足浴が排尿に与える影響に関する基礎的検証

Abstract

背景 足浴は入浴することができない患者のための重要な看護ケアの一つである。足浴の効果は多くの研究者によって調査、実証されており、睡眠パターン、自律神経機能、精神神経免疫機能への効果が報告されている。これらの結果から、足浴はその副交感神経系への効果により、リラクゼーション、睡眠、循環を促進する可能性があることが示唆されている。看護師はしばしば排尿困難のある患者に、水の音や流水、手浴などのケアを用いているが、それらのケアはエビデンスに基づいておらず、また広くリサーチも行われていない。また、足浴が排尿を促す効果の有無についても未検証である。足浴は副交感神経を優位にし、心地よさを提供し、また循環を改善する効果が期待され、その効果が排尿困難を改善することが予測される。目的 本研究は、足浴ケアが排尿に与える影響を明らかにし、その効果を今後の介入研究の一助とすることを目的とした。方法 研究協力の得られた健康な成人11名(男性3名、女性8名)を対象とし、41℃の湯を用いて20分間密封式足浴法を施行し、自律神経の活動、尿量、バイタルサインの変動、主観的反応を評価した。結果 足浴中後60分間において、11名中5名に顕著な尿量の増加がみられ、この5名の交感神経活動(LF/HF)は増加した。一方、他の参加者においては緩やかな尿量の増加が見られ、またHFで示される副交感神経活動量が増加していった。また、全ての参加者が足浴に心地よさを感じ、足浴の温度刺激が指尖温度を改善することも明らかとなった。結論 足浴に対する反応には2つのタイプがあることが、この研究から示唆された。足浴による温熱・湯という刺激によって、気持ちよさや指尖部温の上昇をみるが、交感神経を優位にし尿量の顕著な増加をみるタイプと、そのような効果は認めないが、副交感神経への効果により、心地よさ、リラクゼーションを感じ、短時間での急激な尿の増加をみないという二つのタイプがある可能性が示唆された。

Background Foot bathing is one of the important nursing care for patients who cannot take a bath by themselves. Many researchers examined and verified the effects of foot bathing on people. It was revealed that foot bathing affected participants' sleep pattern, autonomic nervous system, and mental, physical and immunological status. They concluded that foot bathing might facilitate participants' relaxation, sleeping and circulatory system because foot bathing might affect their parasympathetic nervous system. Nurses often use water sound, running water or hand bathing as the care for patients with difficulties in urination; however, the care is not evidence-based and well researched. Furthermore, few researchers examined whether or not foot bathing could facilitate people's urination. Foot bathing could provide comfortable feelings to people and improve their circulatory system; therefore, it was expected that the difficulties in urination might be improved by foot bathing due to its effect on the parasympathetic nervous system. Objective This experimental study aimed at revealing how foot bathing affected urination, and developing the results obtained in order to use them for the next research project. Method Eleven healthy adults (3 males and 8 females) agreed to participate in the study. The participants were provided with closed style foot bathing in water heated to 41℃ for 20 minutes. The researchers checked the activities of the participants' autonomic nervous system the amount of their urination, and changes in their vital signs during the experimentation. Then the researchers evaluated the participants' subjective reaction to the foot bathing. Results It was found that 5 in 11 participants had a marked increase in the amount of urination, 60 minutes before and after the foot bathing. The numerical values of activities of their sympathetic nervous system (LF/HF) were being increased during and after foot bathing. Other had a slow increase in the amount of urination, and the activities of their parasympathetic nervous system, which was measured and shown as HF, were stimulated, and the values were being increased during and after foot bathing. In addition, it was also revealed that the comfort of all participants and the temperature of their toes were improved by the warmth and stimulus of foot bathing. Conclusions The researchers suggested that there might be two types of participant reaction to foot bathing. Some people may feel comfortable and the temperature of their toes may be improved by the warmth and stimulus of foot bathing, but they also may get a marked increase in the amount of urination due to the dominant effect of foot bathing on the sympathetic nervous system. Others may feel comfortable and relaxed by foot bathing because of its effect on the parasympathetic nervous system but may not get a marked increase in the amount of urination in a short term.