ããžã¿ã«ã©ã€ãç ç©¶äŒ
ãðå»ççšèªã
ãã¯ããããããŸã
仿¥ãçŽ æµãªäžæ¥ã«ãªããŸãããã«
2026幎08æ14æ¥ïŒéïŒ09:45æŽæ°
âãçŸå Žã§ãã䜿ããã å»çã»ä»è· ç¥èªã»å°éçšèªé
ããïŒpdfïŒ
âãå»ççšèªïŒå»åŠçšèªïŒã¯ã人äœã®æ§é ãçŸæ£ãæ²»çãæ€æ»ãå»è¬åãªã©ãå»ççŸå Žã§äœ¿ãããå°éçãªèšèªã®ç·ç§°ã§ããè±èªããã€ãèªãã«ã¿ã«ãã®ç¥èªãå€ããçŸå Žã§ã¯ãAPïŒã¢ããïŒè«åçïŒããããªãïŒæè¡ïŒãã®ããã«ççž®ã»é èªåãããŠäœ¿ãããŸãããããã¯æ£ç¢ºãªæ
å ±ãè¿
éã«å
±æããããã«å¿
é ã§ãã
ãã€ããçè·åŠç
âãå»ççšèªïŒå»åŠçšèªïŒãšã¯ãç
åã人äœã®æ§é ãçç¶ãåŠçœ®ãå»è¬åãªã©ãå»ççŸå Žã§çšããããå°éçãªèšèã®ç·ç§°ã§ããæ£ç¢ºãã€è¿
éãªæ
å ±äŒéã®ããã«äœ¿çšãããŸãããäžè¬ã«ã¯èãæ
£ããªã倿¥èªïŒãã€ãèªãè±èªïŒãç¥èªãå€ãå«ãŸããåŸåããããŸããå»ççšèªã®ç¹åŸŽå»ççšèªã¯å€§ãã以äžã®èŠçŽ ã«åé¡ãããŸããæ¥æ¬èªïŒæŒ¢èªïŒ: ãå¿çæ¢å¡ããè³åäžããæªæ§è
«çããªã©ã挢åã§æ§æãããå°éçšèªã倿¥èª: ãã€ãèªç±æ¥ã®ãã®ïŒã«ã«ããã¯ã©ã³ã±ãã¡ãããªã©ïŒãšãè±èªç±æ¥ã®ãã®ïŒã€ã³ãã©ãŒã ãã³ã³ã»ã³ãããªãŒããªã³ã°ã·ã¹ãã ãªã©ïŒãæ··åšããŠããŸããç¥èª: æ¥åã®å¹çåã®ãããã¢ã«ãã¡ããããçä»®åã®ç¥èªãå€çšãããŸãïŒäŸïŒAMIïŒæ¥æ§å¿çæ¢å¡ãICïŒã€ã³ãã©ãŒã ãã³ã³ã»ã³ãïŒãäžè¬åã«åããåãçµã¿å°éçšèªã¯å»çåŸäºè
éã®èª€è§£ãé²ãã¡ãªãããããäžæ¹ã§ãæ£è
ããã®å®¶æã«ãšã£ãŠã¯åããã«ãããšãã課é¡ããããŸãããã®ãããè¿å¹Žã§ã¯å»åž«ããæ£è
ãžåãããããèšèã§èª¬æãããã€ã³ãã©ãŒã ãã»ã³ã³ã»ã³ãïŒèª¬æãšåæïŒãã®éèŠæ§ãé«ãŸã£ãŠããŸããåçåŽåçãªã©ã®å
¬çæ©é¢ãç ç©¶æ©é¢ã§ã¯ãé£è§£ãªå°éçšèªãäžè¬ã®äººåãã«åããããã解説ããçšèªéãªã©ãå
¬éãããŠããŸããåçåŽåçïŒå»çæ
å ±ãããçšèªè§£èª¬åœç«åœèªç ç©¶æïŒå»åŠã»å»çã®å°éçšèªã«ã€ããŠ
ããAI ã«ããæŠèŠïŒ20260406æïŒ
å»ççšèªã®äž»ãªäŸãšçš®é¡
å»çã»ä»è·çŸå Žã§ãã䜿ãããçšèªã¯ä»¥äžã®ããã«åé¡ãããŸãã
沌ç°å©æ ¹å»åž«äŒ
ç¥èªã»é èªïŒçŸå Žã§å€çšïŒ
OP / ãªã: æè¡ (Operation)
AP / ã¢ãã: è«åç (Appendicitis)
ã«ã: ã«ããŒãã«æ€æ»ã»æ²»ç (Catheter)
Dr / ãã¯ã¿ãŒ: å»åž«
Ns / ããŒã¹: çè·åž«
ãã«ã³: å°¿ïŒãã€ãèªã®HarnïŒ
ãã€ãªãã·ãŒ: çæ€ïŒçµç¹æ€æ»ïŒ
çŸæ£ã»ç
å
ãšã / ãšãã: ãŠãããïŒEpilepsyïŒ
ãã€ããŒãã³ã·ã§ã³: é«è¡å§
è³åäž: ã¢ããã¬ãã·ãŒïŒã¢ããïŒ
åŠçœ®ã»æ²»ç
æé€ïŒã°ã£ããïŒ: æè¡åŸã®ããããã¹ïŒéïŒãæãããš
é æïŒãšãã·ãïŒ: çç¶ãåºãæã«è¬ã飲ãããš
æ¿ç®¡ïŒããããïŒ: 管ãå
¥ããããš
沌ç°å©æ ¹å»åž«äŒ
å»ççšèªã®é¡èªã»é¢é£çšèª
å»åŠçšèªïŒããåŠè¡çã»æ£åŒãªåŒç§°
å»çå°éçšèªïŒæè¡çãªè©³çްã衚ãçšèª
å»ççŸå Žã®é èªïŒäž»ã«ã¹ã¿ããéã ãã§éããç¥èªïŒäŸïŒã¢ããããšããïŒ
ã³ã¡ãã£ã«ã«ïŒå»åž«ä»¥å€ã®å»çåŸäºè
ïŒçè·åž«ãæåž«ãã»ã©ãã¹ããªã©ïŒ
沌ç°å©æ ¹å»åž«äŒ
å¹ççãªèŠãæ¹
å»ççšèªã¯ãè³ã§èããæŒ¢åãè±èªïŒã¹ãã«ïŒãç®ã§èŠãŠãå®éã«æžãããšã§å®ççãäžãããŸãããŸããç¥èªã ãã§ãªãæ£åŒåç§°ãšã»ããã§èŠããã®ãéåã§ãã
ãAI ã«ããæŠèŠïŒ20260406æïŒ
âããçŸå Žã§ãã䜿ãããŠããç åã®ç¥èªäžèЧã¬ãŸããšãå»çã»ä»è·é£æºçžè«å®€ïŒ20260719æ¥ïŒ
ç¥ èª ç å ç¥ èª ç å A AAA è ¹éšå€§åèç€ HCC èèãã AF å¿æ¿ç²å HCV CåèçãŠã€ã«ã¹ Af å¿æ¿çްå HD è¡æ¶²éæ AD ã¢ã«ããã€ããŒåèªç¥ç hemiplegia ç麻çºïŒãžãïŒ AKI æ¥æ§è äžå š HT é«è¡å§(ãã€ããŒããŒã·ã§ã³) AMI æ¥æ§å¿çæ¢å¡ HT è³è «ç amputation åè¢åæïŒã¢ã³ãã¿ïŒ hypervenntilation éææ°çå矀 ALS çèçž®æ§åŽçŽ¢ç¡¬åç(ã¢ããã) I Ireus(ã€ã¬ãŠã¹) è žéå¡ apolexy (ã¢ã) è³åäž L LC èºãã AS 倧åèåŒççªç M MCI 軜床èªç¥é害 ASO é塿§åè硬åç ML æªæ§ãªã³ãè « AR 倧åèåŒééäžå š MS å§æ¿åŒççªç B BPH åç«è ºè¥å€§ç MS å€çºæ§ç¡¬åç BC ä¹³ãã MR å§åžœåŒééäžå šç C ca ç(ãã£ã³ãµãŒãã«ã«ããã¯ã¬ãã¹) O OA å€åœ¢æ§é¢ç¯ç CHF ãã£è¡æ§å¿äžå š OCI è³æ¢å¡ CHP(HCM) å¿äžå š P PVCïŒVPC å¿å®€æ§æå€åçž® CKD æ ¢æ§è èç PAC å¿æ¿æ§æå€åçž® COPD æ ¢æ§é塿§èºçŸæ£ polyp æèæ§ã®è «ç CPA å¿èºåæ¢ç¶æ primary åçºå·£ CRF æ ¢æ§è äžå š R RA æ ¢æ§é¢ç¯ãªãŠãã CSDH æ ¢æ§ç¡¬èäžè¡è « RF ãªãŠããç± D DAA è§£é¢æ§å€§åèç€ S S çµ±å倱調ç DIC æç𮿧è¡ç®¡å ååºçå矀 SAH(ã¶ãŒ) ããèäžåºè¡ DG åäºæè žæœ°ç SAS ç¡ç æç¡åŒåžçå矀 DM ç³å°¿ç SB æ°ç®¡æ¯ç DOA å°çææ»äº¡ SSS(ã¹ãªãŒãšã¹) æŽäžå šçå矀 DYS ç¥çµå æ§èè± T TAA èžéšå€§åèç€ Dx è±èŒ TB(ããŒãâ) çµæ ž DLB ã¬ããŒå°äœåèªç¥ç TIA äžéæ§è³èè¡çºäœ dmentia èªç¥ç U UTI å°¿è·¯ææç F FTD åé åŽé åèªç¥ç V VD è¡ç®¡æ§èªç¥ç Fx 骚æ G GFRD èãã ãã®ä» meta(ã¡ã¿) 転移 GU èæœ°ç H HAV AåèçãŠã€ã«ã¹ HBV BåèçãŠã€ã«ã¹ ïŒïŒã«ã«ããçè·èšé²çã«ããèšèŒãããŠããçç¶ç å é¡ çš èª è§£ äžè¬ç¶æ VSã»TPR ïŒãã€ã¿ã«ãµã€ã³ïŒ 説 çåœã®å åãèæã»å¿æã»åŒåžã»äœæž©ã»è¡å§ã»æèãªã©ãå«ãŸãããé©åãªæ²»çãçè·æ³ã決å®ããŠå®æœããäžã§éèŠãªåºç€ããŒã¿ãšãªãã BTã»KTïŒäœæž©ïŒ äœå ã®çååŠåå¿ã«ãã£ãŠçºçããç±ãšäœå€ãžæŸåºãããç±ãšã®é¢ä¿ã§æ±ºãŸãäœã®æž©åºŠãæ£åžž(æäºº)ã¯è çª©äœæž©ã§36ïœ37â BPïŒè¡å§ïŒ RïŒåŒåžïŒ æ£åžžïŒæäººïŒæé«è¡å§130mmHgæªæºãæäœè¡å§85mmHg æ¯ãåžã£ããåãããããããšãæ£åžžåŒåž(æäºº)ïŒåé12ïœ20å PïŒèæïŒ å¿èãèŠåçã«åçž®ããŠè¡æ¶²ãæŒãåºããããã³ã«äœè¡šè¿ããèµ°ãåèã«äŒããåšæçãªæåãæ£åžžèæ(æäºº)ïŒåé60ïœ90çšåºŠ HRïŒå¿ææ°ïŒ äžå®ã®æéå ã«å¿èãæåããåæ°ãéåžž1åéã®åæ°ãããã æ£åžžå€60ïœ90 æè é ãã¯ã£ããããŠããŠãèªåèªèº«ãå€çã®ããšãããã£ãŠããç¶æ æèæž æ ïŒã¬ãã«ã¯ãªã¢ïŒ è³ã» ç¥çµç³» èŠéããŠããç¶æ ã§ãããã«èªåèªèº«ãšåšã(åšå²ã»å€ç)ãèªèã§ããŠããããšã æèæ··æ¿ ãšã(epilepsy) æèã®æž æåºŠã®äœäžã§ã泚æã»èšéã»èŠåœèãé害ãããç¶æ ã è±èªã§ããŠãããããæå³ããã æèå°é£ 泚æãæ£æŒ«ãšãªããèªçºæ§ããªããŠäºè§£ãããæªãã åŸç åšå²ããã®åºæ¿ãããã°èŠéããããããããšããšããŠãæèãæ··æ¿ããç¶æ åç (ãã¿ã) ã¯ã£ãããšèŠããªããã匷ãåºæ¿ã«åå¿ãããäŒè©±ã¯ã§ããªãç¶æ ã æç¡ïŒã³ãŒãïŒ åºæ¿ã«ã¯å šãåå¿ãããç³ååå°ãè ±åå°ãæ¶å€±ããç¶æ ã JCS (ãžã£ãã³ã» ã³ãŒãã»ã¹ã±ãŒã«) 3ã»ïŒã»ïŒåºŠæ¹åŒãšãåŒã¶ãè³è¡ç®¡é害ãé éšå€å·ã®æ¥æ§æã«ããæèé害æ£è ã®æèã¬ãã«ãç¹ã«è³ãã«ãã¢ã®é²è¡ãç¥ãããšã«é·ããŠããã ãèŠéãã軞ã«ã誰ããåãããã«è©äŸ¡ã§ããããšãç®çã«éçºãããææš GCS (ã°ã©ã¹ãŽãŒ ã³ãŒãã»ã¹ã±ãŒã«ïŒ JCS ãšåãããæèã¬ãã«ã®è©äŸ¡ææšã§ãäžççã«åºã䜿çšãããäžçæšæºãšãªã£ãŠããã䜿çšãã蚺çç§ãææ¥ç§ãè³ç¥çµå€ç§ãªã©äžéšã®èšºçç§ã§ããããšãå€ã çæ£(ãããã) ã²ãã€ãã®ããã«ãäžæçãŸãã¯æ¥ãªè³ã®éå°è奮ã«ãã£ãŠãããäžéæçãªçºäœæ§éåçŸè±¡ã èŠåœèé害 å Žæãæéãããããç¶æ³çãããããªããªãããšã 髿¬¡è³æ©èœé害 è³è¡ç®¡çŸæ£ããè³å€å·çã«ããç¥èŠãèšæ¶ãåŠç¿ãæèãå€æãææ ãªã©ã®èªç¥æ©èœã«é害ãèµ·ããç¶æ ã å€±è¡ å€±èª¿ãäžéæéåãçç·åŒµç°åžžãªã©ã®éåé害ãæèŠé害ããªããè¡ãã¹ãåäœãŸãã¯è¡çºãååäºè§£ããŠããã®ã«ã§ããªãç¶æ ã å€±èª èŽèŠé害ãéåé害ãããã³äžè¬çãªç¥èœã»ç²Ÿç¥é害ããªãã®ã«ãè³ã®ç å·£ã«ãããèšèªã®çè§£ã衚åºãé害ããããã®ã å€±èª ä»¥åããçç¥ããŠããã¯ãã®ç©ã人ãèªèããèœåããå šé¢çãããã¯éšåçã«åªå€±ããŠããŸãããšã ååŽç©ºéç¡èŠ æå·ãã倧è³ã®éšäœãšå察åŽã®åºæ¿ã«åå¿ãããæ³šèŠãã空éã®ååŽã«æ³šæãåãããã§ããªãèªèé害ã®çç¶ã éè¡æ©èœé害 髿¬¡è³æ©èœé害ã®1ã€ãèªçºçã«ç©äºãå§ããããšãã§ããªãã 4 å é¡ çš èª è§£ 説 ç³åäžå ïŒã¢ããœã³ãªãŒïŒ è³ã» ç¥çµç³» ç æ°çã«ãããå·Šå³ã®ç³åã®å€§ãããç°ãªãç¶æ ãæ£åžžãªäººã«èŠãããããšãããã åç² è¡ç®¡æ£çž® ïŒã¹ããºã ïŒ çµæ»ã»çµä»£ èŠéã®ååãæ°Žå¹³ãŸãã¯åçŽæ¹åã«æ¬ ããŠèŠããªããªãç¶æ ã è¡ç®¡ã®ç·åŒµã亢é²ããŠãçæ£æ§ã®åçž®ãèµ·ãããèåšãçµç¹ã®è¡æµãäœäžãèè¡çç¶ãèµ·ããã è¡æ¶²ã» 埪ç°åšç³» å¿èã®æå€åçž®ã«ãããèæã®ãªãºã ãä¹±ããèææž¬å®ããéã«èãéåãã(ãŸãã¯èãé£ã¶)ããšã è¡æ¶²ïŒãã©ããïŒ å šèº«ã®çµç¹ãèåšã®äžã«ç¶²ã®ç®ã®ããã«åŒµãå·¡ããããŠããè¡ç®¡ã®äžãæµããèµ€ãæ¶²äœã è¡å¡ïŒã³ã¢ã°ã©ïŒ è¡æ¶²ãåºãŸã£ããã® è¡æ 塿 è¡ç®¡å ã§ãè¡æ¶²æåãåºãŸã£ãŠãè¡ç®¡å ãéå¡ããããšã è¡ç®¡ããå¥ãããè¡æ ã®äžéšãè¡ç®¡å€ããäŸµå ¥ããç°ç©(空æ°ã»èèªç)ãè¡ç®¡ãéå¡ãããããšã åŸè æœè¡ éåžž1åéã«50æªæºã®å¿ææ°ã®ããšã å°¿ã䟿ã«åŸ®éã®è¡æ¶²ãæ··ãã£ãŠããç¶æ ã®ããšã çºäœïŒã¢ã¿ãã¯ïŒ æç ç¹æã®çç¶ãŸãã¯æ¿ããçç¶ãæ¥æ¿ã«èµ·ããããšã é »è æº¶è¡ å¿ææ°ã1åéã«100以äžã®ç¶æ ã èµ€è¡çã®èãç ŽããŠãäžã®ãã¢ã°ããã³ãæµåºããçŸè±¡ã ãã£è¡ éèã®è¡æ¶²åŸªç°ãé害ãããè¡æµãåæ»ããããšã éèç€ïŒããªãã¯ã¹ïŒ éèã®äžéšãäœããã®èŠå ã§èããªãããã®è¡ç®¡ãèšããããšã§çºçããã æ¥æ§åŸªç°äžå š ïŒã·ã§ãã¯ïŒ æ¥ã«å šèº«ã®æ«æ¢¢åŸªç°ãé害ãããããšãçåœãç¶æããã«ã¯è¡å§ãäœããããåœã«ä¿ããç¶æ ã è²§è¡ïŒã¢ãããŒïŒ äžå®éã®è¡æ¶²ã®é žçŽ éæ¬ç©è³ªã®æ¿åºŠãäœäžããç¶æ ã§ã埮ç±ã»æç²åŽæã»é çãåæžã»æ¯åããèµ·ããã ãã¢ããŒãŒ èºãããã¯å¿èã®æ©èœäžå šã«ãã埪ç°é害ã«ãããçŒã»åã»æè¶³ã®çªçãç®èã玫èè²ãŸãã¯æéè²ã«ãªãããšã èè¡ å±ææ§è²§è¡ãçµç¹ãèåšãžã®åèè¡ã®æµå ¥ãé žçŽ äŸçµŠãæžå°ãããã¯éçµ¶ããç¶æ ã 壿»(ãã¯ããŒã·ã¹ïŒ ç æ°ãå·ã«ããã现èãçµç¹ãèŽåœçãªæå·ãåããŠå±æçã«æ»ã¬ããšã å£çœã»è±çœ è¡æ¶²äŸçµŠããªããªããçµç¹ã壿»ãããšããã«çŽ°èææãè æããŠããããšã DICïŒæçš®æ§è¡ç®¡å ååºçåçŸ€ïŒ é節ãªçŸæ£ãåŒãéãšãªããå šèº«ã®è¡ç®¡å ã§è¡æ¶²ååºåå¿ãèµ·ãã£ãŠè¡æ ãã§ãããããèåšäžå šãåºè¡äžè¡ãåŒãèµ·ããã è±æ°Ž äœå ã®æ°Žåãåªå€±ãããæã«é»è§£è³ªãåªå€±ãã壿žãçºç±ãçæ£ãæç¡ãªã©ã®çç¶ãèµ·ããã æµ®è «ïŒãšããŒãïŒ ç®äžã«çµç¹éæ¶²ã貯çããããšã ãã«ã㢠èåšã®äžéšãŸãã¯å šéšãééãè£ãç®ãéããŠç°åžžãªäœçœ®ã«è±åºããããšã (è³ã»æ€éæ¿ã»ãœã±ã€éšçã«çºçãã) çºç±ïŒãã£ãŒããŒïŒ ç æ°ãåå ã§ãäœæž©ã平垞ããäžæããå Žå(37â以äž)ãããã æªå¯ åŒåžåšç³» ãããã³ã° ããããææåæãéæ¿ãªçºç±åæã«ããã¿ãããäžå¿«ãªãããã æ°ç®¡ã«ãã¥ãŒã¬çã®åºæ¿ã人工åŒåžåšãšã®åŒåžãªãºã ãåãããæ£è ã®å³åœåå°ãèªçºããŠãå³ã蟌ãã ç¶æ ã 5 åé¡ çš èª è§£ 説 åŒåžåšç³» ãã¡ã€ãã£ã³ã° æ£è ã®åŒåžãšäººå·¥åŒåžåšã®è£å©ãåŒ·å¶ææ°ãåããªãããšã å³åœïŒããããïŒ å³ãèºã»æ°ç®¡æ¯ã»æ°ç®¡ããã®ç°ç©ã»åºæ¿ç©ã»åæ³ç©ãæé€ã§ããªãå Žåã®é²åŸ¡åå¿ã®ããšã åéïŒãã€ãããïŒ ããã£ãããæšªéèã®çæ£ã«ãã£ãŠçããçç¶ã èžæ°Ž èžèå ã«è²¯çããæ¶²ãéåžžã¯å°éãèžèã®è¡šé¢ã最ããŠããããèžèçã»èºããã»è硬å€ãªã©ã®éã«ã¯å¢å ããã è¡ç° ç°ã«å°éã®è¡ãæ··ãã£ãŠãããã®ã å»åïŒããããïŒ èŠãããã«ãªãããšã åè¡ïŒãã£ãã€ïŒ å³ãšãšãã«æ°éãŸãã¯èºããåãåºãããé®®çŽ è¡ã®å€§éåºè¡ã®ããšã å鳎ïŒããããïŒ æ°ç®¡æ¯åæ¯çã§ãåŒåžæã«ããŒãŒãŒãŒãããã¥ãŒãã¥ãŒããšãããããªç¶æ å声ïŒãããïŒ ãããã声ã声垯ã«ç å€ããããããçºå£°ãç°åžžãªç¶æ ã æ¶ååšç³» ã°ã«é³ åæ° æ¶åããŠãããšãã«ãè žãåããŠçºçããé³ã ã¯ãã åå äžè¡ èã®å 容ç©ãåãåºãããšããŸãã¯çç¶ã®ããšã çŸæ£ã«ããæ¶å管å ã«åºãè¡æ¶²ãèéããåºãããšã çæ§é²åŸ¡(ããã§ã³ã¹ïŒ è¡äŸ¿ è ¹è å ã«äœããã®æ¥æ§ççãèµ·ãããšãåå°çã«ãã®éšåã®è ¹å£ãåºããªã è¡æ¶²ã®æ··ãã£ã倧䟿ã åè¡ è ¹æ°Ž é£éã»èãåäºæè žãªã©ããåºè¡ãããšãã«ããã®è¡æ¶²ãåãããšã è ¹èã®ççãèèã»å¿èã»è èã®çŸæ£ãªã©ã«ããè ¹è å ã«ããŸã£ãæ¶²äœã æ³å°¿åšç³» å€±çŠ å°¿é å°äŸ¿ã»å€§äŸ¿ã»æ¶çãèªåã®ææã«ãããææ³ããŠããŸãããšã èè±å ã«æºãŸã£ãå°¿ãäžæãææ³ã§ããªãç¶æ ã ç¡å°¿ ä¹å°¿ äžæ¥ã®å°¿éã100ml以äžã§èè±ã«å°¿ãããŸããªãç¶æ ã äžæ¥å°¿éã400ml以äžã§ãææ³ããå°¿ãèããå°ãªãç¶æ ã è¿å°¿ è¡å°¿ çœè¡çã®æ··ãã£ãå°¿ãå°¿è·¯ã«ççã®ããå Žåã«ã¿ãããã è èã»èè±ã»å°¿éã®ããããã®éšäœããã®åºè¡ã«ãããå°¿ã«è¡æ¶²ãæ··ãã£ãŠæ¿ãããšã é »å°¿ å€å°¿ æå°¿åæ°ã®ç°åžžãªå¢å ããããçŸæ£ãŸãã¯ç¶æ ã äžæ¥ã®å°¿éã 3000ml ãè¶ ãããã®ãå€éã®æ¶²äœæåãç¥çµè奮ã»èçž®è ã»ç³å°¿ç ã»å°¿åŽ©çãªã©ãåå ã ç¥çµç³» ããŒãã³ãœããºã æ¯æŠãç匷åãåäœç·©æ ¢ãå§¿å¢åå°ãªã©ã®ããŒãã³ãœã³ç é¡äŒŒã®çåãåããç æ ãæãã 仮颿§é¡è² ããŒãã³ãœã³çå矀ã®ïŒå€§çåã®äžã€ãç¡è¡šæ ãšãªããç¬ããå°ãªããäžç¹ãèŠã€ãããããªé¡ã€ããç¹åŸŽã äžéæéå æ¯æŠ é«è¡ç³ ææã®åºã¥ããªãäžåçãªéåã®ããšã ææãšã¯ç¡é¢ä¿ã«ãçèã®åçž®ãåŒç·©ãç¹°ãè¿ãããå Žåã«èµ·ããããªãºãã«ã«ãªæ¯åéåã§ããã çŒçïŒãã€ã³ïŒ ããããçãããšããããã å åæ³ã»ä»£è¬ç³» è¡æ¶²äžã®ãããŠç³ã®æ¿åºŠãã€ãŸãè¡ç³å€ãé«ãç¶æ ãæããé£åŸ 2æéã®è¡ç³å€ã140mg/dL以äžãšãªãç¶æ ãé£åŸé«è¡ç³ãšããã 6 åé¡ çš èª è§£ 説 äœè¡ç³ å åæ³ã» ä»£è¬ç³» åæ è¡æ¶²äžã®ç³åïŒãããŠç³ïŒãå°ãªããªããããŠå·ãæ±ãæèã倱ã£ãããæè¶³ãåããã«ãããªã£ããããç¶æ ãäœè¡ç³ã¯ç³å°¿ç ã®æ²»çè¬ã®å¯äœçšãšããŠèµ·ããããšãå€ã ã ãŒã³ãã§ã€ã¹ æºææ§é¡è²ãã¹ããã€ã䜿çšã«ããå¯äœçšã§ãäœéå¢å ãšãšãã«é¡ããŸãäžžã«ãªãçç¶ã 骚㻠é¢ç¯ç³» 倿 åãåäœã®ããšã äœã®å€åŽã«ã²ããåäœãè¡é¢ç¯çã å æ å€è»¢ äœã®å åŽã«ã²ããåäœãè¡é¢ç¯çã åè¢ãäœæ£äžç·ããé ããããããªé¢ç¯åäœã å 転 屿² åè¢ãäœæ£äžç·ããè¿ã¥ãããã«å æ¹ã«åããé¢ç¯åäœã é¢ç¯ãæ²ããããšã äŒžå± åŸå± é¢ç¯ã䌞ã°ãããšã äœãåŸãã«æ²ããããšã åå± åŽå± äœãåã«æ²ããããšã äœãæšªã«æ²ããããšã èå± æå± æéŠã®éåã§æèåŽã«æ²ããããšã æéŠã®éåã§ææåŽã«æ²ããããšã ROM ïŒé¢ç¯å¯ååïŒ èº«äœã®åé¢ç¯ãé害ãªã©èµ·ããªãã§çççã«éåããããšãã§ããç¯å²ïŒè§åºŠïŒã®ããšã è¯è¢äœ é¢ç¯æçž®ããããããã®äœçœ®ã§åããªããªã£ãŠãæ¥åžžçæŽ»ã«æãæ¯éããªãæè¶³ã®äœçœ®ã æçž® å åå°è¶³ é¢ç¯åãããªãããã«ã次第ã«é¢ç¯ã®åãç¯å²ãçããªã£ãç¶æ ã®ããšã è¶³é¢ç¯ãããªãã¡è¶³éŠããã³ãšäŒžã³ãŠãè¶³ã®åºãå åŽãåãã麻çºã®ããè¶³ã®ç¹æã®æçž®ã®ç¶æ ã åŒ·çŽ åºçž®ã»åŒ·å ãããããã°ãããšã 身äœã®çèãæç¶çã«åŒ·ãããã°ãããšã 鿬 æ§è·è¡ïŒãããã€ããã¯ããïŒ æ©è¡æã«ãµããã¯ããªã©ã®äžè¢ã®çèã«çã¿ããã³ããåºçŸãæ©ãç¶ããããªãç¶æ ãäžå®æéäŒããšå埩ããã ååãæ©è¡ éº»çºåŽã®è¶³ãåãžæ¯ãåºãæã«ãã€ãŸå ãåºé¢ã«åœãããªãããã«ãå€åŽã«å€§åããããæ©è¡ã ã¿ã³ãã æ©è¡ ã€ãããæ©è¡ãçè¶³ã®ã€ãŸå ãšèžµãã€ãªããããã«äº€äºã«è¶³ãåºããŠæ©è¡ããåäœã1 æ¬ã®ç·äžã亀äºã«è¶³ãåºããŠæ©ãåäœã§ããã綱枡ãã®ãããªã€ã¡ãŒãž 粟ç¥ç³» å¹»èŠã»å¹»èŽ çŸå®ã«ãªã人ãç©ãèŠãããããŸãäŒè©±ãèãããããããçµ±å倱調çãèªç¥çã®çš®é¡ã®ãªãã§ããã¬ããŒå°äœåèªç¥çã§ã¯å¹»èŠã衚ããããçç¶ åŠæ³ æ ¹æ ããªããããããšæ³åããããšãäºå®ã§ãªãããšãæ ¹æ ã®èãããšã匷åºã«ç¢ºä¿¡ããŠãããã©ããªææ®µã以ãŠããŠãèšæ£ã§ããªãç¶æ ã ããåŠ æèæ··æ¿ã«å ããŠãå¹»èŠãé¯èŠãèŠããããããªç¶æ ãæãå¿ããŠæå³äžæãªããšãèšãåºãããšã æã〠æ°åãæ²ãã§æŽããªãããšã çŠç¥(ããããã) ã€ã©ã€ã©ããããããããããã¯ãããããããã粟ç¥ç¶æ ã 7 åé¡ çš èª è§£ 粟ç¥ç³» äžç© 説 èœã¡çãã®ãªãããšããŸããåšå²ãžã®èŠæå¿ã匷ããè奮ããã倧ããªå£°ã§å«ãã ããæŽåãæ¯ãã£ããããããç¶æ ã BPSD(åšèŸºçç¶) äžå®ã»æãã€ã»åŸåŸã»å€±çŠã»ãã䟿ããåŠã»åŠæ³ã»åž°å® 顿ã»ä»è·æåŠãªã© èªç¥çã®äžæ žçç¶ã«ãåšå²ã®ç°å¢ã察å¿ãæ§æ Œãªã©ã圱é¿ããŠèµ·ããè¡åãå¿ççç¶ãäžæ žçç¶ã«å¯ŸããŠäºæ¬¡çã«èµ·ãããšããé¢ãããåšèŸºçç¶ãšãåŒã°ãããæŽ»åæ§äº¢é²ïŒäžæ žçç¶é¢é£ã®çç¶ã»è¡åïŒã粟ç¥çç¶ïŒç²Ÿç¥ç æ§çç¶ïŒææ é害ïŒè¡åã³ã³ãããŒã«ã®é害ïŒã¢ãã·ãŒïŒå¯Ÿäººé¢ä¿ã®é害ïŒã® 4ã€ã®ã«ããŽãªãŒã«åé¡ãããã äžæ žçç¶ è³ã®çްèãå£ãããã®åœ¹å²ã倱ãããããšã§èµ·ããçç¶ãå ·äœçãªçç¶ã¯ã以äžã®6ã€ã§ãèšæ¶é害ãçè§£ã»å€æåã®é害ã倱èªã»å€±è¡ã»å€±èªãèŠåœèé害ãå®è¡æ©èœé害ããã ç®èã» åµå·ç³» ç±å·ïŒããŒã³ïŒ ããã©ãããã©ã®æ·±ãã¯å€§ããåãããšâ 床(çŽ æ)⠡床(氎泡)⠢床ã®ïŒæ®µéã«åé¡ãããã⠢床ã«ãªããšç®èã«è¡ã®æ°ããªããªãè ã®ããã«çœããªã£ãããçã§åå·ããå Žåã«ã¯çã®ããã«é»ããªã£ããããã æ«åµ æŠéå· ç©ã«ã¶ã€ãããããŠç®äžçµç¹ãšç®èã®è¡šé¢ã«å·å£ãããå Žåã®æªæã®ããšã æŠãå·ããããå· æŒ¿æ¶² äžè¬çã«èãé»è²éæãªçš®ã ã®äœæ¶²ã®ããšã è¿ïŒã¢ã€ãã«ïŒ ãã¿ãççéšãåè¿ããŠçããé»çœè²ãŸãã¯é»ç·è²ã®äžéæãªç²æ¶²ã 滲åº(ãããã ã€) æ¶²äœãå€ã«ã«ãã¿åºãŠããããšã æŒåºæ§(ãããã ã€) æŒããŠåºãããšã æ°Žç± æ°Žã¶ãããéèµ·ããæ¶²äœã®è©°ãŸã£ãæ°æ³¡ã§èŠãããç®èã®éšåã 耥ç¡(ããããã) æ¥æ¬è€¥ç¡åŠäŒã§ã¯ã身äœã«å ãã£ãå€åã¯éªšãšç®è衚局ã®éã®è»éšçµç¹ã®è¡æµãäœäžããããã¯åæ¢ãããããã®ç¶æ³ãäžå®æéæç¶ããããšçµç¹ã¯äžå¯éçãªé»è¡æ§é害ã«é¥ã耥ç¡ãšãªãããšå®çŸ©ãããŠããã 耥ç¡ãã±ãã ç®èæ¬ æéšãããåºãåµè ã§ããç®äžã«æãã®ã»ãæ·±ãåºãã£ãŠããå Žåããã ã¹ãã³ã㢠ãããæµã«è¶³ãã¶ã€ãããããŒããå¥ãããªã©ã®ç©ççãªå€åã«ãã£ãŠèµ·ããç®èè£å· å»çæ©åšé¢é£å§è¿«åµå·ïŒMDRPUïŒ 2023 幎ã«å»çé¢é£æ©åšè€¥ç¡ã«åç§°ã倿Žã耥ç¡ã«é žçŽ ãã¹ã¯ãçµéŒ»ã«ããŒãã«ã®ããã¹ããã«ã¹ãªãã·ã¡ãŒã¿ãŒçã®å»çæ©åšã«ãã£ãŠãããå§è¿«åµå·ã è窩ç¹ç (ã»ãããããã) é«éœ¢è ã«å€ããç®èã®ææçã§ç®èã®è «ããèµ€ã¿ãšå ±ã«ç±ãåºããªã©ã®çç¶ããããæŸã£ãŠãããšéçåããããšããããèè¡çã壿»æ§çèçãªã©ãããæè¡çãšãªãããšãããã ïŒïŒããè¡ãããŠããæ€æ»çšèª æ€ æ» çš èª è§£ Alb(è¡æž ã¢ã«ããã³) 説 è¡æž äžã®ã¿ã³ãã¯è³ªã®äžçš®ã§ãè¡æ¶²ãè¡ç®¡å ã«ä¿æããåããããŠãããè¡äžæ¿åºŠãäœäžãããšäœæ é€ãèé害ãããããŒãŒçå矀ãèæ ®ããããæ£åžžå€3.8~5.2g/dl AL-P 骚ãèèãªã©ã«å€ãå«ãŸããé µçŽ ã§èã®ãã»è管ã®é害ã§äžæãããæ£åžžå€100~325IU/l 8 æ€ æ» çš èª è§£ AMIïŒã¢ãã©ãŒãŒïŒ 説 èµèãèµæ¶²è ºããåæ³ãããé µçŽ ã§ãèµçãè³äžè ºçãªã©ã®éã«äžæãããæ£åžžå€ è¡æž 55~175mu/ml å°¿30~950mu/ml AST(GOTïŒ/ALT(GPT) AST ã¯è现èãšå¿çãéªšæ Œçã«å€ãå«ãŸããé µçŽ ã§ãALT ã¯èèã®ã¿ã«å€ãå«ãŸããé µçŽ ãã©ã¡ããèèã«é害ããããšè¡æ¶²äžã«æŒãåºãŠãããããå€ãäžæãããåºæºå€ASTïŒ30U/Lä»¥äž ALTïŒ30U/Lä»¥äž BFSïŒããã³ã³ã»æ°ç®¡å èŠé¡æ€æ»ïŒ æ°ç®¡ãæ°ç®¡æ¯ã®äžã«æ°ç®¡æ¯é¡ãæ¿å ¥ããŠãå è ã芳å¯ããããçµç¹ã现èãåæ³ç©ãªã©ã®æ€äœãæ¡åããæ€æ»ã BMDïŒéªšå¯åºŠïŒ ã«ã«ã·ãŠã ããã°ãã·ãŠã ãªã©ã®ããã©ã«ã®éã骚ã«ã©ããããå«ãŸããŠãããæ³å®ããæ€æ»ãæ£åžž80ïŒ ä»¥äž BMIïŒããã£ãã¹ææ°ïŒ è¥æºåºŠãè¡šãææšã ãµã€ã(BMI-18.5 以äž25æªæº)è¥æº(BMI-30以äž)ãã(BMI-18.5æªæº) èšç®åŒBMIïŒäœékg÷(身é·m)2 驿£äœéïŒ(身é·m)2Ã22 BSïŒéæãŸãã¯é£åŸè¡ç³ïŒ è¡ç³å€ã¯é£äºãªã©ã«ããå€åããããå€åæã¯äžå®ç¯å²ã«æ¢ãŸããé£åŸã§ãã£ãŠã140mg/dlã¯è¶ ããªããæ£åžžå€70~139mg/dl BUNïŒå°¿çŽ çªçŽ ïŒ BSã»GLUïŒè¡ç³ã»ã°ã«ã³ãŒã¹ïŒ è¡æ¶²äžã®ãããŠç³ã®ããšãé£åé£åŸãéããŠ70~140mg/dlã®ç¯å²ã§ä¿ãããŠããã è èã®æ©èœãäœäžãããšææ³ãååãããå€ãäžæãããå€ãé«å€ã«ãªããšãå°¿æ¯çãåŒãèµ·ãããæ£åžžå€8~23mg/dl BWïŒäœéïŒ BXïŒãã€ãªãã·ãŒã»çæ€ïŒ 宿çã«å®æœããŠãé£äºçæ³ãããŸããã£ãŠãããã®å€æã«åœ¹ç«ã€ã çäœçµç¹èšºæã声垯ã®çµç¹ãèåšã®äžéšãæ¡åããŠç æ°ã蚺æããæ€æ» CA19-9 æ¶ååšããã®è «çããŒã«ãŒãšããŠåºãçšããããŠãããç¹ã«ããèããã®èšºæã«åœ¹ç«ã€ãåºæºå€37U/mlä»¥äž CEA è «çããŒã«ãŒã® 1 ã€ã现èçã墿®ããŠããçµç¹å ããäœãããã¿ã³ãã¯ã®äžçš®ã§ãåçºãè»¢ç§»ã®æ©æçºèŠçãæ²»ç广ã®ç¹å®ã«æå¹ãåºæºå€5.0/ng/ml CF/TCFïŒå€§è žå èŠé¡æ€æ»ïŒ CHEïŒã¯ã¬ã¢ããã³ïŒ colono fiberscope(å€§è žå èŠé¡æ€æ») çèäžã®ãšãã«ã®ãŒæºãšãªãç©è³ªãã¯ã¬ã¢ããã³ã«å€ãã£ãŠè èããææ³ãããã CRPïŒCåå¿æ§èçœïŒïŒ äœå ã«æ¥æ§ççãææãçµç¹ã®æå·ãããæã«ãè¡æž äžã«å¢ããããã±ã質ã®äžã€ã§äœå ã®ççã®åºŠåããèŠãã CSïŒäžéšæ¶å管å èŠé¡æ€æ»ïŒ colono scope(äžéšæ¶å管å èŠé¡æ€æ») CTïŒã³ã³ãã¥ãŒã¿ãŒæå±€æ®åœ±ïŒ æŸå°ç·ãªã©ãå©çšããŠç©äœãã¹ãã£ã³ãã³ã³ãã¥ãŒã¿ãŒåŠçããããšã§ã骚ãèåšãæ¯èŒççæéã§ç»ååããããã®æ©åšã DEXA(ãããµ)æ³ ECGïŒå¿é»å³ã»ã¢ãã¿ãŒïŒ 骚å¯åºŠæž¬å®ãä»ã«è¶ 鳿³¢æ³ãMDæ³ãCTæ³ãããã å¿èãè¡æ¶²ãéãåºãããã«æåãããšããå¿çãåçž®ããŠåŸ®çްãªé»æ°ãçºçããããã®é»æ°ã®åŒ·åŒ±ã®æ³¢åœ¢ãã°ã©ãåããŠå¿èã®ç æ°ãçºèŠããã eGFR è èã®æ©èœãè©äŸ¡ããããã®ææšãå ·äœçã«ã¯ã糞çäœ(ããã ããã)ã§è¡æ¶²ããéããŠå°¿ãäœãèœåã瀺ãã ERCP FBSïŒç©ºè ¹æè¡ç³ïŒ å èŠé¡çéè¡æ§è管èµç®¡é 圱 ç³ä»£è¬ã®æ€æ»ãäžè¬çã«ã¯æã®ç©ºè ¹æè¡ç³å€ããã£ãŠå€å®ãããã æ£åžžå€70~109mg/dl GIFã»EGD ïŒäžéšæ¶å管å èŠé¡æ€æ»ïŒ å£è ã錻è ããé£é(E)ãè(G)ãåäºæè ž(D)ãŸã§é»åã¹ã³ãŒããæ¿å ¥ããæœ°çãã®ä»ã®çŸæ£ãŸãã¯ç°åžžã®æç¡ã蚺æãããå¿ èŠã«å¿ããŠç å€ã®äžéšãæ¡åïŒçæ€ïŒããŠçµç¹æ€æ»ãè¡ãã 9 æ€ æ» çš èª è§£ 説 HbïŒããŒããŒïŒ ïŒãã¢ã°ããã³æ¿åºŠïŒ è²§è¡ãå€è¡çã®èšºæã«çšããããã åºæºå€(æäºº)ç·æ§13.0~17.0g/dl 女æ§11.0~15.0g/dl HbA1c(ãã¢ã°ããã³A1c) ããã 4~8 é±éã®è¡ç³ã³ã³ãããŒã«ç¶æ ãåæ ãããããé£äºã«åœ±é¿ãããªããç³ä»£è¬ã®å€æã«æå¹ãªæ€æ»ãæ£åžžå€4.5~5.8% HDL-CïŒHDLã³ã¬ã¹ãããŒã«ïŒ ã³ã¬ã¹ãããŒã«ãæ«æ¢¢è¡ç®¡ããèèã«è»¢éããåã(åçã³ã¬ã¹ãããŒã«)ãããã40以äžã¯åè硬åãçããæ£åžžå€ ç·40~70mg/dl 女45~75mg/dl HtïŒãããã¯ãªããïŒ è²§è¡ãå€è¡çã®èšºæã«çšããããã åºæºå€(æäºº)ç·æ§40~50ïŒ å¥³æ§35~45ïŒ Inã»outïŒæ°ŽååºçŽïŒ INã¯ç¹æ»Žã»è¬ã»åŒæ°Žã»é£äºéçäœå ã«å ¥ããã®ãOUTã¯åºè¡éã»å°¿éã»æ±çã®äœå€ã«ææ³ããããã®ã LDH å¿çãèèã»éªšæ Œçã»èµ€è¡çã«å€ãå«ãŸããé µçŽ ã§ãå¿çé害ãèé害ãªã©ãèµ·ãããšäžæãããæ£åžžå€120~240IU/l LDL-CïŒLDLã³ã¬ã¹ãããŒã«ïŒ èèã§äœãããã³ã¬ã¹ãããŒã«ãå šèº«ã«éã¶åãããããæªçã³ã¬ã¹ãããŒã«ãšèšãããé«ããšåè硬åãå¿è¡ç®¡çŸæ£ã®ãªã¹ã¯ãå¢å ãããå¯èœæ§ããããæ£åžžå€140mg/dlä»¥äž MRAïŒç£æ°å ±é³Žè¡ç®¡æ®åœ±ïŒ MRIã®äžçš®ããCT+é 圱å€ãã®ä»£ããã«è³ã®ç¶æ³ãšè³è¡ç®¡ã®å¥åº·ç¶æ³ã調ã¹ãŠãè³åè硬åã®é²ã¿å ·åãè¡ç®¡å éšã®ççªçã調ã¹ãã MRIïŒæ žç£æ°å ±é³Žç»åæ³ïŒ 匷ãç£ç³ãšé»æ³¢ã䜿ã£ãŠäœã®å éšã®ç¶æ ãæ€æ»ããæ¹æ³ãçžŠã»æšªã»èŒªåãçæ§ã ãªè§åºŠããã®é®®æãªæå±€åçãåŸãããšãã§ããã OGTTïŒç³è² è·è©ŠéšïŒ ç©ºè ¹æã®è¡ç³ã枬å®åŸã75gã®ãããŠç³æ¶²ã飲ã¿ããã®åŸ2æéã§è¡ç³å€ãã©ã®çšåºŠå€åãããã調ã¹ãŠãç³å°¿ç ã®å€å®ã«å©çšããè¡æ¶²æ€æ»ã PaO2ïŒåèè¡é žçŽ åå§ïŒ åèè¡ã¬ã¹åæã䜿çšããåèè¡é žçŽ é£œåæ¿åºŠ(åèè¡äžã®é žçŽ ãšçµåããŠãããã¢ã°ããã³ã®å²åã®ããš)ãæž¬å®ããå€ã PETïŒéœé»åæŸåºæå±€æ®åœ±ïŒ ç现èããããŠç³ãåãèŸŒãæ§è³ªãå©çšããŠãæŸå°æ§ç©è³ªãçµã¿èŸŒãã ãããŠç³ãäœå ã«æ³šå°ãç»ååããããšã§ç现èãçºèŠããã QFTïŒã¯ãªã³ãã£ãŒãã§ãã³ïŒ BCGæ¥çš®ãMAC(éçµæ žæ§æé žè)ææã«ã¯åœ±é¿ããããçµæ žã«å¯Ÿããå ç«ã®æç¡ãå€å®ããæ€æ»æ³ã§ãã RBCïŒå°¿æœè¡ïŒ å°¿äžã«å«ãŸããè¡æ¶²ãæ€åºãããã®ãè èã»èè±ã»å°¿éã®ççãçµç³ã»è «çã»åç«è ºççã§éœæ§ãšãªããæ£åžž(ïŒ) RBCïŒèµ€è¡çïŒããŒã è²§è¡ãå€è¡çã®èšºæã«çšããããã åºæºå€ïŒæäººïŒç·æ§400~540äžïŒÎŒl 女æ§370~490ïŒÎŒl SpO2ã»SAT(ãµãã) ïŒãµãŒãã¥ã¬ãŒã·ã§ã³ïŒ æå ãªã©ã«ã¯ãªããã®ããã«æããã«ã¹ãªãã·ã¡ãŒã¿ãŒã䜿çšããŠãåèè¡äžã®é žçŽ ãšçµåããŠãããã¢ã°ããã³ã®å²åãæž¬å®ããå€ã TagesïŒã¿ãŒã²ã¹ïŒ è¡ç³ã®æ¥å å€åãææŒå€é£åã»ææŒå€é£åŸ 2 æéãå€äžã®è¡ç³ã枬å®ããŠããã®å€åã調ã¹ãæ€æ»ã T-BilïŒç·ããªã«ãã³ïŒ èåããèµ€è¡çã®ç Žå£ã«ããããã®è¡è²çŽ ãããªã«ãã³ãšãªããäžéšã¯èèãçµãŠèæ±äžã«ææ³ããããèã»èéç³»çŸæ£çã§äžæããã æ£åžžå€1.1以äžmg/dl T-choïŒç·ã³ã¬ã¹ãããŒã«ïŒ éå°ã«ãªãã°ãè¡ç®¡å£ã«ä»çããŠè¡ç®¡ãçããªã£ãããåŒŸåæ§ã倱ããªã©åè硬åã®åå ãšãªããæ£åžžå€140~199mg/dl TG ïŒäžæ§èèªã»ããªã°ãªã»ã©ã€ãïŒ éå°ã«ãªãã°ãç®äžãèèã«èç©ããŠãè¥æºãèèªèãŸãã¯åè硬åãä¿é²ããããæ£åžžå€30~149mg/dl 10 æ€ æ» çš èª è§£ TPïŒç·èçœïŒ 説 è¡æ¶²äžã®ããã±ãã®éã§ãæ é€ç¶æ ãè é害ã»èé害ãèŠãã æ£åžžå€6.7~8.3g/dl t-spot.TBïŒt-ã¹ãããïŒ QFT ãšTã¹ãããã¯ãçµæ žè矀ã®ç¹ç°æåã§ãªã³ãçãåºæ¿ããã€ã³ã¿ãŒãã§ãã³-Î³ã®æ¿åºŠãç£ç现èã®åæ°ã枬å®ããæ€æ» UAïŒå°¿é žïŒ è èã®ææ³æ©èœã®äœäžãå°¿é žçæã®ä¿é²ã«ãã£ãŠãå€ãé«å€ã«ãªãç颚çãåŒãèµ·ãããæ£åžžå€ ç·3.8~7.5mg/dl 女2.4~5.8mg/dl U-GluïŒå°¿ç³ïŒ UROïŒãŠãããªããŒã²ã³ïŒ äžå®é以äžã®å¢å ã«ããã(+)以äžã®å Žåã¯ç³å°¿ç ãçããããæ£åžž(ïŒ) è¡æ¶²äžã®ããªã«ãã³ãšããè²çŽ ãè žå 现èã«éå ããããã®ã§ã æ£åžž(±) åŒ·éœæ§(2+)以äžã¯èé害ãçãã USïŒè¶ 鳿³¢ã»ãšã³ãŒæ€æ»ïŒ U-TPïŒå°¿èçœïŒ è¶ é³æ³¢ã察象ç©ã«åœãŠãŠããã®åå¿ãæ ååããç»åæ€æ»æ³ã è¡æ¶²äžã«å«ãŸããã¿ã³ãã¯ãå°¿äžã«åºãŠãããã®ãéœæ§ãç¶ããããªãããããŒãŒçã®è çŸæ£ã®å¯èœæ§ããããæ£åžž(ïŒ) VE VF å¥äžå èŠé¡æ€æ» å¥äžé åœ±æ€æ»ãããªãŠã ãæ··ããé£ç©ãå¥äžãããéçšãèŠãæ€æ»ã WBCïŒçœè¡çïŒã¯ã€ã» ççæ§çŸæ£ãè¡æ¶²çŸæ£ã®èšºæã«çšãããããåºæºå€(æäºº)4700ïœ8700/ÎŒl X-PïŒãšã¯ã¹ã¬ã€ã»Xç·æ®åœ±ïŒ ãšãã¯ã¹ç·ç §å°è£ 眮ãšãã£ã«ã ã®éã«äœã眮ããçŒãä»ããŠç»ååããæ€æ» ZZT æ ¢æ§èçã»è硬å€ã»æ ¢æ§ççãè åç çã§å€ãäžæãããæ£åžžå€2.0~12.0U γâGTP èèãªã©ã«ååžããé µçŽ ã§ãèæ±ãã£æ»ã»ã¢ã«ã³ãŒã«ã»è¬ç©ãªã©ã®åœ±é¿ã§äžæãããæ£åžžå€ç·æ§80以äžIU/l 女æ§30以äžIU/l ã¢ã³ã®ãªã°ã©ãã£ãŒ ïŒè¡ç®¡é åœ±ïŒ ã«ããŒãã«ãäž»ã«éŒ åŸéšã®åèããèèãè èãè³ã®è¡ç®¡ãŸã§æ¿å ¥ããé 圱å€ã䜿çšããŠè¡æµãè «çã®ååžãè¡ç®¡ã®ççªãéå¡ãç¥ãããã®æ€æ»ã ããã«ã¯ãªã³åå¿(ãå) çµæ žèã«å¯Ÿãã人äœã®ã¢ã¬ã«ã®ãŒåå¿ãå©çšããŠçµæ žèææã®æç¡ã調ã¹ãæ€æ»ã ããããã¹ã ïŒç®èã¢ã¬ã«ã®ãŒè©ŠéšïŒ æ¥è§Šæ§ç®èçãè¬ç¹ã®åå ç©è³ªã確ããããããçãã®ããç©è³ªãèäžãè ã«è²Œä»ããŠåå¿ã調ã¹ãæ¹æ³ã ãã³ã¢ã°ã©ãã£ãŒ ä¹³è ºã»ä¹³æ¿å°çšã®Xç·è£ 眮ã§ãä¹³æ¿ãå¹³ãã«å§è¿«ããŠæ®åœ±ããæ€æ» ïŒåçŽä¹³æ¿Xç·æ®åœ±ïŒ ïŒïŒããèãæ²»çãå»çåŠçœ®çšèª æ²»çãåŠçœ®ã®çšèª è§£ ACLSïŒäºæ¬¡æåœåŠçœ®ïŒ 説 æ°ç®¡å æ¿ç®¡ãè¬å€ãšãã£ãé«åºŠãªå¿èºèçæ³ã瀺ãããå¿èºåæ¢ã®ã¿ãªãããéçäžæŽèãæ¥æ§å çåçŸ€ãæ¥æ§èè¡æ§è³åäžã®åææ²»çãŸã§ãå«ãã AEDïŒèªåäœå€åŒé€çްååšïŒ å¿å®€çްåã®éã«ãæ©åšãèªåçã«è§£æãè¡ããå¿ èŠã«å¿ããŠé»æ°çãªã·ã§ãã¯ãäžããå¿èã®åããæ»ãããšã詊ã¿ãå»çæ©åšã BLSïŒäžæ¬¡æåœåŠçœ®ïŒ æ¥ã«åããããçªæ¯ãã人ã«å¯ŸããŠããã®å Žã«å± åããã人ããææ¥éãå»åž«ã«åŒãç¶ããŸã§ã®éã«è¡ãå¿æ¥åŠçœ®ã®ããšã 11 æ²»çãåŠçœ®ã®çšèª è§£ 説 CABGïŒå€§åèå åèãã€ãã¹è¡ïŒ èè¡æ§å¿çŸæ£ã®æ²»çã®ãããè¡æµéã®å埩ãã¯ããæè¡ã®ããšã CAPDïŒæç¶æºåž¯åŒè ¹èéæïŒ è ¹èãæµžéèãšããŠå©çšããéææ¹æ³ã浞éå§ãé«ããéææ¶²ãè ¹èå ã«å ¥ããå°¿çŽ ãã¯ãããšããèå»ç©ãæ°Žåããããšããšãããã®ã CPRïŒå¿èºèçæ³ïŒ å¿èºã忢ãã人ãåŒåžãåŸªç°æ©èœãç¶æããç®çã§ãå¿èãããµãŒãžããã³äººå·¥åŒåžãè¡ãããšã CV(äžå¿éè)ã«ããŒãã«ã CVããŒã (ç®äžåã蟌ã¿åäžå¿éèã¢ã¯ã»ã¹ããŒã) äžå¿éèã«ããŒãã«ã¯ãæè¶³ãããå¿èã«è¿ãäœçœ®ã«ããéèã«å€§ããªã«ããŒãã«ãéçæ£è ãé·æéã®ç¹æ»Žæ²»çãå¿ èŠãšããæ£è ã«ç眮ãããCV ããŒããšã¯ãç®äžåã蟌ãäžå¿éèã«ããŒãã«ã®äžéšã§ãæããå€ãé«ã«ããªãŒèŒžæ¶²ã®æäžã«äœ¿çšããã DCïŒé€çްååšïŒ èŽåœçãªäžæŽèã«å¯ŸããŠã黿°ã·ã§ãã¯ãäžããããšã§æ¹åãå³ããã®ã DESIGN-R®2020 æ¥æ¬è€¥ç¡åŠäŒãéçºãã耥ç¡ç¶æ å€å®ã¹ã±ãŒã«ã§ã耥ç¡ã®éç床ãåé¡ããæ²»çéçšãæ°éåããããšã2020å¹Žã«æ¹å® DNAR(DNR) çŽèš³ã¯ãèçã詊ã¿ããªãè±èªåã®äººã«èšããããšãïŒèçãã§ããèŠèŸŒã¿ãäœãã®ã§ïŒèçã詊ã¿ããªããšãããã¥ã¢ã³ã¹ãéèŠãªå€§åæãšããŠDNARã¯å¿åæ¢æã®ã¿æå¹ãªæç€ºã§ãã£ãŠãå¿åæ¢æä»¥å€ã®æ²»çæ¹éã«åœ±é¿ãäžããŠã¯ãããªãã DOAã»DOB DOAã¯dopamineïŒãããã³ïŒ DOBã¯dobutamineïŒããã¿ãã³ïŒã®ç¥èªã§ãããããæ¥æ§åŸªç°äžå šãªã©ã®éã«è¡å§ç¶æã®ããã«çšããããããšãå€ãè¬å€ã GEïŒãžãŒã€ãŒïŒ HDïŒäººå·¥éæã»è¡æ¶²éæçæ³ïŒ è äžå šã«é¥ã£ãæ£è ãå°¿æ¯çã«ãªãã®ã鲿¢ããããã«ãè¡æ¶²ãäœå€ã«å°ãåºããæ°Žåãèå»ç©ãé»è§£è³ªãé€å»ãåã³äœå ã«æ»ãæ²»çæ³ HOTïŒãããã»åšå® é žçŽ çæ³ïŒ é žçŽ ãäžè¶³ããã¡ãªæ£è ããèªå® ãªã©ç é¢ä»¥å€ã®å Žæã§é žçŽ äŸçµŠè£ 眮ã䜿çšããŠé žçŽ ãåžå ¥ããæ²»çæ³ã ICLS ã°ãªã»ãªã³ãå«ãŸããæµ£è žæ¶²ãèéãçŽè žãåºæ¿ãæäŸ¿ãä¿ãã (å»çåŸäºè åãèçãã¬ãŒãã³ã°) çªç¶ã®å¿åæ¢ã«å¯Ÿãã10åéã®å¯Ÿå¿ãšé©åãªããŒã èçãç¿åŸããããšãç®çãšãããã¬ãŒãã³ã°ã³ãŒã¹ã IMïŒçèæ³šå°ïŒ IVã»DIVïŒéèæ³šå°ïŒ çèäžã«è¬æ¶²ãæ³šå ¥ããããšãç®äžæ³šå°ããåžåãæ©ãã è¡ç®¡å ã«è¬æ¶²ãå ¥ããæ³šå°ãè¡è¡ãä»ããŠéããã«å šèº«ã«è¡ããããã OPïŒãªãïŒ PEGïŒãã°ïŒ(èãã) (çµç®å èŠé¡çèç»é èšè¡) operation ã®ç¥ãæè¡ã®ããšã çµå£æåãå°é£ãªæ£è ã«å¯Ÿããäœå€ããèã«ç¹ãã穎ããããŠãã¥ãŒããç眮ããæ é€å€ãæ°ŽåãçŽæ¥æäžããæ é€è£çµŠæ¹æ³ã PICC(ããã¯) æ«æ¢¢æ¿å ¥åŒäžå¿éèã«ããŒãã«ã®ç¥ã§ãèã®éèããäžå¿éèã«æ¿å ¥ããã«ããŒãã«ã§ CV ã«ããŒãã«æ¿å ¥ã« æ¯ã¹ãŠã誀ã£ãŠåèã èºãå·ã€ããŠããŸãå±éºæ§ãäœãã PMïŒããŒã¹ã¡ãŒã«ãŒïŒ å¿èã«é»æ°åºæ¿ãå ããããšã«ãããå¿èã®ãªãºã ãçºçãããå»çæ©åš PPN(æ«æ¢¢éèæ é€) é£äºãã§ããªãæéã1é±éïœ10æ¥äœãŸã§è ãªã©ã®æ«æ¢¢éèããæäžããã SCïŒç®äžæ³šå°ïŒ TIPSïŒãã£ããã¹ïŒ ç®äžçµç¹ã®äžã«è¬æ¶²ãæ³šå ¥ããæ³šå°æ¹æ³ èå éèèéèççµ¡è¡ TPN(äžå¿éèæ é€) äžå¿éèæ é€ïŒTotal Parenteral NutritionïŒãšã¯ãäžå€§éèãªã©å¿èè¿ãã®å€ªãè¡ç®¡ã«ã«ããŒãã«ãç眮ãã髿¿åºŠã®æ é€å€ãæäžããæ¹æ³ 12 æ²»çãåŠçœ®ã®çšèª è§£ ã€ã³ãã¥ãŒãžã§ã³ 説 ã€ã³ãã©ã³ã æ³šå ¥ããããšã å»çåšæã人ã®äœã«åã蟌ãããšã®ç·ç§°ã ãŠã€ãã³ã°ïŒé¢è±ïŒ 人工åŒåžåšããèªçºåŒåžãžãšç§»è¡ã§ããããã人工åŒåžåšã段éçã«å€ãæäœã ãŠãã¹ãããŒïŒäººå·¥èè±ïŒ ãšã³ããªã»ãšã³ããªãŒãŒã·ã§ã³ 塿 è¡ãåèç€ãè «çã®ããè¡ç®¡ã«ãããããªãã®ãè©°ããæ²»çã ã«ããŒãã« å°¿ãææ³ãããããæè¡ã«ãã£ãŠè ¹å£ã«èšããããææ³å£ã®ããšã å»ççšã«çšãããããæããã管ã®ããšãè¡ç®¡ãæ¶å管ã尿管ããŸãã¯èžè ãªã©ã«æ¿å ¥ããäœæ¶²ã®æåºãè¬å€ãé 圱å€ãªã©ã®ç¹æ»Žãæ³šå ¥çãè¡ãã ã«ãã¥ãŒã¬ äœæ¶²ã®æåºãè¬æ¶²ã®æ³šå ¥ãæ°ç®¡åéãããéã®ç©ºæ°ã®éæãªã©ã®ããã«äœå ã«æ¿å ¥ãããã€ãç¶ã®å»çåšå ·ã ã«ã è¡å§èšã®ãã«ãéšå(ãã³ã·ã§ãã)ãã¥ãŒããã«ããŒãã«ã®å 端ã«ã€ããŠãã颚è¹ã®éšåã ã¯ã©ã³ã å»ççšã¯ãªããããåºå®ããããç·©ããããªã©ã®æå³ãæã€åè©ãšããŠçšããããããšãããã ã±ã¢ã»ã±ã¢ã»ã©ã㌠ãµã¯ã·ã§ã³ïŒåžåŒïŒ äž»ã«æããå€ã«ããååŠçæ³ã ç°ã絡ãã§åãåºããªãå Žåãæ°ç®¡ã«ç©ãè©°ãŸãããŠããŸã£ãå Žåãªã©ã«ãå£ã錻ãããã¥ãŒããæ¿å ¥ãåšæ¢°ã§ç°ãªã©ãåžåŒããã ãµã¯ã·ã§ã³ãã¥ãŒã ã·ã£ã³ã ç°ãåžåŒãããšãã«äœ¿çšãããã¥ãŒãã è¡æ¶²ãæ¬æ¥éãã¹ãè¡ç®¡ãšã¯å¥ã®ã«ãŒããæµããç¶æ ã§ãè¡æ¶²éæã§ã¯éèãšåèãèºåŸªç°ç³»ãæ¯çްè¡ç®¡ãä»ããçŽæ¥ã€ãªãããŠããåæãæãã ã¹ã¯ãŠã£ãŒãžã³ã° äœäœãã¬ããŒãžã«å ããŠãæç°ã®å¹æã¢ãããçãæç°æ³ãç°ãæºãŸã£ãŠããèžéã®éšäœã«ææãåœãŠãŠãçµã蟌ãããã«å§è¿«ããŠç°ãååºããåŸæçãªææã§ã空æ°ãåãåºãåãå©çšããããã«å§è¿«ãå ããããšã«ãã£ãŠè²¯çããç°ãäžæ¢æ°éãžãšç§»åãããã ã¹ãã³ã è¡ç®¡ãæ°ç®¡ãæ¶å管çã管è ã®å åŽããåºããå»çæ©åšãççªäžè¡ç®¡ãæ°ç®¡ã®æ¡åŒµã«çšããããã ã¹ããŒãïŒäººå·¥èéïŒ ã¿ããã³ã° è žç®¡ãè ¹éšã®è¡šé¢ã«çŽæ¥åºããŠãææ³å£ã«ãããã®ã æç°æ³ã®äžã€ã§ãæå ãããããæã®ã²ãã軜ãããŒãŸããŠã«ããç¶ã«ãã軜ãèžããããã ãã£ã¹ãïŒãã£ã¹ããŒã¶ãã«ïŒ äœ¿ãæšãŠã®å»çåšå ·ã®ããšã ããªãããã£ã³ããŒ ç¹æ»Žçã茞液ã»ããã«çµã¿èŸŒãŸããŠããéæãªçã§ãç¹æ»Žæ°ã芳å¯ããç®çã§äœãããŠãããæäººçš20滎â1ml å°å çš60滎â1ml ãã¬ãŒã³ äœå ã«è²¯çããè¡æ¶²ã»è¿ã»æµžåºæ¶²ãäœå€ã«æåºããå»çè¡çºãããã¬ããŒãžããšããããã®éã«äœ¿çšãã管ã®ããšãããã¬ãŒã³ããšããã ãã¬ããŒãž ããã©ã€ã¶ãŒ äœå ã«æºãŸã£ãè¿ãäœæ¶²ãäœå€ãžæåºãããããšã åžå ¥åšã®ã²ãšã€ãé§ç¶ã«ããè¬æ¶²ãå£ã錻ããåžå ¥ããŠèè¿çã忝ãªã©åŒåžåšç³»çŸæ£ã®æ²»çã«çšããããã ãã«ã³ã«ããŒãã« ã«ããŒãã«ã®äžçš®ã§ãå 端ã颚è¹äžã«ãªã£ãŠãããèè±ãè¡ç®¡ãªã©ã®å éšã§èšããŸããããšã§ãæ²»çãåŠçœ®ãè¡ãããã®ãã®ã ãã³ã㌠èããã«ããŒãã«ã®å 端ã«ããããŒã åéšåãèå£åŽã§ã«ããŒãã«ãåºå®ããã 13 æ²»çãåŠçœ®ã®çšèª è§£ 説 ãã©ã»ãã»ãã©ã·ãŒãïŒåœè¬ïŒ åœè¬ãåŠæ¹ããŠããè¬ã ãšä¿¡ã蟌ãããšã«ãã£ãŠäœããã®æ¹åãã¿ããããšããæ²»ç广ã®ããšãããã ããªããžïŒæ©çŸ©æ¯ïŒ ãã«ãã³ãã£ãŒïŒç·çŸ©æ¯ïŒ æããæ¯(æ¬ ææ¯)ãè£ããããäººå·¥ã®æ¯ãé£ã®æ¯ãæ¯ãã«ããæ¹æ³ã ç·å ¥ãæ¯ã®ããšã ãã€ã³ã»ã³ã³ãããŒã« çæ§çŒçãªã©ããŸããŸãªé®çè¬ãè£å©è¬ããããã¯ç¥çµãããã¯ãªã©ãçšããŠãå¶åŸ¡ããå»çã ããããã¯ã»çé£ããã¯ ç¹æ»Žãäžæããéãå 端éšåã®è¡æ¶²ãéæµããŠååºããã®ã§ãã«ããŒãã«ã®éå¡ã黿¢ããããã«ã«ããŒãã«å ã«æååºå€ã泚å°çšççé£å¡©æ°Žãå å¡«ããŠããããšã ãã³ãã¬ãŒã¿ãŒïŒäººå·¥åŒåžåšïŒ èªçºåŒåžã®ã§ããªãäººã®ææ°ãè£å©ããèºã«ç©ºæ°ãéãèŸŒãæ©æ¢° ããªãã¯ã»ããªãã¯ãã㌠ããŒã²ã³ãã¥ãŒãã»NGãã¥ãŒã 錻ããèå ã«æ¿å ¥ãããã¥ãŒãã ãã«ãã³ã° å èŠé¡ããªãŒãåé€è¡ã ãã¬ãŒã³ã®äžã«æºãŸã£ãè¡æ¶²ãææ¶²ãæã§æãã ãå°çšã®ããŒã©ãŒçã䜿ã£ããããŠãè©°ãŸããªãããã«æµãäœæ¥ã®ããšã ã©ãã³ã¬ å®éè¥åº è ¹è é¡äžã§ã®èã®ãæåºè¡ å¿èº«ãå®å®ããç¶æ ã§åžå£ããããã«æšªãããããšã ç©ççæ³ ãªãããªããŒã·ã§ã³ã®äžã§ãèšç·Žå£«ãšã®æ²»çã§ã¯ãªãããããããã¯ãçœåŒãæž©ç±ãªã©ã®æ©æ¢°ã䜿ã£ãæ²»çã®ããšã åŽç®¡ïŒãœãã«ã³ïŒ äœäœãã¬ããŒãž äžæ¹æŽ»æ ãæ³šå ¥çšã®æ ããæ³šå ¥ããããšã åæ³šçæ³(ã©ãã¡ã ã) ç°ãå€ãåºããšææçãæ¯èŠããã®åå ãšãªããããç°ãåºãããã«äœã®è§åºŠãåŸããããèžãèäžã軜ããããããããããšã§ææ¶²ãä¿ãæ¹æ³ã å°å°¿ åèããçŽæ¥ããã®çµç¹ã«æ¿åºŠã®æ¿ãæããå€ãæ³šå ¥ããæ²»ç èè±ã«æºãŸã£ãå°¿ãå€å°¿éå£ããå°¿éãéããŠãã«ããŒãã«ãèè±å ãžæ¿å ¥ããŠãäœå€ãžææ³ããæ¹æ³ã æ°åïŒæ°ç®¡åéïŒ æ°ç®¡ãšãã®äžéšã®ç®èãåéããŠããã®éšåããæ°ç®¡ã«ãã¥ãŒã¬ãæ¿å ¥ããæ°é確ä¿ã®æ¹æ³ã éŒ»è æ é€ çµå£æåãã§ããªãããŸãã¯äžååãªæ£è ã®éŒ»è ããæ¶ååšç®¡å ã«ç®¡ãæ¿å ¥ããæµåé£ãæ é€ãçŽæ¥æ³šå ¥ããæ¹æ³ã ïŒïŒãã®ä»ã®å»çã»çè·ã»ä»è·çšèª å»çã»çè·ã»ä»è·çšèª è§£ ïŒ ïŒæ¬¡ææ¥ 説 å ¥é¢ãæè¡ã®å¿ èŠããªããèªåã§å蚺ã§ããæ¯èŒç軜çãªæ£è ã«å¯Ÿå¿ãäŒæ¥ã»å€éãªã©ç é¢ã®å¶æ¥æéå€ã«ãããã¿ã€ãã³ã°ã§ãéçã§ã¯ãªããã®ã®å蚺ãå éãã§ããªãå Žåã®ããŒãºã«å¿ããã ïŒ ïŒæ¬¡ææ¥ å ¥é¢ãæè¡ãå¿ èŠãªæ£è ã 24 æéäœå¶ã§åãå ¥ãããåæææ¥ããæ¬éãããŠããæ£è ã«å¯Ÿå¿ããæ¥ãæ±ºããããŠããç é¢ïŒç é¢çŸ€èŒªçªå¶ïŒããéœéåºçç¥äºãèªå®ããææ¥å瀺å»çæ©é¢ïŒææ¥æå®ç é¢ïŒãªã© ïŒ ïŒæ¬¡ææ¥ äžæ¬¡ææ¥ãäºæ¬¡ææ¥ã§ã¯å¯Ÿå¿ãé£ããçåœã«é¢ããéçæ£è ã«å¯Ÿå¿ããææ¥å»çïŒäœå¶ïŒãææ¥å»çã®æåŸã®ãšãã§ãšããŠãéçæ£è ãè€æ°ã®èšºçç§ã«ãããçç¶ãããéç¯€ãªæ£è ããåå24æéäœå¶ã§å¿ ãåãå ¥ããã 14 å»çã»çè·ã»ä»è·çšèª è§£ A ACP (ã¢ããã³ã¹ã±ã¢ãã©ã³ãã³ã°) 説 人çã®æçµæ®µéã§åããå»çãã±ã¢ãªã©ã«ã€ããŠãæ£è æ¬äººãšå®¶æãªã©ã®èº«è¿ãªäººãå»çåŸäºè ãªã©ãäºåã«ç¹°ãè¿ã話ãåãåãçµã¿ã®ããšã人çäŒè° ADL æ¥åžžç掻åäœãé£äºã»ææ³ã»çè±è¡£ã»å ¥æµŽã»ç§»åãªã©æ¥åžžç掻ãéãããã«å¿ èŠãªåºæ¬åäœãã¹ãŠãæãã AST B BI(Barthel Index) æèè¬é©æ£äœ¿ç𿝿ŽããŒã ããŒãµã«ã€ã³ããã¯ã¹ãæ¥åžžç掻ã®è©äŸ¡æ³ BSC(ãã¹ããµããŒãã£ãã±ã¢) 广çãªå¯ŸåŠãæ®ãããŠããªãå Žåãªã©ã«ãç©æ¥µçãªæ²»çã¯è¡ãããçç¶ç·©åã®æ²»çãè¡ããæ£è ããã® QOLïŒç掻ã®è³ªïŒã®ç¶æã«å°å¿µããããšãæå³ããã C CCTãŸãã¯UST ææ³ã±ã¢ããŒã CCUïŒå çŸæ£éäžæ²»çå®€ïŒ å¿èçŸæ£ã®æ£è ãå°éã«ç®¡çãããæ¥æ§å¿çæ¢å¡ãæ¥æ§å¿äžå šãªã©ãæ¥å€ããçŸæ£ãå€ããããæè¡çããã«å¯ŸåŠã§ããäœå¶ããšãããŠããã CL 蚺çæãå»é¢ CMïŒã±ã¢ããïŒ CN ä»è·æ¯æŽå°éå¡ã»ã±ã¢ãããžã£ãŒ èªå®çè·åž« CNS CwïŒã±ã¢ã¯ãŒã«ãŒïŒ å°éçè·åž« è³æ Œã®æç¡ã«é¢ãããä»äºãšããŠä»è·ãè¡ã£ãŠãã人 D DMAT  çœå®³æŽŸé£å»çããŒã æ¯ç§è¡ç士 DPAT DRAT çœå®³æŽŸé£ç²Ÿç¥å»çããŒã çœå®³æå©æ¯æŽããŒã Dr DST å»åž« èªç¥çã±ã¢ãµããŒãããŒã E EMT ER ææ¥æåœå£« ææ¥æåœå®€ ENT éé¢ F FDAR (ãã©ãŒã«ã¹ãã£ãŒãã£ã³ã°) FDAR ãšã¯ãF(Focus)ãD(Data)ãA(Action)ãR(Response)ã®é æåãåã£ããã®ãçè·ã±ã¢ãšæ£è ã®åå¿ãæç¢ºã«ãªãèšé²æ¹æ³ F-SOAIP(ãšããœã»ã¢ã€ããŒ) å¯Ÿäººæ¯æŽã«ç¹åããèšé²æ³ãF(Focus)ççŒç¹S(Subjectivedata)äž»èŠ³çæ å ±O(Objective data)å®¢èŠ³çæ å ±ãA(assessment)ã¢ã»ã¹ã¡ã³ããI(Intevention)ä»å ¥ã»å®æœ P(Plan)èšç»ã®é æåããšã£ããã®ã Fã»Fr(ãã¬ã³ã) FIM(ãã£ã ) ã«ããŒãã«ã®ãµã€ãºã衚ãåäœ æ¥åžžç掻ã®å°ºåºŠ(æ©èœçèªç«åºŠè©äŸ¡æ³)ããŠããADLã®è©äŸ¡æ³ G G(ã²ãŒãž) GH(ã°ã«ãŒãããŒã ) 泚å°éã®å€åŸãéã®å€ªã èªç¥ç察å¿åå ±åçæŽ»ä»è· GLIM(ã°ãªã )åºæº H Hr(ãã«ã³) äœæ é€èšºæåœéåºæº å°¿ HCU(é«åºŠã±ã¢å®€ããã€ã±ã¢ãŠãããïŒ ICUãšäžè¬ç æ£ã®äžéã«äœçœ®ããç æ£ã§ãICUããç§»ãããŠããæ£è ã察象ãšããé«åºŠæ²»ç宀ã HDS-R æ¹å®é·è°·å·åŒç°¡æç¥èœè©äŸ¡ã¹ã±ãŒã«ã9 é ç®ã®èšåã§æ§æãããã æºç¹ã¯30ç¹ 15 å»çã»çè·ã»ä»è·çšèª è§£ H p 説 ç é¢ I IADL ææ®µçæ¥åžžç掻åäœãèªç«ããŠãããããã®ããå¹ åºãåäœçŸ€ã äŸïŒæŽæ¿¯ã»è²·ç©ã»æž æã»é»è©±ã»æè¬ç®¡çã»éé管çãªã© IC (ã€ã³ãã©ãŒã ãã»ã³ã³ã»ã³ãïŒ æ£è ã»å®¶æããçŸæ£ã»æ€æ»ã»æ²»çã®å 容ãçè§£ããäžã§æææ±ºå®ãè¡ããããã«ãå»åž«ã»å»çããŒã ãç ç¶èª¬æãè¡ãããšã§ãããæ å ±ã®æäŸãšæææ±ºå®æ¯æŽãå«ãã ICD ICF ææç®¡çå»åž« åœéé害åé¡ã人ãçããŠããããã®æ©èœããçæŽ»æ©èœããšããçæŽ»æ©èœã«åœ±é¿ããèŠå ãšããŠãçŸæ£ã(å¥åº·ç¶æ )ã«å ããèæ¯å åã(ç°å¢å å)ãšãå人å åããšã®çžäºäœçšãšããŠãšãããã ICN ICT ææç®¡çèªå®çè·åž« ææå¯ŸçããŒã ICT ã人ãšäººãã€ãªãããæ å ±ãå ±æãããæè¡ãå ·äœçã«ã¯ãããœã³ã³ãã¹ããŒããã©ã³ã®ã¢ããªãå©çšããŠè¡ããªã³ã©ã€ã³èšºçããé»åã«ã«ããå©çšããŠé¢ããå Žæã«æ å ±ãå ±æããããšãªã© ICUïŒéäžæ²»çå®€ïŒ éç¯€ãªæ£è ã«å¯Ÿããå»åž«ãçè·åž«ã 24 æéäœå¶ã§é«åºŠãªå»çã»çè·ãè¡ãããšãç®çãšããç é¢å ã®æœèšã®ããšã K Kot(ã³ãŒã) KP 䟿 ããŒããŒãœã³ M MEãŸãã¯CE CE ã¯èšåºããã®èšåºå·¥åп士ãME ã¯æ©æ¢°ããã®èšåºå·¥åп士ãšããããããšãããããå®éåºå¥ã¯ãªãã MMSE MSW èªç¥æ©èœæ€æ»ã11é ç®ã®èšåã§æ§æãããæºç¹ã¯30ç¹ã å»çãœãŒã·ã£ã«ã¯ãŒã«ãŒ MTïŒã ã³ãã©ïŒ ç ç¶èª¬æã®ããšã§ãããã1997 幎以éå»çæ³æ¹æ£ã§ãã€ã³ãã©ãŒã ãã»ã³ã³ã»ã³ããšããæ¹æ³ã«å€ãã£ãŠããŠããã N NICUïŒæ°çå éäžæ²»çå®€ïŒ è¶ äœäœéå ãäœããã®çŸæ£ã®ããæ°çå ãéäžçã«ç®¡çã»æ²»çããããã®éšå±ã»éšéã®ããšã NP n.p 蚺ççè·åž« ç°åžž(æèŠïŒãªã NS NST çè·åž« æ é€ãµããŒãããŒã O OT P PT äœæ¥çæ³å£« çåŠçæ³å£« Pt(ã¯ã©ã³ã±) PNS (ããŒãããŒã·ãã ããŒã·ã³ã°ã·ã¹ãã ) Ph æ£è çè·åž«2人ã1çµãšãªã£ãŠè€æ°ã®æ£è ãåãæã€äºäººäžèåã®çè·æ¹åŒã®ããšã2 åã®çè·åž«ãããäºãã®ç¹æ§ã掻ãããŠæ¥åã®è£å®ãè²¬ä»»ã»æ å ±ãå ±æããã P PSW è¬å€åž« 粟ç¥ä¿å¥çŠç¥å£« Pãã€ã¬ã»PT Q QQ ããŒã¿ãã«ãã€ã¬ ææ¥ã®æå³ 16 S å»çã»çè·ã»ä»è·çšèª S-BAR ïŒãšã¹âããŒïŒ è§£ 説 è¿ éãã€é©åãªã³ãã¥ãã±ãŒã·ã§ã³ãä¿é²ããããã®ææ³ã§ãããSBAR ã®ååSituation, Background, Assessment, Recommendation ã®é æåããæãç«ã€ã SCUïŒè³åäžæ²»çå®€ïŒ è³åäžïŒè³åºè¡ãããèäžåºè¡ãè³æ¢å¡ãªã©ïŒãæ¥æ§çºçããç·æ¥ã®åŠçœ®ã»ç®¡çãç®çãšããç é¢ã®æœèšã®ããšã SOAP(ãœãŒã) å»çæ©é¢ã«ãããçè·èšé²ãããããã®èšå ¥åœ¢åŒããSOAPããšã¯ããSubjectïŒäž»èŠ³çæ å ±ïŒãããObjectïŒå®¢èŠ³çæ å ±ïŒãããAssessmentïŒè©äŸ¡ïŒãããPlanïŒèšç»ïŒãã®ããš SOFA SP(ã¹ããŒã¿â) éçåºŠææš ç° ST susp èšèªèŽèŠå£« ãçããã®æã äŸ)èæœ°ççãgastric ulcer susp SW R RD 瀟äŒçŠç¥å£« ç®¡çæ é€å£« ROM W W/C é¢ç¯å¯ååãé¢ç¯ã®éåç¯å²ã°(床)ã§è¡šãã è»ãã W.N.L æ£åžžç¯å²å WOC(ãŠã©ã¯ããŒã¹) 㢠ã¢ãŠããªãŒã ç®èã»ææ³ã±ã¢èªå®çè·åž« å°åã«åºåããŠè¡ãããš ã¢ãµãŒã·ã§ã³ ã¢ã»ã¹ã¡ã³ã çžæãå°éãã€ã€èªåã®æèŠã䞻匵ããã³ãã¥ãã±ãŒã·ã§ã³æ¹æ³ã®1ã€ å¯Ÿè±¡ãæ±ããåé¡ç¹ãåªå 床ãå€å®ããçè·ã±ã¢ã®æ¹åæ§ãæç¢ºåããããšã ã¢ãã ããŒãŒã»ã¢ãã ã ã¢ã¬ã¹ã(arrest) æ¢åŸæŽã®ããšãå ¥é¢ã«ããã£ãŠãæ£è ã®å ¥é¢æŽãç ç¶ãèãããšã å¿åæ¢ cardiac arrrest ã®ããšã 〠ã€ã³ããŒã¯ æŽå©ãæ±ããŠçžè«æ©é¢ã»æœèšã蚪ããè ã«ããœãŒã·ã£ã«ã¯ãŒã«ãŒãªã©ã颿¥ããŠãåé¡ãèãåãããšã ã€ã³ãã©ãŒãã« ãš ãšã³ããã äžè¬çã«å®¶æãå人ãè¿é£ããã©ã³ãã£ã¢ãªã©ã«ããæ¯æŽ åãå·»ã瀟äŒè³æºãå³åŒåãããã® ãš ãšã³ãã¯ãŒã¡ã³ã çµç¹ãæ§æãã1人ã²ãšããæ¬æ¥æã£ãŠããåãçºæ®ããèªãã®æææ±ºå®ã«ãããèªçºçã«è¡åã§ããããã«ããããš ãšãã»ã³ïŒãã€ãèªïŒ ãšããŒã(ED) é£äºãé£ã¹ç© æµ®è «ïŒããã¿ïŒ ãšããã³ã¹ïŒEBMïŒ ãª ãªã¹ãã¡ã€ã å®èšŒã«åºã¥ããå»ç 人工èéã»äººå·¥èè±ä¿æè ã®ããš ãªã ãªã³ã³ãŒã« æè¡ã®ããšã æ¥æ£æã®å¯Ÿå¿åœ¹ãšããŠãåŸ æ©ããããšããã€ã§ãåºå€èŠè«ã«å¿ãããããããé£çµ¡ã®åããç¶æ ã ã« ã«ã³ãã¡ã¬ã³ã¹ ã ãã£ãªã¢ æã¡åãããäŒè°ã®ããšã ä¿èè ã ãã¥ã¢ 㯠ã¯ãŒãªã³ã°ãªã æ²»çã®ããš æžé¢ã確èªããŠãã8æ¥ä»¥å ã¯æ¡ä»¶ã§è§£çŽã§ããå¶åºŠ 17 å»çã»çè·ã»ä»è·çšèª è§£ 㯠ã¯ãªãã£ã«ã«ã±ã¢ 説 çŸç ãå€å·ã䟵襲ã®å€§ããªæè¡ãªã©ã§çåœã®å±æ©ã«çããŠããæ£è ãžã®çè·ã®ããšãã éçéäžçè·ã ã¯ãªãã«ã«ãã¹ æ²»çãæ€æ»ã«ããã£ãŠã©ã®ãããªåŠçœ®ãè¡ãã®ãããã®å®æœå 容ãé åºãå ¥åããã¹ã±ãžã¥ãŒã«è¡šã®ããšã ã°ãªãŒãã±ã¢ 身è¿ãªäººãšæ»å¥ãçµéšããæ²åã«ããã人ã®ãã°ã§æ²ãã¿ãªããç«ã¡çŽããããã«æ¯æŽããããšããéºæã±ã¢ãããæ²åã±ã¢ããšãåŒã°ããŠããã ã± ã±ã¢ãã©ã³ åã ã®ããŒãºã«åãããé©åãªä¿éºã»å»çã»çŠç¥ãµãŒãã¹ãæäŸãããããã«ãã±ã¢ãããžã£ãŒãäžå¿ã«äœæãããèšç»æž ã³ ã³ãŒãã³ã° ã³ã¡ãã£ã«ã« ã¹ãã¬ã¹ã«å¯ŸåŠããããã®è¡å å»åž«ã®æç€ºã®äžã§æ¥åãè¡ãå»çåŸäºè ã³ã³ã(conventional ã®ç¥) ãµ ãµãŒãã€ã©ã³ã¹ åŸæ¥ã®(æ¹æ³)ãæ £äŸçãªãæ £äŸãšããæå³ã ææçã«å¯Ÿãã調æ»ã»ç£èŠããããšã ãµããªãŒ ãµé«äœ æç« ã®éèŠãªéšåãç°¡æœã«ãŸãšããŠè¡šçŸããããšãçè·ãµããªãŒãªã©ã ãµãŒãã¹ä»ãé«éœ¢è åãäœå® ãµè²¬ ã· ã·ã§ãŒãïŒSSïŒ ãµãŒãã¹æäŸè²¬ä»»è çæå ¥æç掻ä»è·ã»çæå ¥æçé€ä»è· ãžã§ãã°ã©ã ã¹ ã¹ã¿ããã³ãŒã« å®¶ç³»å³ ã¹ã¿ããã¯ããçŽã¡ã«ããå³åº§ã«ãã®æã ã¹ããŒã ã¹ãã(ãã€ãèªã®sterbenã®ç¥) èŽèšºåšã æ»äº¡ããã ã» ã»ã«ã³ããªãããªã³ æ£è ãèªèº«ã®äž»æ²»å»ä»¥å€ã®å¥ã®å»åž«ã«èšºæãæ²»çæ³ãé©åãã第2ã®æèŠããæ±ããããšã ãŒã¯(ãã€ãèªã®Sektionã«ç±æ¥) ç çè§£åã®ããšã ã»ã«ããã°ã¬ã¯ã èªå·±æŸä»»ãèªåèªèº«ã«ããäžè©±ã®æŸæ£ã»æŸä»» ã¿ ã¿ãã(Tachycardiaã«ç±æ¥) é »èã«ãªãããšã ã¿ãŒããã« ã¿ãŒããã«ã±ã¢ çµæ«æ çµæ«æã®äººã«å¯Ÿãã身äœçã»ç²Ÿç¥çãªã±ã¢ãå¥åãã¹ãã¹ã±ã¢ ã ããŒã ããŒã·ã³ã° ããŒã ã¡ã³ããŒã決ããŠããã®ãªãã«ãªãŒããŒãã¡ã³ããŒã§ããçè·åž«ãçè·è£å©è ãªã©ãå ¥ããŠããŒã å šäœã§çè·ããããªã£ãŠããçè·æ¹åŒã ã ãã¯ããšã€ã éããçã«å¯Ÿãå·¥åŠæè¡ã®é¢ããæ¯æŽããç·ç§°ããããçŠç¥çšå ·ãµãŒãã¹ããäœå® ã®æ§ç¯ã»æ¹ä¿®ãµãŒãã¹ãŸã§å«ãã ã ãã©ã³ã¹ ãã©ã³ã¹ãã¡ãŒ è»¢é¢ ç§»ä¹åäœ ããªã¢ãŒãž çœå®³å»çã®çŸå Žã§ãéãããå»çè³æºãæå€§é掻çšãããããè² å·è ãå·ç ã®ç·æ¥æ§ã»éç床ã«å¿ããŠåé¡ããèŽå·ã®åªå é äœã決å®ããããšã ã ããŒãã©ã€ãŒãŒã·ã§ã³ éããã®æç¡ã«é¢ããããå šãŠã®äººãå¹³çã«ç€ŸäŒã®æ§æå¡ãšããŠèªç«ããçæŽ»ãç€ŸäŒæŽ»åãå¶ãããšã§å¯èœã«ããããšãããããŸãŸã«å人ãšããŠå°åã§ç掻ãè¡åã§ããããšã ã ãã«ã³ ããªããŒã·ã§ã³ å°¿ èªç¥çã®æ¹ãšã®ã³ãã¥ãã±ãŒã·ã§ã³æè¡ã®ã²ãšã€ 18 å»çã»çè·ã»ä»è·çšèª è§£ ã ã㹠説 å°å飿ºãã¹(ãããè³åäžãå€§è ¿éªšãã¹ãªã©) ããŒãœã³ã»ã»ã³ã¿ãŒãã»ã±ã¢ èªç¥çã«ãªã£ãŠããã®äººããããç¶æã§ããããã«èªç¥çã®äººãå°éãããã®èŠç¹ãç«å Žã«ç«ã£ãŠã±ã¢ãè¡ãä»è·ææ³ ãã¯ãŒãªãããªããŒã·ã§ã³ ç¶ææã»æ ¢æ§æã®ãªãããªããŒã·ã§ã³ãšããŠãäž»ã«æ©åšãå©çšããçèãã¬ãŒãã³ã°ãè¡ããªãããªããŒã·ã§ã³æè¡ ã ãã¡ãŒã©ãŒäœ ãããã®é éšã 45ïœ60°æäžããäœäœã§ããããããã®äžæ¹ã«æ»ããããããã èã 15°ã»ã©å±æ²ãããäœäœãã»ããã¡ãŒã©ãŒäœã¯ãããã®é éšãçŽ30°æäžããäœäœ ãã§ã€ã¹ã·ãŒã å奿Žå©ã«ãããã€ã³ããŒã¯ã«ãããŠåãããå©çšè ã®æ å ±ãèšèŒããèšé²çšçŽã®ããšã ãã©ãŒãã« ãã¬ã€ã« å¶åºŠã«åºã¥ãæ¯æŽ ãå 霢ãšãšãã«å¿èº«ã®æŽ»åïŒéåæ©èœãèªç¥æ©èœçïŒãäœäžããçæŽ»æ©èœãé害ãããå¿èº«ã®è匱æ§ãåºçŸããç¶æ ã§ãé©åãªä»å ¥ã»æ¯æŽã«ãããçæŽ»æ©èœã®ç¶æåäžãå¯èœãªç¶æ åãšãããŠãããå¥åº·ãªç¶æ ãšæ¥åžžç掻ã§ãµããŒããå¿ èŠãªä»è·ç¶æ ã®äžéãæå³ããã ãããŒã·ãŒã èšèãæç« ã§ããã»ã¹ã説æããããã«äœ¿çšããããäž»ã«äººéå士ã®ã³ãã¥ãã±ãŒã·ã§ã³ãç®çãšããŠããã ãããŒãã£ãŒã å³ãã°ã©ãã§äœæ¥ã«ã€ããŠåŠçæé ãå·¥çšãªã©äžé£ã®æµãã衚ãããã®ã ãã©ã€ããªãŒã±ã¢ 身è¿ã«ãã£ãŠãäœã§ãçžè«ã«ä¹ã£ãŠãããç·åçãªå»çããããã€ãå»(å®¶åºå»)ãäž»ãªæ ãæã§ããã ã ãã©ã€ããªãŒããŒã·ã³ã° 1äººã®æ£è ããã«å¯ŸããŠã1 人ã®çè·åž«ãå ¥é¢ããéé¢ãŸã§è²¬ä»»ãæã¡ãçè·èšç»ã®ç«æ¡ãè©äŸ¡ãªã©ãè¡ããçè·æ¹åŒã®1〠ãã©ãã£(Bradycardia ã®ç¥) åŸèã«ãªãããšã ã ããã£ãŒã¡ã«ãã¯ã¹ ååŠçåçãæŽ»çšããä»è·ã®æ¹æ³ãæå°ã®åŽåã§ä»è·ãããããç²åŽãå°ãªããè °ç鲿¢ã«ãã€ãªããã ããªãã¡ãŒãã·ãŒ ãè€æ°ããæå³ãããpolyããšã調å€ïŒè¬å±ïŒããæå³ãããpharmacyããããªããã害ã®ããå€å€æçšããæå³ããèšèãè¬ã«ããæå®³äºè±¡ïŒè¬ç©æå®³äºè±¡ïŒã¯åŠæ¹ãããè¬ã®æ°ã«æ¯äŸãããšãããè¬ã®æ°ã6çš®é¡ãè¶ ãããšçºçé »åºŠã倧ããå¢å ãããšããããŠããã ã¡ ã¡ã¿ããªãã¯ã·ã³ãããŒã (ã¡ã¿ã) å èè¥æºã«é«è¡å§ã»é«è¡ç³ã»è質代è¬ç°åžžãçµã¿åãããããšã«ãããåè硬åã®å±éºå åãé«ãŸãå¿èç ãè³åäžãªã©ã«ãªããããç æ ã 㢠ã¢ãã¿ãªã³ã° ㊠ãŠãããã±ã¢ ã±ã¢ãã©ã³ã«æ²¿ã£ãä»è·ãµãŒãã¹ãæ£ããæäŸããããã確èªããããš ä»è·æœèšã§ 10 人çšåºŠã®å ¥å± è ã 1 ãŠããããšããŠç掻ããããšã§ãèªå® ã«è¿ãç°å¢ãç®æãä»è·ã®åœ¢ã 㪠ãªãããªããŒã·ã§ã³ 身äœçã粟ç¥çããã€ãŸã瀟äŒçã«èœåãæå€§éã«å埩ããç©æ¥µçãªèªç«ãä¿ãããšãå»åŠçãæè²çãè·æ¥çã瀟äŒçãªãããªããŒã·ã§ã³ã®4 åéãããã ãªãã³ã°ãŠã£ã« çåãã€å€æåããããã¡ã«èªãã®çµæ«æå»çã«é¢ããåžæãèšããŠããã㚠㬠ã¬ã¹ãã€ãã±ã¢ ä»è·è ã®ç²åŽãã¹ãã¬ã¹è»œæžãç®çãšããä»è·ãäžæçã«æ ãå®¶ææ¯æŽ 19 å»çã»çè·ã»ä»è·çšèª è§£ ã ãã³ã¢ãã£ãã·ã³ãããŒã (ãã³ã¢) éååšçå矀 説 éååšã®é害ã®ããã«ç«ã£ããæ©ãããããããã®èº«äœèœåïŒç§»åæ©èœïŒãäœäžããç¶æ ã ã ç°é£ ç¶ææ æ®éé£ç©ãšãããŠããªããã®ãå£ã«å ¥ããŠããŸãè¡çºã ããããçºçãã6ãæä»¥éããããçŸåšã¯ãäž»äœçãªæå³ã蟌ãçæŽ»æãšæããŠããã ç§»ä¹ äžè¬çšå»è¬å ããããè»ããããã€ã¬ãªã©ãžã®ä¹ãç§»ãåäœ å»åž«ã®åŠæ¹ãç¡ããŠããè¬å€åž«ãããã°è¬å±çã§è³Œå ¥ã§ããè¬ã å»çDX (ããžã¿ã«ãã©ã³ã¹ ãã©ãŒã¡ãŒã·ã§ã³) ä¿éºã»å»çã»ä»è·ã«é¢ããæ å ±ãããŒã¿ã掻ãããŠç æ°ã®äºé²ãããè¯ãå»çãšä»è·ã®å®çŸãç®æãããã«ç€ŸäŒãçæŽ»ãå€ããããšãæããå¥åº·èšºæãã«ã«ãã蚺çå ±é ¬ãªã©ããå€ãã®ããŒã¿ã掻ãããŠãªã³ã©ã€ã³è³æ Œç¢ºèªãé»åã«ã«ãæ å ±ã®æšæºåãªã©ãè¡ãã äžå å ã éåæ§æ§é³é害 æè¬æç¹æ¯ã«äžå ããããš è³è¡ç®¡çŸæ£ã«ãããé¡é¢ã»å£åã»èã»åœé çã«éº»çºããããèšèãæ£ããçºé³ã§ããªãç¶æ ã ã 壿» å¥äžå°é£ 身äœã®çްèãçµç¹ã®ããéãããéšåãæ»ã¬ããšã é£ç©çã®é£²ã¿èŸŒã¿ãã§ããªããå¥äžé害ãšããããšãããã ã æªå¯ã»æŠæ (ãããã€) ãè¬æåž³ çºç±ãèŠå ãšãªãã坿°ãæããããšãæŠæ ã¯ãã®éã«äœãéããã㚠調å€ãããè¬ã®å±¥æŽããŸãšããæåž³ã ã ä»è·çŠç¥å£« 瀟äŒçŠç¥å£«ããã³ä»è·çŠç¥å£«æ³ã«åºã¥ãåœå®¶è³æ Œãå°éçç¥èããã³æè¡ããã£ãŠèº«äœäžãŸãã¯ç²Ÿç¥äžã®é害ã«ããæ¥åžžçæŽ»ãå¶ãã®ã«æ¯éãããè ã«ã€ãä»è·ãä»è·è ãžã®æå°ãè¡ãã ä»è·ä¿éºæœèš åæ³æ³ ä»è·ä¿éºæ³ã«ããæœèšãµãŒãã¹ãè¡ãæœèšã é«éœ¢è ã®å¿ççæ³ã®äžã€ã§ãèªåã®éå»ã話ãããšã§ç²Ÿç¥ãå®å®ããããšããææ³ å埩æãªã ç°¡ææžæ¿æ³ïŒãããããã ãã»ãïŒ ããããçºçãã6ãæ é å€ãã«ãã»ã«å€ãçµç®¡æ é€ãã¥ãŒãããæäžéãç²æ«ã®ç¶æ ã«ããã«æž©æ¹¯(55âçšåºŠ)ã«å ¥ã厩å£ãæžæ¿ãããŠæäžããæ¹æ³ã ææ å€±çŠ å«åœ(ãããã) èªç¥çã®çç¶ã®ã²ãšã€ãææ ã®èª¿æŽãããŸããããªããªãããšã ããã ç倿© çè·å°èŠæš¡å€æ©èœåå± å® ä»è· ç·©åã±ã¢ çåœãè ããç ã«é¢é£ããåé¡ã«çŽé¢ããŠããæ£è ãšãã®å®¶æã®ã¯ãªãªãã£ã»ãªãã»ã©ã€ã(QOLïŒç掻ã®è³ª)ããçã¿ããã®ä»ã®èº«äœçã»å¿ç瀟äŒçã»ã¹ããªãã¥ã¢ã«ãªåé¡ãæ©æã«èŠåºãç確ã«è©äŸ¡ãè¡ã察å¿ããããš ã æ©æ¢°æµŽ èµ·åº§äœ é床é害è çšå ¥æµŽåšã䜿çšããå ¥æµŽ äžå身ãèµ·ãããªãŒããŒããŒãã«ãªã©ã«ãããããããååŸãä¿ã€å§¿å¢ åšè³ªæ§æ§é³é害 åšè³ªçã«å£ã錻ã»åã«ãããŠäœãããã®åå ã®ããæ£ããçºé³ã§ããªãç¶æ ã æ©èœæ§æ§é³é害 åºæºè¬å± åå ãç¹å®ã§ããªãããèšèãæ£ããçºé³ã§ããªãç¶æ ã éœéåºçã®è¬å€åž«äŒã«ããèªå®ãããè¬å±ã å± å® ã ä»°è¥äœ(ããããã) å± å® ä»è·æ¯æŽäºæ¥æ ä»°åãã®ç¶æ ã®ããšã 20 å»çã»çè·ã»ä»è·çšèª è§£ ã æ¥æ§æãªã 説 ã çœåŒ(ãããã) ããããçºçãã1ãæ é žæ€ãè °æ€ãåŒã£åŒµãæ²»çã å¥åŽ å¹»èŠ æ£åŽ(麻çºãé害ã®ããåŽ)ã®å察ãå¥åº·ãªæ¹ã®åŽã å®éã«æèŠçãªåºæ¿ã察象ããªãã®ã«ãããããã«ç¥èŠããããš ã å£è ã±ã¢ 誀å¥(ããã) å£è æž æããå§ãŸããé£ã¹ç©ã®æãæ¹ã誀å¥ã®é²æ¢ã 飲ã¿èŸŒãã æ°Žãé£ç©ãåŸæ¶²çãé£éã§ã¯ãªãæ°ç®¡ã®æ¹ã«å ¥ã£ãŠããŸãããšã èª€å¥æ§èºç åœä¿é£ å£è å ã®çްèãåŸæ¶²ãèæ¶²ãšå ±ã«èºã«æµã蟌ãã§çããèºçã åœæ°å¥åº·ä¿éºå£äœé£åäŒ åæµŽ ã æ®è¬ å®¶åºã§èšçœ®ãããããª1人ãµã€ãºã®æµŽæ§œã 䜿çšããã«æ®ã£ãè¬ã ã 瀟äŒçå ¥é¢ æ¬æ¥ã®æ²»çç®çã§å ¥é¢ããŠããã®ã§ã¯ãªããæ²»çã®å¿ èŠãªãé·æå ¥é¢ãç¶ããç¶æ ã®ããšã 瀟å è «è¹(ãã ã¡ãã) 瀟äŒçŠç¥åè°äŒ ççãªã©ãåå ã§äœã®çµç¹ãåšç®¡ã®äžéšãè «ãäžããããšã èªåéå èªè²»ãã«ã èªåã§éåããããšã èªè²»ã§ããŒã ãã«ããµãŒãã¹ãåããã çµæ«æ å°èŠæš¡ å埩ãèŠèŸŒãããå幎以å ã®æ»äº¡ãäºæ³ãããç¶æ ãšãªã£ãææã®ããš å°èŠæš¡å€æ©èœåå± å® ä»è·æœèš ã æé£ã»å¥äžé害 é£ã¹ç©ãèŠãŠãå£ã«åã蟌ã¿ãååŒããŠå¡ãäœã飲ã¿èŸŒã¿ãé£éãé£ã¹ç©ãééããéçšã«äœããã®åé¡ãçããããšã çä¿ å šè·éã»éšåè·é (F/PBW) çæŽ»ä¿è· 骚æåŸã®æ²»çã®äœéã®ããæ¹ ã åŽè¥äœ(ãããã) ã ä»åéå æšªãåããŠå¯ãå§¿å¢ ä»è ã«åãããŠãããäºã åŠäŒãŸãã¯ãµåŠ ç«¯åäœ ãµãŒãã¹æ åœè äŒè° ãããçã®æšªã«è¶³ãäžãã座ã£ãäœäœã ã¡ å°åã±ã¢äŒè° åå¥ã±ãŒã¹ã®æ¯æŽå å®¹ã®æ€èšã«ããåå¥èª²é¡ã®è§£æ±ºã®ã¿ãç®çãšããããšãªããå°åã®èª²é¡è§£æ±ºã«åããé¢ä¿æ©é¢ã®é£çµ¡èª¿æŽã»åœ¹å²åæ ãå³ããå¿ èŠãªå°åã¥ããã»è³æºéçºãè¡ãæ¿ç圢æã«ç¹ããŠããã å°åå æ¬ã±ã¢ã·ã¹ãã å»çã»ä»è·ã»çŠç¥ã»äœãŸãã»äºé²ã®åé åã®ãµãŒãã¹ãæ¥åžžç掻ååã«ãããŠãé©åã«çµã¿åãããŠæäŸããããšã«ããçæŽ»äžã®å®å šã»å®å¿ã»å¥åº·ã確ä¿ããŠããã å°åãªãããªããŒã·ã§ã³ CBR(Community Based Rihabilitaition é害ã®ãã人ãé«éœ¢è åã³ãã®å®¶æãäœã¿æ £ãããšããã§ãããã«äœã人ã ãšäž»ã«ç涯ãå®å šã«çãçããšããçæŽ»ãéãããããå»çãä¿å¥ãçŠç¥åã³ç掻ã«ãããããããã人ã ãæ©é¢ãçµç¹ããªãããªããŒã·ã§ã³ã®ç«å Žããååãåã£ãŠè¡ã掻åã®å šãŠãèšãã å°åå¯ç 〠éãªã å°åå¯çåãµãŒãã¹ éæãªãããªããŒã·ã§ã³ 21 22 å»çã»çè·ã»ä»è·çšèª è§£ 説 ãš ç¹å®è¡çºçè·åž« çè·åž«è¡çºç ä¿®ãä¿®äºããè ç¹é€ ç¹å¥é€è·è人ããŒã 㯠åŸåŸ ããŠããªãæ©ããŸããïŒããã«èŠããïŒè¡åã®ããš å»çšçå矀 å¿èº«ã®äžæŽ»åãæãæ§ã ãªæ©èœäœäžãçæŽ»äžæŽ»çºç ãšãåŒã°ããã ãµ æè¬ã«ã¬ã³ã㌠æ¥ä»ããšã«ä»åããããã±ããã®äžã«ããã®æ¥ã«æçšããè¬ãå ¥ããŠã飲ã¿å¿ãã誀飲ãé²ãæè¬è£å©å ·ã æè¬ãŒãªãŒ 飲ã¿èŸŒã¿ãã§ããªãããã¥ããè¬ã®æè¬ã容æã«ãã誀å¥ãé²ãã 㻠蚪ç 蚪åçè· èšªå蚺çãšåŸèšº 蚪å蚺çã¯ãæ¯é±ãææ¥ã®ãæãªã©ã¹ã±ãžã¥ãŒã«ã決ãã宿çã«æ£è æ§ã®èªå® ã«èšªåãããŠèšºå¯ãæ²»çãå¥åº·çžè«ãªã©ãè¡ãã蚪åé »åºŠã¯å人差ããããæã«æ°åºŠã«ãªãããšãå€ãã åŸèšºã¯ãæ¥å€ãªã©çªçºçãªäºæ ãèµ·ãã£ããã®ã®ãææ¥è»ãåŒã¶ã»ã©ã§ã¯ãªããšãã£ãå Žåã«ãæ£è æ§ããå®¶æããã®èŠè«ãåããŠå»åž«ãèªå® ã«èšªåãããµãŒãã¹ã 蚪åãªã 蚪åãªãããªããŒã·ã§ã³ ä¿çŠ ä¿å¥çŠç¥äºåæ å æ¬ å°åå æ¬æ¯æŽã»ã³ã¿ãŒ ã å€éããåŠ å€ã«ãªããšè奮ããéšãåºãããšãæèã®æ··æ¿ã䌎ãã ã ææ ææè人ããŒã ã é€è· é€è·è人ããŒã ã èœå±(ãããã€) ç®èãªã©ã®è¡šç®è§è³ªå±€ã®äžå±€éšãå¥ããèœã¡ãããšã ã èå¥ ä»è·è人ä¿å¥æœèš ãã䟿 ææ³ãã䟿ãããŠããã¶è¡çºã®ããšã ïŒïŒãã䜿ãããè¬å€é¢é£ã®ç¥èªã»ç¥å ç¥ èª è§£ 説 ç¥ å è§£ 説 A ã¢ã³ãã« c.n.b 宿¯éŠé žãããªãŠã ã«ãã§ã€ã³ A å€ INA(ã¢ã€ã) ã€ãœãã¢ãžã(çµæ žã®è¬) Cap ã«ãã»ã« NB éæ¹ ãã« çé žæ°ŽçŽ ãããªãŠã Garg ãããè¬ SL ä¹³ç³ Lot ããŒã·ã§ã³ ZS äºéè¯åè»è M æ ã¢ã³ãã« å®æ¯éŠé žãããªãŠã n.d.E é£åŸ å¡©ã¢ã å¡©é žã¢ã«ãã O.D. å³ç® ã«ã㪠ãã§ããŒã«äºéè¯ãªãã¡ã³ã O.L. å·Šç® ã«ã é žåãã°ãã·ãŠã O.Z. äž¡ç® ã°ãªæµ£() ã°ãªã»ãªã³æµ£è ž odé å£è å 厩å£é çé£(ããããã) ççé£å¡©æ°Ž P.O çµå£ åè åã·ããã Rp åŠæ¹ ãã€ã ããªç¡«é žãããªãŠã 23 ç¥èª è§£ 説 ç¥å è§£ 説 Suppo(ãµã) åå€ ããªã¯ã¿ãã³ å¡©åã¡ãã«ãã¶ããªã³ T(tables) é å€ ãã é žåäºé V ãã€ã¢ã« ãªã³ã³ã ãªã³é žã³ãã€ã³ v.d.E. é£å ç¡«èŠ ç¡«é žãã°ãã·ãŠã z.d.E. é£é ç¡«ãã© æµåãã©ãã£ã³ ããŒãX ããŒããšãã¹ ãªãããŒã« ã¢ã¯ãªããŒã« ïŒïŒããèããã©é£ããäœã®åå éšäœã®åå è§£ 説 éšäœã®åå è§£ 説 çŒçŒ(ãããã) ãŸã¶ã è(ãã) ãžã ç«æ¯(ããããã) ãŸã€ã èéš(ã§ãã¶) å°» è³ä»(ããã) è³ã®è²æ®»ç¶ã®åœ¢ã®éšå æè(ãã ã¯ã) æã®ç² è³æ¶(ãã ) è³ãã¶ ææ(ãã ããã) æã®ã²ã å£è§(ãããã) åã®äž¡èã®éšå è¶³è(ããã¯ã) è¶³ã®ç² é žéš(ããã¶) é ãšèŽãã€ãªãéšå èžéš(ãã¶) ããã¶ã è 窩(ããã) èã®äžã®ããŒãã æ èžµéš(ãããã¶) ãããš äžè (ããããã) äºã®è ç¬¬ïŒæ 芪æ åè (ãããã) èããæéŠãŸã§ã®éšå ç¬¬ïŒæ äººå·®ãæ å€§è ¿(ã ããã) ãã ç¬¬ïŒæ äžæ äžè ¿(ããã) ãã ç¬¬ïŒæ è¬æ éŒ åŸ(ããã) è¶³ã®ä»ãæ ¹ ç¬¬ïŒæ å°æ 足趟 è¶³ã®ãã³ â»çšèªéã¯ãçžè«å®€ããŒã ããŒãžã«ãŠãé»ååªäœãã§ããŠã³ããŒãã§ããŸãã æ¥åã§äœ¿çšãããŠãããã¿ãã¬ãããªã©ãã«å ¥ããŠãå©çšãã ããã ãŸãããé ç®ã®è¿œå ãããæ²èŒçšèªã®ä¿®æ£ããªã©ã®ãæèŠããããŸããã ãQRã³ãŒãããäžèšãªã³ã¯ããŸã§ãå¯ããã ããã å€è·çš®é£æºã®ããã®çšèªé æèŠã»ææ³ãã©ãŒã – Google ãã©ãŒã ãŸã㯠h
å»ççšèªããŒãžéèš 2025幎10æ25æ¥ïŒéïŒ
Copyright © 2026 ããžã¿ã«ã©ã€ãç ç©¶äŒ


