学会誌 VOL.7 No.3 September 2014
総説
| がん患者に求められる医療コミュニケーションとは ー多角的アプローチ |
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| 高瀬 久光 |
| ［要旨］ がんは身体的にも精神的にも一人ではとても耐えられない病であり，患者との良好なコミュニケーションの確立が，今後のがん治療を大きく左右する．すなわち，事象のみで薬剤選択をとらえ，服薬指導を重視した患者との関係性は十分とはいえず，いまに至った経緯を後ろ向きに検討するスキルが必要である．薬物療法のみならず，心因性も含めた論理的なアプローチができてはじめて，良好なコミュニケーションが可能になる．がん関連のコミュニケーションスキルとして，悪い知らせを患者に伝える SPIKES 理論が存在するが，これは医療コミュニケーションに大切なスキルでもあった．患者心理として，時間的距離感と物理的距離感，肯定的表現の大切さ，説明書の伝え方などを意識する必要がある．事実，福岡大学病院緩和ケアチームの調査によると，身体的苦痛と精神的苦痛には相関関係がなく，疼痛スケールに表出しない要素が含まれる結果となった．薬剤師は，安全性と有効性が常に併存する薬物療法において，医療情報を引き出す糧となるコミュニケーションを通じ，事象に対する検討・検証につなげていくプロファイル作成力を身につけることで，全人的医療の提供に近づくものである． |
| キーワード： コミュニケーション，がん治療，SPIKES 理論，身体的苦痛，精神的苦痛 |
原著論文
| 生理的pH条件下の電荷に基づくオピオイドの分布容積の評価 |
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| 植沢 芳広，加賀谷 肇 |
| ［要旨］ オピオイドの物理化学的特徴と定常状態における分布容積（Vdss）の関係を把握することは，薬物体内動態的情報が不足しているオピオイドを評価するための重要な知見を与える．そこで，Vdss が既知である 26 種類のオピオイドの多様な物理化学的特徴を化学構造に基づいて算定するとともに，Vdss 予測モデルの構築を目的として有意な相関を示す特徴を探索した．その結果，生理的 pH 条件下における電荷が，Vdss に対する最も有意な物理化学的変動要因であることを見出した．この知見は，新薬候補化合物，オピオイドの活性代謝物，違法薬物等の動態情報が未知のオピオイドに対する Vdss の予測に有用であると考えられる． |
| キーワード： オピオイド，薬物体内動態，分布容積，定量的構造動態相関，電荷 |
| Comparison of Anti-Nociceptive and Anti-Inflammatory/Analgesic Effects of Essential Oils in Experimental Animal Models |
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| Naoki CHIBA, Toshihiro AIUCHI, Tsutomu SUZUKI, Tomohisa MORI, Masahiro SHIBASAKI, Yukari KAWAHITO, and Seiji SHIODA |
| Abstract: Previous studies have shown that some essential oils have anti-nociceptive and anti-inflammatory actions; however, the mechanisms underlying how such essential oils exert these actions are not fully understood. In the present study we examined anti-nociceptive and anti-inflammatory properties of essential oils in rats and mice. The anti-nociceptive effects of essential oils on rats were assessed by a Randall Selitto assay. Application of 2% ginger and true lavender essential oils to the hindpaw produced significant anti-nociceptive effects compared to control. Furthermore, stimulatory pressure-induced c-Fos expression in spinal dorsal horn neurons was significantly suppressed by the application of 2% ginger essential oil. As impurities and/or aarroo–matic components may exist in essential oils as a consequence of thermal denaturation, a ginger cell-extract containing non-denatured and purified compounds was tested. In this way, we compared the anti-nociceptive effects of ginger essential oil to those of the ginger cell-extract using a von Frey test after injection of complete Freund＇s adjuvant into the hindpaw of mice. When applied to the paw, both agents induced significant anti-inflammatory and anti-nociceptive effects compared with control; however there was no significant difference between the two agents in terms of their potency. Interestingly, gas chromatography-mass spectrometry experiments indicated that the principal active ingredients of ginger essential oil were different from those of the ginger cell-extract. These results suggest that the constituents of essential oils produce their anti-inflammatory and anti-nociceptive effects transdermally via different mechanisms. |
| Key words： c-Fos, complete Freund＇s adjuvant, Ginger cell-extract, ginger essential oil, von Frey test |
| Irsogladine Maleate Reduces Radiotherapy or Chemoradiotherapy Oral Mucositis in Patients with Head and Neck Cancer |
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| Hisamitsu TAKASE, Koujiro FUTAGAMI, Takayuki SUETA, Hitomi HIGUCHI, Toshifumi SAKATA,Tomoharu AKAI,and Takashi NAKAGAWA |
| Abstract: To investigate the effect of irsogladine on radiotherapy-induced oral mucositis, a prospective rraanndd–omized study of 43 patients (10 female, 33 male) with head and neck cancer was conducted from November 2010 to December 2011. Group A (n ＝21) received irsogladine 4 mg/day during radiotherapy and Group B (n＝ 22) received radiotherapy without irsogladine. Oral Mucositis Weekly Questionnaire─Head and Neck Cancer (OMWQ-HN), Revised Oral Assessment Guide (ROAG), Numeric Rating Scale (NRS) and Common Terminology Criteria for Adverse Events (CTCAE) scores were analyzed by the Mann-Whitney U-test. Quality of life measured by OMWQ-HN gradually declined in both groups. However, the score for Group A was significantly higher than that for Group B at 50 Gy of radiotherapy. A significant increase in ROAG score was observed in both groups, but the score for Group A was significantly lower than that for Group B after 20 Gy. There was no difference in safety score between the two groups as measured by CTCAE ver. 4. In conclusion, it was found that irsogladine reduced oral mucositis lesions associated with radiotherapy in patients with head and neck cancer. |
| Key words： irsogladine, radiotherapy, head and neck cancer, mucositis |