4 research outputs found
重症例からみた気管支喘息治療の現状と危機管理に関する検討
No full text1998年よりステロイド剤規則的吸入療法を主体としたガイドライン療法が導入され喘息死は徐々に減少してきたが,2000年度の本邦における喘息死は4,473名を数える.標準的治療が確立されたにもかかわらずなぜ死亡例が多いのかを,救命救急センターに3次救急搬送された重症気管支喘息患者54例を対象に検討した.救急搬送前の投薬内容をみると,ガイドラインにそった治療は行われず,喘息発作時だけβ受容体刺激剤(スプレー)を使用していた症例が平均92.9%でCPA(cardio pulmonary arrest)症例では100%であった.それに対してステロイド剤規則的吸入療法は2例3.7%にしか行われていなかった.気管支喘息を専門とする呼吸器専門医やアレルギー専門医はガイドラインにそった治療を行っているが,一般臨床医には未だ浸透していない可能性が示唆された.気管支喘息死を減少させるには,一般臨床医による患者教育の徹底,ステロイド剤規則的吸入療法をベースにした適切な定期的通院・治療の厳守,発作急変時に備えた病歴カードの常時携帯,救急医療機関側は救急隊のオーバートリアージを容認するなど危機管理の徹底を図ることが重要と考えられた.Asthmatic deaths have been gradually reduced since 1998 when regular steroid inhalation therapy was proved effective and widely introduced as guideline therapy. There were, however, still as many as 4,473 Japanese people who died of asthma in 2000. We examined the reasons for this large number of deaths, despite establishment of the guideline therapy, by investigating emergency patients who were carried to our emergency care center by ambulance as tertiary emergency cases for treatment of serious asthma. The investigation of medications used before emergency arrival showed that patients were not treated according to the guideline therapy: 92.9% of all patients and 100% of CPA (cardio pulmonary arrest) patients were treated with β-receptor stimulators (spray) only when they had asthmatic fits, and regular steroid inhalation therapy was performed on only 2 patients (3.7%). Although respiratory and allergy experts specializing in bronchial asthma follow the guideline therapy, it may not be widespread among general clinicians. To reduce the deaths from bronchial asthma, it is important to fully manage the possible risks of bronchial asthma by making general practitioners give patients full information on the disease; making patients strictly follow the appropriate hospital visit and treatment schedule based on regular steroid inhalation therapy; instructing patients to always carry their medical history cards for sudden attacks of bronchial asthma; and persuading emergency care centers to permit over-triaging by ambulance teams
重症例からみた気管支喘息治療の現状と危機管理に関する検討
Get PDF1998年よりステロイド剤規則的吸入療法を主体としたガイドライン療法が導入され喘息死は徐々に減少してきたが,2000年度の本邦における喘息死は4,473名を数える.標準的治療が確立されたにもかかわらずなぜ死亡例が多いのかを,救命救急センターに3次救急搬送された重症気管支喘息患者54例を対象に検討した.救急搬送前の投薬内容をみると,ガイドラインにそった治療は行われず,喘息発作時だけβ受容体刺激剤(スプレー)を使用していた症例が平均92.9%でCPA(cardio pulmonary arrest)症例では100%であった.それに対してステロイド剤規則的吸入療法は2例3.7%にしか行われていなかった.気管支喘息を専門とする呼吸器専門医やアレルギー専門医はガイドラインにそった治療を行っているが,一般臨床医には未だ浸透していない可能性が示唆された.気管支喘息死を減少させるには,一般臨床医による患者教育の徹底,ステロイド剤規則的吸入療法をベースにした適切な定期的通院・治療の厳守,発作急変時に備えた病歴カードの常時携帯,救急医療機関側は救急隊のオーバートリアージを容認するなど危機管理の徹底を図ることが重要と考えられた.Asthmatic deaths have been gradually reduced since 1998 when regular steroid inhalation therapy was proved effective and widely introduced as guideline therapy. There were, however, still as many as 4,473 Japanese people who died of asthma in 2000. We examined the reasons for this large number of deaths, despite establishment of the guideline therapy, by investigating emergency patients who were carried to our emergency care center by ambulance as tertiary emergency cases for treatment of serious asthma. The investigation of medications used before emergency arrival showed that patients were not treated according to the guideline therapy: 92.9% of all patients and 100% of CPA (cardio pulmonary arrest) patients were treated with β-receptor stimulators (spray) only when they had asthmatic fits, and regular steroid inhalation therapy was performed on only 2 patients (3.7%). Although respiratory and allergy experts specializing in bronchial asthma follow the guideline therapy, it may not be widespread among general clinicians. To reduce the deaths from bronchial asthma, it is important to fully manage the possible risks of bronchial asthma by making general practitioners give patients full information on the disease; making patients strictly follow the appropriate hospital visit and treatment schedule based on regular steroid inhalation therapy; instructing patients to always carry their medical history cards for sudden attacks of bronchial asthma; and persuading emergency care centers to permit over-triaging by ambulance teams
在宅静脈栄養(Home Parenteral Nutrition: HPN)が著効している重度短腸症候群(Short Bowel Syndrome: SBS)の1例
Get PDF短腸症候群は大腸が正常でも残存小腸が60cm以下では完全静脈栄養(TPN)からの離脱は困難とされる重症病態で,それにともない日常生活範囲も制限されることが多い.我々は残存腸管が食道・胃・十二指腸・S状結腸・直腸の重度短腸症候群で,在宅静脈栄養(以下HPN)に大部分が依存しているが,術後9年間にわたり海外出張をこなすまで社会復帰しているQOLの高い1症例を経験したので報告する.患者は38歳,女性.29歳時,過食後の腹痛・血圧低下により救急搬送され,汎発性腹膜炎の診断で緊急手術を施行した.2期的手術の後,現状となり退院後はHPNによる栄養管理を行い現在に至っている.HPNは皮下埋め込みリザーバーポートを留置し,輸液ポンプを用いて夜間間歇的投与で自由摂食としている.輸液は清潔操作の簡便性と製剤の安定性よりシングルバッグ製剤を用いており,H_2-blockerを800mg/日,微量元素製剤および脂肪乳剤を週2日投与している.また夏季には脱水予防のため細胞外液輸液を追加投与している.退院後9年目の現在,代償性に肥大した十二指腸,軽度骨密度低下を認めるが,栄養状態は良好である.合併症としてTPNの観点からの肝機能障害(脂肪肝)とHPNの観点からのカテーテル感染症があるが,どちらも重症化することなく対処している.国内の長距離移動にはクール宅急便を,海外には郵便輸送によって輸液製剤を搬送しているが,大きなトラブルもなく良好な社会生活を営んでいる.Short bowel syndrome (SBS) is a serious condition that often limits daily activities. This paper reports a case with serious SBS where the residual intestine is limited to the esophagus, stomach, duodenum, sigmoid colon, and rectum (there is no small intestine). Although the patient largely depends on HPN, she has been successfully rehabilitated for 9 years postoperatively and obtained a high QOL. She arrived at our hospital in 1993 in an ambulance due to abdominal pain and hypotension (shock state) after overeating when she was 29 years old. She was diagnosed with general peritonitis and had an emergency operation. After she discharged from hospital, a subcutaneous implantable reservoir port for HPN was placed. She has been allowed to intermittently administer HPN adlibitum with the infusion pump at night. The port had to be replaced twice due to infection and once due to the occlusion of the catheter in 9 years. The following tests were performed to determine her digestion and absorption ability were low, indicating poor digestion. The duodenum and sigmoid colon was enlarged to compensate for the loss of the intestine. For the delivery of infusion preparations for traveling, it is useful to use home delivery services with refrigerated cars for domestic travel and the postal service for travel abroad. The applicable regulations differ between countries
在宅静脈栄養(Home Parenteral Nutrition: HPN)が著効している重度短腸症候群(Short Bowel Syndrome: SBS)の1例
No full text短腸症候群は大腸が正常でも残存小腸が60cm以下では完全静脈栄養(TPN)からの離脱は困難とされる重症病態で,それにともない日常生活範囲も制限されることが多い.我々は残存腸管が食道・胃・十二指腸・S状結腸・直腸の重度短腸症候群で,在宅静脈栄養(以下HPN)に大部分が依存しているが,術後9年間にわたり海外出張をこなすまで社会復帰しているQOLの高い1症例を経験したので報告する.患者は38歳,女性.29歳時,過食後の腹痛・血圧低下により救急搬送され,汎発性腹膜炎の診断で緊急手術を施行した.2期的手術の後,現状となり退院後はHPNによる栄養管理を行い現在に至っている.HPNは皮下埋め込みリザーバーポートを留置し,輸液ポンプを用いて夜間間歇的投与で自由摂食としている.輸液は清潔操作の簡便性と製剤の安定性よりシングルバッグ製剤を用いており,H_2-blockerを800mg/日,微量元素製剤および脂肪乳剤を週2日投与している.また夏季には脱水予防のため細胞外液輸液を追加投与している.退院後9年目の現在,代償性に肥大した十二指腸,軽度骨密度低下を認めるが,栄養状態は良好である.合併症としてTPNの観点からの肝機能障害(脂肪肝)とHPNの観点からのカテーテル感染症があるが,どちらも重症化することなく対処している.国内の長距離移動にはクール宅急便を,海外には郵便輸送によって輸液製剤を搬送しているが,大きなトラブルもなく良好な社会生活を営んでいる.Short bowel syndrome (SBS) is a serious condition that often limits daily activities. This paper reports a case with serious SBS where the residual intestine is limited to the esophagus, stomach, duodenum, sigmoid colon, and rectum (there is no small intestine). Although the patient largely depends on HPN, she has been successfully rehabilitated for 9 years postoperatively and obtained a high QOL. She arrived at our hospital in 1993 in an ambulance due to abdominal pain and hypotension (shock state) after overeating when she was 29 years old. She was diagnosed with general peritonitis and had an emergency operation. After she discharged from hospital, a subcutaneous implantable reservoir port for HPN was placed. She has been allowed to intermittently administer HPN adlibitum with the infusion pump at night. The port had to be replaced twice due to infection and once due to the occlusion of the catheter in 9 years. The following tests were performed to determine her digestion and absorption ability were low, indicating poor digestion. The duodenum and sigmoid colon was enlarged to compensate for the loss of the intestine. For the delivery of infusion preparations for traveling, it is useful to use home delivery services with refrigerated cars for domestic travel and the postal service for travel abroad. The applicable regulations differ between countries
