A nursing intervention to prevent pneumonia in the weak elderlys as a reserve bed-ridden group

本文研究了呼吸训练对呼吸道感染发热发生率的影响。本研究以长谷川忧郁量表（HDS-R）为评估工具，以入住老人院为序，评估老人之失智程度。HDS-R评分为22分或以上的居民被随机分配到训练组或对照组。训练组接受一组训练，包括呼吸肌力量训练、呼吸肌耐力训练和有效咳嗽训练，每天30分钟，每周3天，持续12周。每天测量体温。每个训练周期测量呼气峰流速（PEF）。每四周获得最大吸气压（PImax）和呼气压（PEmax）。分配到对照组的受试者也被要求接受相同的呼吸功能测试。我们根据这些参数的比较来估计训练的效果。训练组（5名男性，20名女性）和对照组（6名男性，24名女性）的基本数据分别为年龄80.0+/-7.2和79.7+/-7.3岁，HDS-R分别为26.5+/-2.5和25.7+/-2.4岁，体温分别为36.3 +/-0.4和36.4+/-0.4 ℃。虽然训练组的PEF在开始时显著高于对照组（p<0.05），但组间的PImax和PEmax无差异。当体温等于所有体温值的平均值加上两个标准差或更高时，我们判断受试者发烧。两组发热天数/总体温记录数比较无差异。我们的结论是，在本研究中进行的呼吸训练未能降低由于呼吸道感染引起的发热的发生率。

The effect of respiratory training on the incidence of fever due to respiratory tract infection was studied. We assessed the degree of dementia of the residents in order of admission to a senior nursing home using the revised Hasegawa's Depression Scale (HDS-R). Residents whose HDS-R score was 22 or more were assigned at random either to training or control group. One set of training, including respiratory muscle training for power-up, respiratory muscle endurance training, and training of effective coughing, was loaded to the training group for 30 minutes per day, three days per week for 12 weeks. Body temperature was measured everyday. Peak expiratory flow rate (PEF) was measured every training period. Maximal inspiratory (PImax) and expiratory (PEmax) pressures were obtained every four weeks. Subjects assigned to the control group also were asked to receive the same respiratory function tests. We estimated the effect of the training based on comparison of these parameters. The basic data for the training (5 males, 20 females) and control (6 males, 24 females) group were, 80.0+/-7.2 and 79.7+/-7.3 years for age, 26.5+/-2.5 and 25.7+/-2.4 for HDS-R,36.3+/-0.4 and 36.4+/-0.4ﾟC for body temperature, respectively. Although PEF of the training group was significantly higher at the start than that of the control group (p<0.05), there was no between-groups difference in the PImax and PEmax. We judged that a subject had fever, when the body temperature became his mean plus two standarad deviation of all body temperature values or higher. Comarison of the numbers of Days of fever/total temperature records number between both groups showed no difference. We conclude that the respiratory trainig as performed in the present study failed to decrease the incidence of fever due to respiratory tract infection.