒ᚋ䛿Ỉศᦤྲྀ䛾䜿䜰䛻㛵䛩䜛┳ㆤ⫋䜔௓ㆤ⫋䛾ㄆ㆑䛻䛴䛔䛶䛥䜙䛺䜛ㄪᰝ䛜ᚲせ䛷䛒䜛䚹➹⪅䜙  䛿䚸⪁ேಖ೺᪋タ䛾┳ㆤ㒊㛗䛸᭷ᩱ⪁ே䝩䞊䝮䚸䜾䝹䞊䝥䝩䞊䝮䛾௓ㆤ⫋䛻ᑐ䛩䜛⬺Ỉண㜵䛻㛵䛩䜛ㄆ㆑䛻䛴䛔䛶䛾䜲䞁䝍䝡䝳䞊ㄪᰝ䜢⾜䛳䛯䚹䛭䛾⤖ᯝ䚸⬺Ỉ⑕䛾ุ᩿ᇶ‽䛸䛧䛶䛿䚸┳ㆤ⫋䜒௓ㆤ⫋䜒䛂䛔䛴䜒䛸㐪䛖䛃䛸䛔䛖┤ឤ䛷䛒䜚䚸┳ㆤ⫋䛿䚸䝸䝇䜽䛾㧗䛔㧗㱋⪅䛾ሙྜ䛻䛿Ỉศฟ⣡䛾ほᐹ䜢⾜䛔䚸๓⬚㒊䛾䝒䝹䝂䞊䝹䜔⓶⭵䛾≧ែ䚸᳨ᰝ䝕䞊䝍䛾䝏䜵䝑䜽䛺䛹䜢⾜䛳䛶䛔䛯䚹ᚲせ᫬䛿་ᖌ䛻ሗ࿌䛧䚸㍺ᾮ䜢⾜䛖ሙྜ䜒䛒䛳䛯䚹≉䛻䚸᪂䛧䛔ホ౯ᣦᶆ䛸䛧䛶䚸ཱྀ⭍ෆ䛾஝⇱䛾≧ែ䜢䜏䛶䛚䜚䚸ཱྀ⭍ෆ䛾஝⇱䛿䚸ᄟୗᅔ㞴䚸㣗ḧపୗ䚸࿪ᄮᅔ㞴䚸⬺Ỉ䛻ᙳ㡪䜢ཬ䜌䛩䛸ឤ䛨䛶䛔䛯䚹௓ㆤ⫋䛿䚸Ỉศᦤྲྀ㔞䛾ῶᑡ䜔ᒀᅇᩘ䛾ῶᑡ䚸⓶⭵䛾䝒䝹䝂䞊䝹పୗ䚸ᒀ
㔞䛜 500ml/᪥௨ୗ䜢୰ᚰ䛸䛧䛶䛔䛯䚹䛔䛴䜒䛸㐪䛖ᵝᏊ䛜⬺Ỉ⑕䛻㉳ᅉ䛩䜛䛛䛜ุ᩿䛧䛻䛟䛔䛾䛷䚸ゼၥ┳ㆤᖌ䜔་ᖌ䛺䛹䛻᝟ሗᥦ౪䛧䛶ุ᩿䛧䛶䜒䜙䛳䛶䛔䛯䚹᪋タ䛻䛚䛡䜛⬺Ỉ䛾䜰䝉䝇䝯䞁䝖ᣦᶆ䛿☜❧䛥䜜䛶䛚䜙䛪䚸௒ᚋ┳ㆤ⫋䛸௓ㆤ⫋䛾ඹ㏻䛾䜰䝉䝇䝯䞁䝖ᣦᶆ䛜ᚲせ䛷䛒䜛䛸ㄆ㆑䛧䛶䛔䛯䛸䛔䛖⤖ᯝ䜢ᚓ䛯䚹௨ୖ䛾䛣䛸䛛䜙䚸⬺Ỉ⑕ண㜵䛾䜿䜰䛻㛵䛩䜛┳ㆤ⫋䜔௓ㆤ⫋䛾ㄆ㆑䛻䛴䛔䛶ㄪᰝ䛧䛯◊✲䛜- 89 -ዟᒣ䞉す⏣㻌 㻦㻌 㧗㱋⪅䛾⬺Ỉ⑕ண㜵䛾䜿䜰䛻㛵䛩䜛ᩥ⊩ⓗ⪃ᐹ㻌ᑡ䛺䛔䛣䛸䚸䜎䛯䚸䜟䛪䛛䛻䛒䜛ㄪᰝሗ࿌䛛䜙䚸┳ㆤ⫋䜔௓ㆤ⫋䛿䚸䜿䜰䜢ᐇ᪋䛩䜛ୖ䛷䛿ᑛཝ䛒䜛䜿䜰䛜ᐇ᪋䛥䜜䛻䛟䛔⌧≧䛷䛒䜛䛸ㄆ㆑䛧䛶䛔䜛䛣䛸䚸㧗㱋⪅䛾⬺Ỉ⑕䛾䜰䝉䝇䝯䞁䝖䛿㞴䛧䛟䚸᪂䛯䛺䜰䝉䝇䝯䞁䝖ᣦᶆ䛜ᚲせ䛷䛒䜛䛸ㄆ㆑䛧䛶䛔䜛䛣䛸䛜♧၀䛥䜜䛯䚹௒ᚋ䚸┳ㆤ⫋䚸௓ㆤ⫋䛾ㄆ㆑䜢䛥䜙䛻ㄪᰝ䛩䜛ᚲせ䛜䛒䜛䛸ᛮ䜟䜜䜛䚹䠑䠊⬺Ỉ⑕ண㜵䛾䜿䜰䛻㛵䛩䜛௒ᚋ䛾ㄢ㢟ᩥ⊩䝺䝡䝳䞊䛛䜙䚸ᡃ䛜ᅜ䛾㧗㱋⪅䛿䚸⏕ά䛾ሙ䛜䛹䛣䛷䛒䛳䛯䛸䛧䛶䜒⬺Ỉ⑕䛾䝸䝇䜽䛜㧗䛔䛣䛸䚸≉䛻せ௓ㆤ≧ែ䛷䛒䜚᪋タ䛷௓ㆤ䜢ཷ䛡䛶䛔䜛⪅䜘䜚䜒䚸ᆅᇦ䛷⏕ά䛩䜛㧗㱋⪅䛾᪉䛜䜘䜚䝸䝇䜽䛜㧗䛔䛣䛸䛜♧၀䛥䜜䛯䚹䜎䛯䚸⬺Ỉ⑕䛾䜰䝉䝇䝯䞁䝖㡯┠䜢♧䛧䛯◊✲䜒ᩓぢ䛷䛝䛯䛜䚸౫↛䛸䛧䛶䜰䝉䝇䝯䞁䝖䛾㞴䛧䛥䛜䛒䜛䛸ᛮ䜟䜜䛯䚹䛥䜙䛻䚸⬺Ỉ⑕ண㜵䛾䛯䜑䛾䜿䜰䛿䚸Ỉศᦤྲྀ䛜⤯ᑐ䛷䛒䜚䚸Ỉศᦤྲྀ䛜㞴䛧䛔㧗㱋⪅䜒ቑ䛘䛶䛔䜛⌧≧䛾䛺䛛䚸䛂㣧䜣䛷䜒䜙䜟䛺䛡䜜䜀䛺䜙䛺䛔䛃䛸䛔䛖ᙉ㏕ほᛕ䛜┳ㆤ⫋䚸௓ㆤ⫋䛸䜒䛻䛒䜛䛸᥎䛥䜜䛯䚹௒ᚋ䛿䚸⬺Ỉ⑕ண㜵䛾䜿䜰䛾ᐇែ䜔䜿䜰䛩䜛ഃ䛾ᚰ⌮ⓗᙳ㡪䜢ྵ䜑䛶䛥䜙䛻ㄪᰝ䛩䜛ᚲせ䛜䛒䜛䚹䜎䛯䚸㧗㱋⪅䛾⬺Ỉ⑕䛾䝸䝇䜽ホ౯䜢⾜䛖䛯䜑䛾⡆౽䛺䜰䝉䝇䝯䞁䝖ᣦᶆ䛾㛤Ⓨ䛾ᚲせᛶ䛜♧၀䛥䜜䛯䚹䊤䠊ᩥ⊩䠍)ᡁ஬㑻(2008)䠖㧗㱋⪅䛾⬺Ỉ䛸⤒ཱྀ⿵Ỉ⒪ἲ,⪁ᖺ་Ꮫ,46䠈577-581.
2)Ᏺᑿ୍᫛(2008)䠖⬺Ỉ⑕䛾⑓ែ,⑓ᆺ䠖㧗㱋⪅䛻≉ᚩⓗ䛺⑓ែ,⑓ᆺ䛿䛒䜛䛛,⪁ᖺ་Ꮫ,46䠈
559-566.
3)➉஭⩏⣧,ኴ⏣⚈୍,⾜ᒸဴ⏨(2005)䠖⬺Ỉ⑕,⇕୰⑕,ᩆᛴ་Ꮫ,29䠈1839-1843.
4)஭⸨ⱥ႐(2008)䠖㧗㱋⪅䛾⬺Ỉ⑕䞉⇕୰⑕䜢䜑䛠䛳䛶, ⪁ᖺ་Ꮫ,46䠈557.
5)Hannah Bryant(2007)䠖Dehydration In Older People: Assessment and Management,emergency
nurse,15(4),22-26䠊
6)McCarthy, Susan Manning, Deborah(2012)䠖Water for wellbeing: promoting oral
hydration in the elderly, Continence Journal ,18(2),52-6.
7)Schols JM, De Groot CP, van der Cammen TJ(2009) 䠖 Preventing and treating
dehydration in the elderly during periods of illness and warm weather. Nutr Health
Aging,13(2),150-7.
8) Ma G, Zhang Q, Liu A,(2012)䠖Fluid intake of adults in four Chinese cities,Nutr
Rev.,70(2),105-10.
9)ᮡᒣ䜏䛱Ꮚ,Ლ஭ᩥᏊ(2002)䠖䛂᪂⪁ே䛾఍䛃䛾⬺Ỉ≧ែ䛻㛵䛩䜛ㄪᰝ,䝷䜲䝣䞉䝥䝷䞁䝙䞁䜾䞉䝉
䞁䝍䞊2001 ᖺᗘ◊✲ᴗ⦼ᖺሗ,22,85̺88䠊10)Ლ஭ᩥᏊ(2003)䠖೺ᗣ㧗㱋⪅䛾⬺Ỉ≧ែ䛾᪩ᮇⓎぢ䛾䛯䜑䛾䜰䝉䝇䝯䞁䝖㡯┠䛾㛤Ⓨ䛻㛵䛩䜛◊✲,᪥ᮏ೺ᗣᰤ㣴䝅䝇䝔䝮Ꮫ఍ㄅ,3(3),225-234䠊
11)Ლ஭ྐᏊ,ᮡᒣ䜏䛱Ꮚ,஬࿡㑳Ꮚ(2006)䠖ᅾᏯ⹫ᙅ㧗㱋⪅䛻䛚䛡䜛⬺Ỉ≧ែ䛸Ỉศᦤྲྀ≧ἣ,⪷㊰ຍ┳ㆤ኱Ꮫ⣖せ,32(3),43-50䠊12)ሐ㞞ᜨ,ᑠᯘ ᩄ⏕,ᑠᕝ ᬒᏊ,௚(2003)䠖䝞䜲䜸䜲䞁䝢䞊䝎䞁䝇ἲ䜢⏝䛔䛯㧗㱋⪅䛾యෆỈศ㔞ᐃ:䜿䜰䝝䜴䝇ධᡤ⪅䛸≉ู㣴ㆤ⪁ே䝩䞊䝮ධᡤ⪅䜢ᑐ㇟䛸䛧䛶,ᒣཱྀ┴❧኱Ꮫ┳ㆤᏛ㒊⣖せ,7,85-88䠊13)ሐ㞞ᜨ,బ⸨ ⨾ᖾ ,ᑠᯘ ᩄ⏕(2003)䠖䜿䜰䝝䜴䝇ධᡤ㧗㱋⪅䛻䛚䛡䜛యෆỈศ㔞䛾Ꮨ⠇ኚ

- 90 -ᒣ㝧ㄽྀ㻌 ➨ 㻝㻥 ᕳ㻌 㻔㻞㻜㻝㻞㻕㻌ື䠉䝞䜲䜸䜲䞁䝢䞊䝎䞁䝇ἲ䜢⏝䛔䛯ኟᏘ䛸෤Ꮨ䛾ẚ㍑᳨ウሐ㞞ᜨ,ᒣཱྀ┴❧኱Ꮫ┳ㆤᏛ㒊⣖
せ,8,19-23䠊14)㛗἟⌮ᜨ,⾲ᚿὠᏊ,ሯᓮ ᜨᏊ(2005)䠖ᅾᏯせ௓ㆤ㧗㱋⪅䛾ኟᏘ䛻䛚䛡䜛⬺ỈⓎ⏕䛻㛵䛩䜛ᐇែㄪᰝ䠉䝕䜲䝃䞊䝡䝇฼⏝⪅䜢ᑐ㇟䛻䠉,㔠኱་ಖ䛴䜛䜎ಖ೺Ꮫ఍ㄅ,29(2),105-112䠊
15)Ლ஭ᩥᏊ(2002)䠖㧗㱋ධ㝔ᝈ⪅䛾⬺Ỉ≧ែ䛾᪩ᮇⓎぢ䛾䛯䜑䛾┳ㆤ䜰䝉䝇䝯䞁䝖䠉㧗ᙇᛶ⬺Ỉ䛾⾑ᾮ᳨ᰝᣦᶆ䛸ほᐹᡤぢ䛛䜙䛾ศᯒ䠉,䛚Ⲕ䛾Ỉ་Ꮫ㞧ㄅ,50(3), 115-132.
16)ᑠᯇග௦,ᒸᒣᑀᏊ,ᮌᮧ䜏䛥䛛(2003)䠖᪥ᖖ⏕ά⾜ື䛾⮬❧䛧䛯ᅾᏯ㧗㱋⪅䛾㣧Ỉ㔞(㣧Ỉ⾜ື䛸䛾㛵㐃),᪥ᮏ⏕⌮ே㢮Ꮫ఍ㄅ 9(2)䠖25-30䠊
17)ᒸᒣᑀᏊ,ᑠᯇ ග௦, ᮌᮧ 䜏䛥䛛(2004)䠖ᵝ䚻䛺⎔ቃୗ䛻䛚䛡䜛㧗㱋⪅䛾Ỉศฟ⣡䛸㣧Ỉ⾜ື,ி㒔ᗓ་኱ㄅ,113(6),337-344.
18)ᑠᯇග௦,ᒸᒣᑀᏊ,ᮌᮧ䜏䛥䛛(2004)䠖᪥ᖖ⏕ά⾜ື䛾⮬❧䛧䛯ᅾᏯ㧗㱋⪅䛾㣧Ỉ㔞 : 㣧Ỉ⾜ືせᅉ䛸䛾㛵㐃,᪥ᮏ⏕⌮ே㢮Ꮫ఍ㄅ,9(2),71-76䠊
19)Ლ஭ᩥᏊ(2007)䠖௓ㆤಖ㝤᪋タ䛻䛚䛡䜛せ௓ㆤ㧗㱋⪅䛾⬺Ỉண㜵䛾䛯䜑䛾Ỉศᦤྲྀ䛻㛵䛩䜛᥼ຓ䛾ᅾ䜚᪉䛻㛵䛩䜛◊✲,኱࿴ドๆ䝦䝹䝇㈈ᅋ◊✲ᴗ⦼㞟,30,68-73.
20)Weinberg AD Minaker KL et al(1995):Dehydration and Management Older
Adults-JAMA 274,1552-1556.
21)Sherry B.Robinson(2002)䠖Can A Beverage Cart Help Improve Hydration,GeriatricNursing,23(4),208-211.
22)᪥ᮏ⪁ᖺ་Ꮫ఍ᖹᡂ 23 ᖺᗘ⪁೺஦ᴗ᳨ウጤဨ఍䞉䝽䞊䜻䞁䜾䜾䝹䞊䝥(2011)䠖㧗㱋⪅䜿䜰䛾ពᛮỴᐃ䝥䝻䝉䝇䛻㛵䛩䜛䜺䜲䝗䝷䜲䞁,ேᕤⓗỈศ䞉ᰤ㣴⿵⤥䛾ᑟධ䜢୰ᚰ䛸䛧䛶.
23)ዟᒣ┿⏤⨾,ᮧୖ⏕⨾(2007)䠖╧╀⎔ቃ䛚䜘䜃╧╀䝇䝍䜲䝹䛜㧗㱋⪅䛾೺ᗣ≧ែ䛻ཬ䜌䛩ᙳ㡪䠉⬺Ỉண㜵䛻↔Ⅼ䜢䛒䛶䛶䠉,ᒸᒣ┴❧኱Ꮫᖹᡂ 19 ᖺ≉ู◊✲ሗ࿌᭩,19-24䠊

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