JP2020194063A - Tissue model for pressure ulcer treatment training - Google Patents
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Abstract
Description
本発明は褥瘡ケアを練習するための生体組織モデルに関する。特に、褥瘡処置に必要な手技を学ぶための生体に近い質感、感触を備えている褥瘡処置トレーニング用組織モデルに関する。 The present invention relates to a biological tissue model for practicing pressure ulcer care. In particular, it relates to a tissue model for pressure ulcer treatment training that has a texture and feel close to that of a living body for learning the procedure necessary for pressure ulcer treatment.
褥瘡とは、患者が長期間寝たきり等、同じ体勢で過ごした場合に、身体とそれを支持する面との接触局所で血行不全となり、周辺組織が壊死を起こす状態をいう。寝たきりの高齢者や、脊髄損傷、終末期の患者など、様々な病状において自力で体位を変換するのが困難な患者において、褥瘡を発症しやすい。 Pressure ulcer refers to a condition in which when a patient spends a long time in the same posture, such as being bedridden, blood circulation becomes inadequate at the site of contact between the body and the surface that supports it, causing necrosis of surrounding tissues. Pressure ulcers are more likely to occur in bedridden elderly patients, spinal cord injuries, end-of-life patients, and other patients who have difficulty repositioning on their own in a variety of medical conditions.
褥瘡は定期的に体位変換を行うといった予防が最も重要であるが、褥瘡ができた場合には、創傷がどこまで到達しているかなど、褥瘡の重症度（ステージ）に応じて、適切な治療を行うことが必要である。褥瘡は的確な診断を行い、適切な処置を行うことが重要である。 Prevention of pressure ulcers, such as regular repositioning, is of utmost importance, but if pressure ulcers occur, appropriate treatment should be given according to the severity (stage) of the pressure ulcer, such as how far the wound has reached. It is necessary to do. It is important to make an accurate diagnosis of pressure ulcers and take appropriate measures.
平成２７年１０月より、褥瘡処置を含む特定行為に係る看護師の研修制度が施行され、医師が患者を特定した上で、特定行為を実施するように指示した場合には、看護師は病状の確認を行った後、手順書に定められた「診療の補助の内容」を実施することができる。褥瘡処置の場合には、看護師は、手順書により身体所見等を確認し、血流のない遊離した壊死組織を滅菌ハサミ、滅菌鑷子等で取り除き、創洗浄、注射針を用いた排膿、止血等の処置を行う。しかしながら、これら一連の処置はステージごとに処置が異なることもあり、医師の指導のもと習得する機会はさほど多くはないことから、褥瘡処置を行うことのできるトレーニングモデルが必要とされてきた。 From October 2015, a training system for nurses related to specific actions including pressure ulcer treatment will be enforced, and if a doctor specifies a patient and then instructs them to carry out the specific action, the nurse will have a medical condition. After confirming, the "contents of medical assistance" specified in the procedure manual can be implemented. In the case of pressure ulcer treatment, the nurse confirms physical findings, etc. according to the procedure manual, removes free necrotic tissue without blood flow with sterile scissors, sterile tweezers, etc., and cleans the wound, drains pus using an injection needle, etc. Take measures such as stopping bleeding. However, since these series of treatments may differ from stage to stage and there are not many opportunities to learn them under the guidance of a doctor, a training model capable of performing pressure ulcer treatment has been required.
褥瘡の診断等の習熟のために、褥瘡モデルが公開されている（特許文献１、２）。特許文献１には、褥瘡診断訓練用の生体組織モデルが公開されている。また、特許文献２には、褥瘡モデル動物が開示されている。さらに、褥瘡の進行のステージを理解するために仙骨部にできた褥瘡を再現したステージ毎のモデルも販売されている。また、褥瘡モデルではないものの、従来はブタなどの動物を用いて行われていた生体組織の切開、縫合、剥離などの手技訓練を行うための病変部を模擬した生体モデルも開示されている（特許文献３）。 A pressure ulcer model has been published for the purpose of mastering the diagnosis of pressure ulcers (Patent Documents 1 and 2). Patent Document 1 discloses a biological tissue model for pressure ulcer diagnosis training. Further, Patent Document 2 discloses a pressure ulcer model animal. In addition, a stage-by-stage model that reproduces the pressure ulcer formed in the sacral region to understand the stage of pressure ulcer progression is also on sale. In addition, although it is not a pressure ulcer model, a biological model that simulates a lesion for performing surgical training such as incision, suturing, and peeling of biological tissue, which was conventionally performed using animals such as pigs, is also disclosed ( Patent Document 3).
特許文献１の褥瘡モデルは、超音波検査装置を用いて褥瘡診断の訓練を行うことを前提に作製されている。このモデルでは、超音波装置による褥瘡診断を行うことができるものの褥瘡の処置を訓練できるものではない。特許文献２の褥瘡モデルは、動物モデルであり、褥瘡発症要因の究明や治癒過程の評価、発症抑制のために有効な薬剤の探索のためのものであり、褥瘡の処置を訓練するためのものではない。また、特許文献３などに、開示されているポリビニルアルコールを材料とする生体モデルは、切開、縫合などの手技について習熟するためのモデルであるが、病変部としてがん、血栓、プラークなどを対象としており、褥瘡を対象としたものではない。褥瘡病変は、がんや血栓病変とは異なり、切開して除去するだけではなく、洗浄が必要であるなど、褥瘡に独特の処置方法があるだけではなく、黒色痂皮があるため触感も大きく異なっており、褥瘡処置に習熟するためには褥瘡に特化したモデルが必要である。 The pressure ulcer model of Patent Document 1 is created on the premise that training for pressure ulcer diagnosis is performed using an ultrasonic inspection device. In this model, pressure ulcer diagnosis can be performed by an ultrasonic device, but pressure ulcer treatment cannot be trained. The pressure ulcer model of Patent Document 2 is an animal model for investigating the cause of pressure ulcer onset, evaluating the healing process, searching for an effective drug for suppressing the onset of pressure ulcer, and training the treatment of pressure ulcer. is not. In addition, the biological model using polyvinyl alcohol disclosed in Patent Document 3 and the like is a model for mastering techniques such as incision and suturing, but targets cancer, thrombus, plaque, etc. as lesions. It is not intended for pressure ulcers. Unlike cancer and thrombotic lesions, pressure ulcer lesions not only have unique treatment methods for pressure ulcers, such as the need for incision and removal, but also have a large tactile sensation due to the presence of black eschar. They are different and require a pressure ulcer-specific model to become proficient in pressure ulcer treatment.
また、現在販売されている褥瘡モデルもあるが、褥瘡の進行をステージ毎に学び、褥瘡の洗浄、閉鎖包帯法などの訓練は行うことができるものの、壊死組織の切除など実臨床により近い褥瘡処置を訓練するためのものではない。そのため、褥瘡の処置を習得するより生体組織に似たモデルが必要とされている。特に、従来の褥瘡モデルでは行うことができない壊死組織の切除トレーニングを行うことのできるモデルが求められていた。 There is also a pressure ulcer model currently on the market, but although it is possible to learn the progression of pressure ulcers at each stage and perform training such as pressure ulcer cleaning and closed bandage method, pressure ulcer treatment that is closer to actual clinical practice such as excision of necrotic tissue. It is not for training. Therefore, there is a need for a model that resembles living tissue rather than learning how to treat pressure ulcers. In particular, there has been a demand for a model capable of performing excision training for necrotic tissue, which cannot be performed by a conventional pressure ulcer model.
本発明は、褥瘡のステージを学習し、さらに褥瘡の処置を行うための組織モデルを提供することを課題とする。
（１）骨、筋層、黄色痂皮、黒色痂皮を含む皮膚層の４層を有し、各層ごとに触感、色が異なることを特徴とする褥瘡処置トレーニング用組織モデル。
（２）前記筋層、黄色痂皮、黒色痂皮を含む皮膚層の３層は、濃度の異なるＰＶＡ溶液を用いて製造されていることを特徴とする（１）に記載の褥瘡処置トレーニング用組織モデル。
（３）前記ＰＶＡ溶液の濃度は、黄色痂皮、筋層、黒色痂皮を含む皮膚層の順に濃度が高いＰＶＡ溶液を用いて製造されていることを特徴とする（１）、又は（２）記載の褥瘡処置トレーニング用組織モデル。
（４）前記筋層内に模擬血液が封入された模擬血管が配置されていることを特徴とする（１）〜（３）いずれか１項記載の褥瘡処置トレーニング用組織モデル。
An object of the present invention is to provide a tissue model for learning the stage of pressure ulcer and further performing treatment for pressure ulcer.
(1) A tissue model for pressure ulcer treatment training, which has four layers of a skin layer including bone, muscle layer, yellow scab, and black scab, and each layer has a different tactile sensation and color.
(2) The pressure ulcer treatment training according to (1), wherein the three layers of the muscle layer, the yellow scab, and the skin layer including the black scab are produced by using PVA solutions having different concentrations. Organizational model.
(3) The concentration of the PVA solution is characterized in that it is produced using a PVA solution having a higher concentration in the order of yellow scab, muscle layer, and skin layer containing black scab (1) or (2). ) Tissue model for decubitus treatment training described.
(4) The tissue model for pressure ulcer treatment training according to any one of (1) to (3), wherein a simulated blood vessel in which simulated blood is enclosed is arranged in the muscle layer.
本発明の組織モデルは、ハサミやピンセットなどを使用して壊死組織を切除する訓練ができることから、従来の褥瘡モデルとは全く異なるトレーニングを行うことができる。また、切除時間や壊死組織の取り残し、出血の有無といった項目によって、トレーニーの技術を具体的項目によって評価することができる。 Since the tissue model of the present invention can be trained to excise necrotic tissue using scissors, tweezers, or the like, training completely different from the conventional pressure ulcer model can be performed. In addition, the trainee's technique can be evaluated by specific items based on items such as excision time, leftover necrotic tissue, and presence or absence of bleeding.
以下、図面を参照して、本発明の褥瘡処置トレーニング用組織モデルについて説明する。なお、以下では特定のステージの組織モデルを例に説明するが、深達度が浅い軽症のステージＩから、各ステージのモデルを作製することができることは言うまでもない。 Hereinafter, the tissue model for pressure ulcer treatment training of the present invention will be described with reference to the drawings. In the following, a tissue model of a specific stage will be described as an example, but it goes without saying that a model of each stage can be created from a mild stage I having a shallow depth of invasion.
褥瘡の重症度は一般的に褥瘡が組織のどこまで到達しているか、すなわち深達度によって分類されている。褥瘡分類には多くの分類法があるが、国際的には、米国褥瘡諮問委員会（Ｎａｔｉｏｎａｌ Ｐｒｅｓｓｕｒｅ Ｕｌｃｅｒ Ａｄｖｉｓｏｒｙ Ｐａｎｅｌ：ＮＰＡＵＰ）の深達度分類、ヨーロッパ褥瘡諮問委員会（Ｅｕｒｏｐｅａｎ Ｐｒｅｓｓｕｒｅ Ｕｌｃｅｒ Ａｄｖｉｓｏｒｙ Ｐａｎｅｌ：ＥＰＡＵＰ）のグレードが多く用いられている。日本では、「褥瘡の予防・治療ガイドライン」において、深達度をＩ〜ＩＶ度の４段階に分類する方法が考案され、その後、７段階に分類する改訂版ＤＥＳＩＧＮ−Ｒが２００８年に開発されたことから、臨床現場ではこれを用いて診断・治療が行われることが多い。 The severity of pressure ulcers is generally categorized by how far the pressure ulcer reaches the tissue, that is, the depth of invasion. There are many classification methods for pressure ulcer classification, but internationally, the National Pressure Ulcer Advisory Panel (NPAUP) invasion classification, the European Pressure Ulcer Advisor (European Pressure Ulcer Apple) ) Grades are often used. In Japan, a method for classifying invasion into 4 levels from I to IV was devised in the "Guidelines for Prevention and Treatment of Decubitus", and then a revised DESIGN-R was developed in 2008 to classify into 7 levels. Therefore, in clinical practice, diagnosis and treatment are often performed using this.
ＤＥＳＩＧＮツールによる褥瘡判定スケールとは、褥瘡の状態をＤｅｐｔｈ（深さ）、Ｅｘｕｄａｔｅ（滲出液）、Ｓｉｚｅ（大きさ）、Ｉｎｆｌａｍｍａｔｉｏｎ／Ｉｎｆｅｃｔｉｏｎ（炎症／感染）、Ｇｒａｎｕｌａｔｉｏｎ ｔｉｓｓｕｅ（肉芽組織）、Ｎｅｃｒｏｔｉｃ ｔｉｓｓｕｅ（壊死組織）、及びＰｏｃｋｅｔ（ポケット）の７項目について評価（Ｒａｔｉｎｇ）を行い、褥瘡の重症度、及び評価を行うためのツールである。ＤＥＳＩＧＮツールによって、重症度、経過の観察が行われている。 The pressure ulcer judgment scale by the DESIGN tool is the condition of the pressure ulcer: Depth (depth), Exudate (exudate), Size (size), Inflammation / Infection (inflammation / infection), Granulation tissue (granulation tissue), Necrotic tissue (granulation tissue). It is a tool for evaluating 7 items of (necrotic tissue) and Pocket (pocket), and evaluating the severity of pressure ulcer. The severity and course are monitored by the DESIGN tool.
実施態様に示す褥瘡処置トレーニング用組織モデルは、この判定スケールのうち、深さ、滲出液、大きさ、炎症／感染、肉芽組織、壊死組織、ポケットについて、確認することができることから、褥瘡の病期を学習するモデルとしても使用することができる。 Since the tissue model for pressure ulcer treatment training shown in the embodiment can confirm the depth, exudate, size, inflammation / infection, granulation tissue, necrotic tissue, and pocket of this determination scale, the disease of pressure ulcer It can also be used as a model for learning the period.
褥瘡の治療は、外用薬の塗布、ドレッシング材による被覆などの保存的治療の他、褥瘡の傷に電気や水などの物理的な刺激を与える物理療法、外科的治療がある。いずれの治療を選択するにしても、褥瘡のステージ、滲出液や感染の有無などの病態に応じて、適切な治療方法を選択することになるため、褥瘡判定は重要である。 Treatment of pressure ulcers includes conservative treatments such as application of external medicines and dressing materials, physical therapy that gives physical stimuli such as electricity and water to pressure ulcer wounds, and surgical treatments. Regardless of which treatment is selected, the pressure ulcer determination is important because an appropriate treatment method will be selected according to the stage of the pressure ulcer, the pathological condition such as exudate and the presence or absence of infection.
さらに、本発明の褥瘡処置トレーニング用組織モデルは、生体組織に近い感触や状態を模し、褥瘡除去、壊死組織の切除のトレーニングに使用することができる。上述のように褥瘡の治療は、医師だけではなく、特定行為に係る看護師が直接的な処置を行うことがある。したがって、ハサミやピンセットなどを使用して壊死組織を切除する手技を組織モデルによって習得することは、治療経験のない看護師にとって非常に重要なトレーニングとなる。 Furthermore, the tissue model for pressure ulcer treatment training of the present invention can be used for training for pressure ulcer removal and necrotic tissue excision by imitating a feel and condition close to that of living tissue. As mentioned above, the treatment of pressure ulcers may be performed directly not only by doctors but also by nurses involved in specific actions. Therefore, it is very important training for nurses who have no treatment experience to learn the technique of excising necrotic tissue using scissors or tweezers by using a tissue model.
一般的にヒト組織は外側から皮膚、筋層、骨の層状構造となっており、本発明の組織モデルもこれを踏まえて作製されている。図１（Ａ）に本実施例の褥瘡処置トレーニング用組織モデルの斜視図を示すが、褥瘡処置トレーニング用組織モデル１は、外側から黒色痂皮２を含む皮膚層３、黄色痂皮４、筋層５、骨６の４層構造となっている。また、図１（Ｂ）に示すように、血管７を筋層内に形成している。血管７は、模擬血液を筋層内の管状の空洞に封入して作製しているので、切除過程で血管を傷つけた場合には、傷つけた箇所から模擬血液が滲み出る。したがって、切除が適切に行われているかをチェックすることができるとともに、誤って血管を傷つけた場合の止血処置についても練習することができる。血管は筋層内や褥瘡部と健常組織の境界領域に何本か形成することができる。 Generally, human tissue has a layered structure of skin, muscular layer, and bone from the outside, and the tissue model of the present invention is also prepared based on this. FIG. 1 (A) shows a perspective view of the tissue model for pressure ulcer treatment training of this example. The tissue model 1 for pressure ulcer treatment training has a skin layer 3 including black eschar 2, yellow eschar 4, and muscle from the outside. It has a four-layer structure consisting of layer 5 and bone 6. Further, as shown in FIG. 1 (B), the blood vessel 7 is formed in the muscle layer. Since the blood vessel 7 is prepared by enclosing the simulated blood in a tubular cavity in the muscle layer, when the blood vessel is damaged during the excision process, the simulated blood exudes from the damaged portion. Therefore, it is possible to check whether the excision is performed properly, and to practice hemostasis treatment when a blood vessel is accidentally injured. Several blood vessels can form in the muscularis and in the border area between the pressure ulcer and healthy tissue.
褥瘡の表面は、皮膚及び皮下組織の壊死により、壊死した皮膚と滲出液が乾燥して固くなった黒色痂皮が存在することが多い。本発明の組織モデルは形態、質感を実際の褥瘡部位に酷似するように、外面には黒色痂皮を配置し、外観も酷似するように製造されている。黒色痂皮の周囲には炎症が生じ、発赤が見られることが多いことから、発赤等、実際の褥瘡に似た色調としている。 The surface of the pressure ulcer often has black eschar, which is hardened by drying and hardening the necrotic skin and exudate due to necrosis of the skin and subcutaneous tissue. The tissue model of the present invention is manufactured so that the morphology and texture closely resemble the actual pressure ulcer site, the black eschar is arranged on the outer surface, and the appearance also closely resembles. Inflammation occurs around the black eschar, and redness is often seen. Therefore, the color tone is similar to that of an actual pressure ulcer, such as redness.
本発明の組織モデルは褥瘡や壊死組織の切除のトレーニングを行うことが目的であることから、各層の色、弾力、硬さ、及び質感が、実際の組織に酷似するように作製されている。その結果、実際の患者において壊死組織等を切除する際の触感と、非常に近い感覚でトレーニングを行うことができる。 Since the purpose of the tissue model of the present invention is to train the excision of pressure ulcers and necrotic tissues, the color, elasticity, hardness, and texture of each layer are made to closely resemble the actual tissues. As a result, it is possible to perform training in an actual patient with a feeling very close to the tactile sensation when excising necrotic tissue or the like.
褥瘡組織モデルは、人体の形状を模した台座８に埋め込むように設置して使用することができる。図２は仙骨に褥瘡ができた場合を想定し、腰部形状の台座に組織モデルを埋め込んだものを示しているが、褥瘡ができやすい部位であれば、モデルを設置するのはどの部分でも構わない。褥瘡は、長時間同じ姿勢でいることにより生じることから、圧迫された場合に骨が突き出した部位にできやすい。寝る姿勢によって、褥瘡ができる部位は異なるが、仰向けに寝ている場合には、後頭部、肩甲部、仙骨部、かかとに、横向きに寝ている場合には、耳、肩、ひじ、腸骨、ひざ、くるぶしにできることが多い。これら褥瘡ができやすい部位の台座を用意し、褥瘡組織モデルを設置することによって、より実臨床に近い形でトレーニングを行うことができる。 The pressure ulcer tissue model can be installed and used so as to be embedded in a pedestal 8 that imitates the shape of a human body. Figure 2 shows a case where a pressure ulcer is formed on the sacrum and a tissue model is embedded in a lumbar-shaped pedestal. However, the model can be installed at any part as long as the pressure ulcer is likely to occur. Absent. Since pressure ulcers are caused by staying in the same position for a long time, they tend to form in the area where the bone protrudes when compressed. Depending on the sleeping posture, the area where pressure ulcers occur varies, but when lying on the back, the back of the head, shoulders, sacrum, and heels, and when sleeping sideways, the ears, shoulders, elbows, and ilium. Often on the knees and ankles. By preparing a pedestal for these pressure ulcer-prone sites and installing a pressure ulcer tissue model, training can be performed in a form closer to actual clinical practice.
褥瘡処置トレーニング用組織モデルを人体形状の台座に設置することによって、壊死組織の切除などの処置時には、術者の身体の位置など、実際の臨床現場と同じようにトレーニングを行うことができるだけではなく、処置後にドレッシング材をあて、包帯を巻くなどの処置に関しても、実際と類似した状況を再現することができる。また、陰圧閉鎖療法（ＶＡＣシステム）のトレーニングにも用いることができる。 By installing the tissue model for pressure ulcer treatment training on a pedestal shaped like a human body, it is possible not only to perform training such as the position of the operator's body during treatment such as excision of necrotic tissue, as in the actual clinical setting. It is possible to reproduce a situation similar to the actual situation with respect to the treatment such as applying a dressing material after the treatment and wrapping a bandage. It can also be used for training in negative pressure wound therapy (VAC system).
[実施例１] 褥瘡処置トレーニング用組織モデルの製造方法
実施態様に示す褥瘡モデルの製造方法について説明する。ここでは、骨以外の組織を濃度の異なるＰＶＡを用いて、質感、硬さ等が生体に近い状態を再現しているので、液状のＰＶＡを凍結し成型できるように型を用いている。まず、模擬骨を型にセットする。実施例では模擬骨は無発砲ウレタンを用いているが、色、質感が骨に類似している素材であればどのようなものを用いてもよい。具体的には硬質樹脂等が挙げられる。
[Example 1] Method for manufacturing a tissue model for pressure ulcer treatment training A method for manufacturing a pressure ulcer model shown in an embodiment will be described. Here, since the texture, hardness, and the like of tissues other than bone are reproduced by using PVA having different concentrations, a mold is used so that the liquid PVA can be frozen and molded. First, the simulated bone is set in the mold. In the embodiment, non-foaming urethane is used for the simulated bone, but any material may be used as long as the material is similar in color and texture to the bone. Specific examples thereof include hard resins.
次に、筋層を作製する。筋層は液状のＰＶＡを凍結、融解することによって作製している。筋層は軟組織としては比較的硬いことから、筋層を製造するためのＰＶＡは、８％以上１７％以下の濃度のＰＶＡ水溶液を用いることができる。好ましくは、１０％以上１５％以下、より好ましくは１２％以上１４％以下の濃度とする。筋層は実際には赤身を帯びた色調であることから、青、赤、白、黄色などの色素を混合して色調を整えている。模擬骨とＰＶＡが完全に接着するように、模擬骨表面に接着剤を塗布する。接着剤が乾く前に、筋層用のＰＶＡを型に流し込む。 Next, the muscle layer is prepared. The muscular layer is prepared by freezing and thawing liquid PVA. Since the muscle layer is relatively hard as a soft tissue, a PVA aqueous solution having a concentration of 8% or more and 17% or less can be used as the PVA for producing the muscle layer. The concentration is preferably 10% or more and 15% or less, more preferably 12% or more and 14% or less. Since the muscular layer is actually a reddish color tone, pigments such as blue, red, white, and yellow are mixed to adjust the color tone. Adhesive is applied to the simulated bone surface so that the simulated bone and PVA are completely adhered. PVA for the muscle layer is poured into the mold before the adhesive dries.
筋層の間に、模擬血液を封入した血管を作製する場合には、筋層用のＰＶＡ溶液を２／３から３／４程度型に入れて凍結させる。凍結後、凍結したＰＶＡの上に血管と同程度の直径の円筒を配置し、筋層用ＰＶＡ溶液を円筒の周囲に滴下し、再度凍結させ固定する。円筒が固定されたら、残りの筋層用ＰＶＡ溶液を型に流し、凍結する。 When a blood vessel containing simulated blood is prepared between the muscle layers, the PVA solution for the muscle layer is placed in a mold of about 2/3 to 3/4 and frozen. After freezing, a cylinder having a diameter similar to that of a blood vessel is placed on the frozen PVA, a PVA solution for muscle layer is dropped around the cylinder, and the PVA solution is frozen again and fixed. Once the cylinder is fixed, the remaining muscle layer PVA solution is poured into a mold and frozen.
筋層が完全に凍結したら、冷凍庫から取り出し、室温で解凍する。解凍後、円筒を抜き出し、模擬血液を注入する。模擬血液は、ここではオイルに赤い油性色素を混入したものを使用しているが、血液に類似した粘度、質感を再現することができれば、何を用いてもよい。模擬血管の両端は筋層用ＰＶＡで予め栓を作製しておき、両端に嵌めて模擬血液が漏れないようにし、再度凍結する。 When the muscle layer is completely frozen, remove it from the freezer and thaw at room temperature. After thawing, the cylinder is pulled out and simulated blood is injected. As the simulated blood, a mixture of oil and a red oily pigment is used here, but any simulated blood may be used as long as it can reproduce the viscosity and texture similar to blood. Both ends of the simulated blood vessel are prefabricated with PVA for the muscular layer, and fitted to both ends to prevent the simulated blood from leaking, and then frozen again.
凍結完了後、黄色痂皮用ＰＶＡを流し、冷凍する。黄色痂皮用ＰＶＡ溶液は、４％以上１２％以下の濃度のＰＶＡ水溶液を用いることができる。好ましくは、５％以上９％以下の濃度、より好ましくは、６％以上８％以下の濃度とする。黄色痂皮用ＰＶＡ溶液には、白、黄色、茶などの色素を添加して、黄色痂皮の色を再現する。 After the freezing is completed, PVA for yellow scab is poured and frozen. As the PVA solution for yellow scab, a PVA aqueous solution having a concentration of 4% or more and 12% or less can be used. The concentration is preferably 5% or more and 9% or less, and more preferably 6% or more and 8% or less. Pigments such as white, yellow, and brown are added to the PVA solution for yellow scabs to reproduce the color of yellow scabs.
これらの組織層とは別に、黒色痂皮を製造しておく。黒色痂皮は、組織層を作製した型より一回り小さい型か、同径の型を用い作製後、周囲を一回り小さくカットすればよい。黒色痂皮用ＰＶＡ溶液は、１２％以上１８％以下の濃度のＰＶＡ水溶液を用いることができる。好ましくは１３％以上１７％以下、より好ましくは１４％以上１６％以下の濃度とする。黒色痂皮用ＰＶＡ溶液には、黒、赤などの色素を混合して黒色痂皮の色調を再現する。また、硬さ、質感等を再現するために繊維状の素材を混合する。繊維状の素材としては、和紙、洋紙などの紙、脱脂綿、グラスウール、布繊維などを用いることができる。黒色痂皮用ＰＶＡ溶液は、２〜５ｍｍ程度の厚さになるように型に流し、冷凍する。繊維状の素材とＰＶＡを混合することにより、黒色痂皮の質感、触感を再現することができる。繊維状素材は、ＰＶＡ溶液に対し、２％以上６％（重量％）以下、より好ましくは３％以上５％以下の割合で混合することができる。黒色痂皮は冷凍、融解後、型から外して乾燥させる。 Separately from these tissue layers, black eschar is produced. The black eschar may be made by using a mold one size smaller than the mold in which the tissue layer is prepared, or by using a mold having the same diameter, and then cutting the circumference one size smaller. As the PVA solution for black eschar, a PVA aqueous solution having a concentration of 12% or more and 18% or less can be used. The concentration is preferably 13% or more and 17% or less, and more preferably 14% or more and 16% or less. A pigment such as black or red is mixed with the PVA solution for black scab to reproduce the color tone of black schar. In addition, fibrous materials are mixed in order to reproduce hardness, texture, etc. As the fibrous material, paper such as Japanese paper and Western paper, absorbent cotton, glass wool, cloth fiber and the like can be used. The PVA solution for black eschar is poured into a mold to a thickness of about 2 to 5 mm and frozen. By mixing the fibrous material and PVA, the texture and tactile sensation of black eschar can be reproduced. The fibrous material can be mixed with the PVA solution at a ratio of 2% or more and 6% (% by weight) or less, more preferably 3% or more and 5% or less. After freezing and thawing the black scab, remove it from the mold and dry it.
次に、黄色痂皮まで作製した組織モデルに黒色痂皮を設置する。ＰＶＡ溶液は、１２％以上１８％以下の濃度のＰＶＡ水溶液を用いることができる。好ましくは１３％以上１７％以下、より好ましくは１４％以上１６％以下の濃度のＰＶＡ溶液を用いる。黒色痂皮の周囲は、青、赤、黄色、白の色素を添加した黄色味を帯びた溶液と、赤い色素を添加した赤味を帯びた溶液の２種類の溶液を準備し、黒色痂皮部分を接着する。黒色痂皮を黄色痂皮の上に配置し、黄色のＰＶＡ溶液を外側に流した後、赤いＰＶＡ溶液を黒色痂皮と黄色のＰＶＡ溶液の間に流すことにより、２色のＰＶＡ溶液が自然に混合し、発赤を生じた褥瘡部分と同じような外観となる。冷凍、融解させ、さらに表面のみ乾燥させる。筋層、黄色痂皮、黒色痂皮を含む皮膚層に異なる濃度のＰＶＡを用いることによって、壊死組織を切除するトレーニングを行った際に、ヒト組織を用いたときと同様の触感を得ることができる。 Next, the black eschar is placed on the tissue model prepared up to the yellow eschar. As the PVA solution, an aqueous PVA solution having a concentration of 12% or more and 18% or less can be used. A PVA solution having a concentration of 13% or more and 17% or less, more preferably 14% or more and 16% or less is used. Around the black scab, prepare two types of solutions, a yellowish solution with blue, red, yellow, and white pigments and a reddish solution with red pigments, and prepare the black scab. Glue the parts together. A two-color PVA solution is naturally produced by placing the black eschar on the yellow eschar, flowing the yellow PVA solution outward, and then flowing the red PVA solution between the black eschar and the yellow PVA solution. The appearance is similar to that of the reddish pressure ulcer. Freeze, thaw, and dry only the surface. By using different concentrations of PVA in the skin layer, including the muscularis, yellow eschar, and black eschar, it is possible to obtain the same tactile sensation as when using human tissue when training to remove necrotic tissue. it can.
[実施例２] 褥瘡処置トレーニング用組織モデルを用いたトレーニング方法
実施例１で製造した褥瘡モデルを用いたトレーニング方法について説明する（図３）。褥瘡モデルは、経験の浅い看護師、医師等が、熟練した看護師、医師等から手技を学ぶためのものであるから、熟練した手技を有するトレーナーの指導のもと、トレーニーが訓練を受ける。
[Example 2] Training method using a tissue model for pressure ulcer treatment training A training method using the pressure ulcer model manufactured in Example 1 will be described (FIG. 3). Since the pressure ulcer model is for inexperienced nurses, doctors, etc. to learn the procedure from skilled nurses, doctors, etc., trainees are trained under the guidance of trainers who have skilled procedures.
褥瘡モデルを設置することのできる台座には、モデルと同じ大きさの穴があいている（図２参照）。台座にはめ込むことによって、患者を処置する際と同様の位置でトレーニングを行うことができる。 The pedestal on which the pressure ulcer model can be placed has a hole the same size as the model (see Figure 2). By fitting it into the pedestal, training can be performed in the same position as when treating the patient.
トレーニーは、褥瘡患部の様子を観察、測定し、褥瘡の状態をＤＥＳＩＧＮ−Ｒ判定ツール、ＮＰＡＵＰ、あるいはＥＰＡＵＰなどの判定基準によってステージを判定する。特定行為に係る看護師は、医師が特定した患者の病状の確認を行う必要があることから、褥瘡のステージについて判断することは重要である。トレーナーはトレーニーの判断が正しいか確認を行う。 The trainee observes and measures the condition of the affected area of the pressure ulcer, and determines the stage of the pressure ulcer by a criterion such as a DESIGN-R determination tool, NPAUP, or EPAUP. It is important to determine the stage of pressure ulcers, as nurses involved in specific actions need to confirm the medical condition of the patient identified by the doctor. The trainer confirms that the trainee's judgment is correct.
褥瘡の判定を行った後、トレーニーは褥瘡の処置を行う。具体的には、黒色痂皮や壊死組織の切除、患部の洗浄、消毒、外用薬、ドレッシング材で被覆、包帯を巻くなどの処置を行う。トレーナーは、トレーニーの手技に対してアドバイスを行う。また、切除すべき壊死組織の取り残し、切除時間、出血の有無等の項目により、トレーニーの手技を評価することができる。 After making a pressure ulcer determination, the trainee treats the pressure ulcer. Specifically, treatments such as excision of black eschar and necrotic tissue, cleaning and disinfection of the affected area, topical medicine, covering with a dressing material, and bandaging are performed. The trainer gives advice on the trainee's procedure. In addition, the trainee's procedure can be evaluated based on items such as leftover necrotic tissue to be excised, excision time, and presence / absence of bleeding.
褥瘡モデルを用いることによって、トレーニーは具体的に自身の手技で気をつけるべき点を習熟することができるようになる。患者の褥瘡処置を行う前に褥瘡モデルによって一連の手技をトレーニングできることは、看護師にとっても、患者にとっても大きなメリットとなる。今後、高齢者の増加とともに、寝たきりとなる患者の増加、褥瘡患者の増加が予想されることから、確実な手技を習得した看護師の増加のためにも褥瘡モデルを用いて習熟することは非常に重要となる。 By using the pressure ulcer model, trainees will be able to master specific points to be aware of in their own procedures. Being able to train a series of procedures with a pressure ulcer model before performing a patient's pressure ulcer procedure is of great benefit to both the nurse and the patient. In the future, as the number of elderly people increases, the number of bedridden patients and the number of pressure ulcer patients are expected to increase, so it is extremely difficult to master using the pressure ulcer model in order to increase the number of nurses who have mastered certain procedures. Is important to.
１…褥瘡処置トレーニング用組織モデル、２…黒色痂皮、３…皮膚層、４…黄色痂皮、５…筋層、６…骨、７…血管、８…台座 1 ... Tissue model for pressure ulcer treatment training, 2 ... Black eschar, 3 ... Skin layer, 4 ... Yellow eschar, 5 ... Muscular layer, 6 ... Bone, 7 ... Blood vessel, 8 ... Pedestal
Claims (4)
各層ごとに触感、色が異なることを特徴とする褥瘡処置トレーニング用組織モデル。 It has four layers of skin, including bone, muscular layer, yellow scab, and black scab.
A tissue model for pressure ulcer treatment training characterized by different tactile sensations and colors for each layer.
濃度の異なるＰＶＡ溶液を用いて製造されていることを特徴とする請求項１に記載の褥瘡処置トレーニング用組織モデル。 The three layers of the muscular layer, the yellow scab, and the skin layer including the black scab are
The tissue model for pressure ulcer treatment training according to claim 1, wherein the tissue model is produced by using PVA solutions having different concentrations.
黄色痂皮、筋層、黒色痂皮を含む皮膚層の順に濃度が高いＰＶＡ溶液を用いて製造されていることを特徴とする請求項１、又は２記載の褥瘡処置トレーニング用組織モデル。 The concentration of the PVA solution is
The tissue model for pressure ulcer treatment training according to claim 1 or 2, wherein the tissue model is produced by using a PVA solution having a higher concentration in the order of yellow scab, muscle layer, and skin layer containing black scab.
The tissue model for pressure ulcer treatment training according to any one of claims 1 to 3, wherein a simulated blood vessel in which simulated blood is enclosed is arranged in the muscle layer.
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| US6241525B1 (en) * | 1999-09-28 | 2001-06-05 | Basf Corporation | Pressure ulcer wound care models, methods and kits |
| JP3184695U (en) * | 2013-04-26 | 2013-07-11 | 株式会社高研 | Soft tissue incision practice model |
| JP2017146413A (en) * | 2016-02-16 | 2017-08-24 | テルモ株式会社 | Biological model |
| US20170345339A1 (en) * | 2016-05-26 | 2017-11-30 | Cari JoAnn Normand | Wound Debridement Model |
| JP2018097180A (en) * | 2016-12-14 | 2018-06-21 | 学校法人自治医科大学 | Debridement simulator |
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| JP6467532B1 (en) | 2018-01-17 | 2019-02-13 | 学校法人近畿大学 | Puncture training model |
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| US6241525B1 (en) * | 1999-09-28 | 2001-06-05 | Basf Corporation | Pressure ulcer wound care models, methods and kits |
| JP3184695U (en) * | 2013-04-26 | 2013-07-11 | 株式会社高研 | Soft tissue incision practice model |
| JP2017146413A (en) * | 2016-02-16 | 2017-08-24 | テルモ株式会社 | Biological model |
| US20170345339A1 (en) * | 2016-05-26 | 2017-11-30 | Cari JoAnn Normand | Wound Debridement Model |
| JP2018097180A (en) * | 2016-12-14 | 2018-06-21 | 学校法人自治医科大学 | Debridement simulator |
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