紀要論文 NICU 環境(照度・音刺激)における早産児の睡眠と身体活動生理学的反応への影響 ― 日内変動と昼夜別比較から ―
The influence of premature infants’ sleep and physiological response under NICU environment (illuminance, noise) ― seen from circadian variation and comparison of day and night ―

新小田, 春美  ,  木下, 義晶  ,  光武, 玲子  ,  上野, ふじ美  ,  荒田, 弘樹  ,  清原, 千賀子  ,  末次, 美子  ,  古賀, 靖子  ,  穴井, 謙  ,  白水, 雅子  ,  落合, 正行  ,  加来, 恒壽  ,  SHINKODA, Harumi  ,  KINOSHITA, Yoshiaki  ,  MITSUTAKE, Reiko  ,  UENO, Fujimi  ,  ARATA, Hiroki  ,  KIYOHARA, Chikako  ,  SUETSUGU, Yoshiko  ,  KOGA, Yasuko  ,  ANAI, Ken  ,  SHIRAMIZU, Masako  ,  OCHIAI, Masayuki  ,  KAKU, Tsunehisa

17 ( 1 )  , pp.35 - 44 , 2015-03-20 , 三重大学医学部看護学科
ISSN:1344-6983
NII書誌ID(NCID):AA11353824
内容記述
I .目 的NICU における照度,音の治療環境による睡眠・覚醒状態と,生理的身体活動反応への影響や日内変動および昼夜別の関係を明らかにし,児にとって発達に望ましい養育環境を考察する.II.方 法在胎31~32 週齢で生まれ,呼吸循環状態が落ち着いた修正在胎33~36 週齢時(生後8~21 日)に,男児27 名(75%),女児9 名(25%)の計36 名のNICUクベース収容児に,生理的活動量と睡眠状態の観測を行った.Actigraph 活動計を児の足首に装着し,照度と音圧測定器は児の頭上近くに設置し,それぞれ1 分毎の値をカウントした.観察項目は,Actigraph による活動量,呼吸心拍モニターによる呼吸数,心拍数,経皮酸素飽和度,児の就寝環境である部屋の照度と音圧を3 日間昼夜にわたり継続測定した.解析は,Sadeh らのアルゴリズムを用いたソフトウェアActionW をinfant に設定し,自動解析した.分析にはSPSS Ver.16 を使用し,統計学的分析には,対応のある2 群のT 検定, 時間毎の昼夜における活動量の多重比較にはScheff Posthoc 検定を行った.活動量と環境(照度,音圧)の相関係数を求め,有意差検定は有意水準5%以下とした.1 分間隔で睡眠の質判定(覚醒,動睡眠,静睡眠)の経時的推移と昼夜別割合の比較を行った.III.結 果1. 対象児の測定開始時期は, 修正在胎週齢35.3 ± 2.6 週で, 環境条件は, 照度167.0 ± 251.7lx(n=16503),音圧68.5 ± 10.4dB(n=12530)であった.2.3 日間の活動量は,3 日間とも昼帯の方が有意に多く,呼吸については夜帯の変動は少なく,昼間の変化が大きかった.3.同時測定した養育環境は,夜帯の方が照度は低く,音刺激は日による差が大きく昼夜の音圧の有意な差はなかった.4.時間経過による睡眠の質から睡眠・覚醒はウルトラデイアンリズムを認めた.5.昼夜の睡眠の質判定は,昼帯では覚醒27.3%,静睡眠22.3%,動睡眠50.4%,夜帯では覚醒21.4%,静睡眠24.5%,動睡眠54.1%であった.IV.結 論児の成熟度による差については今後追跡調査が必要であるが,昼夜の明暗環境を保持しつつ,過度な人為的刺激をせずに入眠を促す必要性が示唆された.
I ObjectiveThis study demonstrated sleep-wake state under the treatment environment by illuminance and noise in the neonatal intensive care unit (NICU), the influence of physiological response, circadian variation and the relationship between day and night, and considered the desirable nurturing environment for infant’s development.II MethodsThirty-six premature infants who were born in 31-32weeks gestational age, 27 boys (75%), 9 girls(25%), participated in this study when their respiratory status and circulation state were stable in gestational age 33 ~ 36 weeks (8 ~ 21days old). These premature infants in the NICU incubatorswere observed for the amount of physiological activity and sleep-wake state. Actigraphs were attached to the infant’s ankles. Illuminance meter and sound source meter were installed over infant’s head. The data of actigraphs was collected every minutes. Monitoring points were following, amount of activity through actigraphs, breathing rate, heart rate, oxygen saturation, illuminance and the noise in the premature infants’ room. These were monitored day and night for three days continuously.Automatic analysis was conducted by the software ActionW used Sadef's algorithm. SPSS ver.16 was used for analysis. Statistical analysis was undertaken by using paired-sample t-test. The multiple comparison of the amount of activity on day and night was perfomed by Scheffé Posthoctest. The correlation coefficient of amount of activity and environment (illuminance and noise) were calculated. The significance level was made into 5% or less. We observed the longitudinal course of the quality of sleep (w, S1, S2) which was judged every minutes, and compared the rate of the quality of sleep between day and night.III Results1. Measurement was started when premature infants were gestational age 35.3 ± 2.6weeks under the environmental conditions which illuminance was 167.0 ± 251.7 (n=16503), sound pressure level was 68.5 ± 10.4 dB (n=12530).2. The amount of activity in night was significantly higher than in daytime for three days. There was little change of respiration in night whereas the change in daytime was large.3. About the nursing environment measured simultaneously, illuminance was low in night.Although sound stimulation was different every day, there was no significant difference of sound pressure in day and night.4. Ultradian rhythm was recognized from longitudinal course of the quality of sleep.5. The rates of the quality of sleep between day and night were following. In daytime, Wakefulness 27.3%, Sleep 22.3%, Unsound sleep 50.4%. In night, Wakefulness 21.4%, Sleep 24.5%, Unsound sleep 54.1%.IV ConclusionAlthough the follow-up review is needed about the difference of maturity of infants, we suggest that the developmental care is needed to encourage sleep, with maintaining the light-and-darkness environment, without the excessive artificial stimulus.the quality of sleep (w, S1, S2) which was judged every minutes, and compared the rate of the quality of sleep between day and night.III Results1. Measurement was started when premature infants were gestational age 35.3 ± 2.6weeks under the environmental conditions which illuminance was 167.0 ± 251.7 (n=16503), sound pressure level was 68.5 ± 10.4 dB (n=12530).2. The amount of activity in night was significantly higher than in daytime for three days. There was little change of respiration in night whereas the change in daytime was large.3. About the nursing environment measured simultaneously, illuminance was low in night.Although sound stimulation was different every day, there was no significant difference of sound pressure in day and night.4. Ultradian rhythm was recognized from longitudinal course of the quality of sleep.5. The rates of the quality of sleep between day and night were following. In daytime, Wakefulness 27.3%, Sleep 22.3%, Unsound sleep 50.4%. In night, Wakefulness 21.4%, Sleep 24.5%, Unsound sleep 54.1%.IV ConclusionAlthough the follow-up review is needed about the difference of maturity of infants, we suggest that the developmental care is needed to encourage sleep, with maintaining the light-and-darkness environment, without the excessive artificial stimulus.
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