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֪͢ǽᬩᏹგȐȎ6078062 ̱᥆ࢍࠞᇼԖᬩᏹဪ̜႔2ȑ
Department of Emergency Medicine, Rakuwakai Otowa HospitalȐ2, Otowa chinnjicho, yamasina, Kyoto, Japanȑ
Tel: 0755934111ǽFax: 0755015747
◆⸻ᢿᛛⴚ⻠ᐳ◆
ᛡᛡᛡᛡᛡᛡᛡᛡᛡᛡᛡᛡᛡᛡᛡᛡᛡᛡᛡᛡᛡᛡᛡᛡᛡᛡᛡᛡᛡ
はじめに
ǽᣋࢳᴩCritical CareɁඬȾɛɝ۹ᒨب˪п
ᴥMOF: multiple organ failureᴦɁผჵɂᆬ
ȾױȨɟȷȷȕɞȟᴩး٣Ⱥɕ4ᒨب͏˨Ɂ ˪пᒨبɥᄉდȪȲکնɁୗ֤လɂ˪ᓦȺȕ ɞ1)ᴫ۹ᒨب˪пɁผჵȾ᪨ȪȹɂᴩȰɁდ ࣊ɥᄑᆬȾΙȪఙȾӛȽผჵɥᩒܿȬɞ ȦȻȟᛵȺȕɞᴫ ǽᒨب᪩Ɂდ࣊Ιศɂᴩ॑˪пপᐐȾΈ ႊȨɟɞForresterґ᭒ȽȼɁɛșȽյᒨبȾ ࿑ႱᄑȽΙศȻᴩρȁɁᒨبൡᑤȾߦȬɞ࿑ ႱॴɂऍԇȬɞɕɁɁ۹ᒨب᪩ɥ፱֪ȻȪȹ સțɞΙศȾ۾ҝȨɟɞᴫటሟȺɂऻᐐɁ۹ ᒨ ب ൡ ᑤ ᪩ დ ψ ᏰᴥMODS: multiple organ
dysfunction syndromeᴦȾߦȬɞΙศȾȷȗȹ ᣖɌɞᴫ 多臓器機能障害症候群（MODS）の 重症度評価基準 ǽდ࣊ΙศȾɂᴩቼˢȾρȁɁপᐐȾȷȗ ȹᜊᄑȽ̙ऻ̙ລȟժᑤȽൈȺȕɞȦȻᴩ ቼ̝Ⱦߦ៎পᐐɥ࠙ҝԇȪᴩஃᜫᩖȺผჵ ɁᢎՒɆষڨ̬૰ɁȲɔɁцᣮൈȻȪȹൡ ᑤȪीɞȦȻᴩቼ˧ȾպˢপᐐɁგৰɁጽᄑ ۰ԇɥᣜᡀȬɞȦȻȾɛɝผჵਖ਼ɁᦉȻȽ ɞȦȻᴩȽȼɁᏲȟސ٣Ȭɞᴫ ǽMODSɁΙژໄɂّю۶Ⱦȹୣ۹Ȣ૬ᇉ ȨɟȹȠȲȟᴩൈɁ࣊ɁࢃႱᴩᒨبුɁ᪩ ᄉდɁᩖࢃᴩյᒨبɁผჵՕख़ॴɁᄾᤏȽ ȼɁျႏȞɜፋˢȨɟȲΙژໄɂᇉȨɟȹȗ ȽȗᴫSIRSɁകॡɥ૬כȪᪿ˹ผჵɁᬻڒȺ ˹॑ᄑमҾɥȲȪȹȗɞACCP / SCCPնպ ɵʽʟɫʶʽʃȾȝȗȹɕᴩMODSɁްᏲɥ ᇉȬȾႡɑɝᴩȰɁΙژໄȾȷȗȹɂՒȨ ɟȽȞȶȲᴫ ǽటሟȺɂးཟȺˢख़ɁಏચȻܵछॴȟᇉȨ ɟᴩȞȷࢿȢႊȗɜɟȹȗɞMODSȾߦȬɞ დ࣊ΙศȾȷȗȹകᝢȬɞᴫ 重症度評価法の種類と特徴 ǽး٣ΈႊȨɟȹȗɞ˿Ƚ፱նდ࣊ҜްศȻ Ȫȹɂ͏˩ɁɕɁȟȕɞᴫ
1ᴦ APACHE (acute physiologic and chronic health
臓器障害の診断法
ާ ႎ ѧ णᴧ
Evaluation methods for the severity of multiple organ dysfunction syndrome
Fuyuhiko YASUDA.M.D.ᴧ
Key words: multiple organ dysfunction syndrome (MODS),
acute physiologic and chronic health evaluation (APACHE), sequential organ failure assessment (SOFA),
cellular injury score (CIS)
ާႎѧण ᐔᚑరᐕਃ㊀ᄢත㧘หᄢቇ㒮ಽሶ∛ᘒቇᢎቶ ߦߡ࠶࠻ࡊࡠ࠹ࠗࡦ㧿ߩ⎇ⓥߦߡඳ჻ภข ᓧ㧚หᄢቇ⢷ㇱᄖ⑼කຬ㧘ഥᚻ߮㓸ਛᴦ≮ ㇱᢇᕆㇱഥᚻߥߤࠍ⚻ߡ㧘* ᐕ߆ࠄ㜞⍮Ꮢ ┙Ꮢ᳃∛㒮ᔃ⤳ⴊ▤ᄖ⑼ක㐳ࠍോࠆᔃ⤳ⴊ ▤ᄖ⑼߮ᢇᕆኾ㐷කߢࠅ㧘* ᐕ߆ࠄ੩ ㇺᵡળ㖸⠀∛㒮ᢇᕆࡦ࠲ㇱ㐳㧘 ߦ⥋ࠆ㧚
evaluation) IᴩIIᴩIII
2ᴦ SAPS (simplified acute physiology score) IᴩII
3ᴦ MODs (multiple organ dysfunction score)
4ᴦ SOFA (sequential organ failure assessment)
5ᴦ CIS (cellular injury score)
ǽȦɟɜɁʃɽɬʴʽɺʁʃʐʪɂȬɌȹᒨب ᪩Ɂდ࣊ɥΙȬɞȲɔȾͽȨɟȲɕɁ ȺȕɝஃᜫȾɛɝ๊ႊኰٍɂറȁȺȕɞȟᴩͽ ȨɟȲᄻᄑȞɜ۾ȠȢ2ȷȾґ᭒ȺȠɞᴫȬ Ƚɢȴ̙ऻΙɥȪȹͽȨɟგৰɁდ ࣊ȾᩜȪȹ࣊Ɂᯚȗʃɽɬʴʽɺʁʃʐʪ ᴥAPACHEᴩSAPSᴦȻᴩผჵӛɥҜްȬɞɁ Ⱦ ҟ ႊ Ι Ϗ Ɂ ᯚ ȗ ʃ ɽ ɬ ʴ ʽ ɺ ʁ ʃ ʐ ʪ ᴥMODsᴩSOFAᴩCISᴦȺ ȕ ɞᴫ ͏ ˩ Ⱦ յ ȁ Ɂ
ʃɽɬʴʽɺʁʃʐʪɁകᛵɥᣖɌɞᴫ 予後評価を重視したスコアリングシステム （APACHE, SAPS） ǽAPACHE ʃ ɽ ɬ ɂ1981ࢳᴩKanusɜ ȟ34 ᬱᄻɁൈɥʃɽɬԇȪᴩȰɁնȾɛɝ̙ऻ ҜްɥᚐȶȲɕɁȺȕɞᴥAPACHE IᴦᴫȰɁऻ ൈɁᬱᄻɥዊጨԇȪᴩΙɁԨጠԇɥஃȪȹ ᄉ᚜ȨɟȲɁȟAPACHE IIȺȕɞ2)ᴫ ǽAPACHE IIȺɂ֣ˁैၥˁ೫౼ʑ˂ʉኄ ȽȼɁ15ᬱᄻȾȷȗȹ4᪡Ⱦґ᭒ȪᴩȦɟ ȾࢳᳮᴩᑔȾȕɞ৻ॴপȽȼɁʃɽɬɥӏ țȹͽȨɟɞᴫȾȦɁϏɥɕȻȾ፯ॲ࣊Ȼ পɁɒȸȤɥᚐȗᴩ̙ລඳ̪လȟአҋȨɟ ɞᴥᝊጯȽአҋศȾȷȗȹɂऻᣖᴦᴫAPACHE III ȺɂAPACHE IIȺႊȗɜɟȲႆျޙᄑൈ ɥᓦȪᴩᚌɶʃȽɜɆȾᇘጽጕɁႱࢠȾ ᒲɁཟୣԇɥᚐȶȲᴫɑȲপґ᭒ɕጯґԇȪ ȹAPACHE IIɛɝඩᆬॴᴩឧҝᑤɥտ˨ȨȮ ȲᴫȪȞȪᴩAPACH IIIȺɂ̙ऻ̙ລአɁȲ ɔɁপɁɒ͇ȤΡୣɗоጽᡅҝɁΡୣȟ у᚜ȨɟȹȗȽȗȲɔᴩਾȟّȺɂႊȨɟɞ ȾᒴȶȹȝɜȭᴩးཟȺɂAPACHE IIɁ ȟႊȨɟȹȗɞᴫ ǽȾʟʳʽʃɥ˹॑ȻȪȹᴩȦɁAPACHE ʃɽɬʴʽɺʁʃʐʪɥᴩɛɝԨጠԇȪგৰȾ ߦȪȹպኄɁඩᆬȨɥ΄ȮɕȶȲൈȻȪȹᩒ ᄉȨɟȲɁȟSAPS I ȺȕɞᴫȰɁऻSAPS Iɂ ᓦȨɟᴩSAPS IIȻȽɝᴩ֣ˁឧʶʣʵˁ ैၥˁࠇᦀȽȼ15ᬱᄻȾȷȗȹоӌɥᚐșȦ ȻȾɛɝዊԨȾʃɽɬȟአҋȨɟɞɛșȾȽ ɝᴩ˿ȻȪȹʲ˂ʷʍʛȺΈႊȨɟȹȗɞ3) ᴫ ǽȦɟɜɁʃɽɬʴʽɺʁʃʐʪɁ̙ऻΙȾ ߦȬɞᤛնॴȾᩜȪȹɂ۾ȠȽࢃɂᝓɔȭ4) ᴩ ඔዢȺɂȗȭɟɁʃɽɬʴʽɺɕպൌȺΈႊ Ȩɟȹȗɞᴫ ǽȰɁऻඳ̪̙ລလɛɝɕผჵɁױӛɁҜ ްɗᒨب˪пɁ̙᩻ȾȠɥᏚȢɌȠȺȕɞȻ ɁᐎțȞɜᴩȲȽʃɽɬʴʽɺʁʃʐʪȟᆬ ȨɟɞɛșȾȽȶȲᴫȰɁՁҬɂᴩḧᒨب˪ пɥall or nothing ȺȻɜțȽȗȦȻᴩḨᒨب ˪пɂᩖጽᤈȻȻɕȾ۰ԇȪȹəȢɁȺጽ ᄑ۰ԇɥȻɜțɞȦȻȟȺȠɞȦȻᴩḩᒨب˪ пɁҜژໄɂԨጠȺՕेȪȹዊԨȾीɜɟɞ ʑ˂ʉȾɛɞɕɁȺȕɞȦȻᴩɁ3ཟȻȨɟȲᴫ 治療効果の判定を重視した
スコアリングシステム（MODs, SOFA, CIA）
ǽMODSɁდ࣊ɥୣϏԇȪᴩপᐐɁ̙ऻ̙ ລȻȻɕȾผჵӛɁҜްɥᚐșȦȻɥᄻൈȾ ᩒᄉȨɟȲʃɽɬʴʽɺʁʃʐʪȻȪȹɵʔʊ ɁMarshall ɜȟ1995ࢳȾᄉ᚜ȪȲɁȟMODs ᴥMOD scoreᴦȺȕɞ1) ᴫMODsɂյᒨبɁൈ ȻȽɞᚌ೫౼ϏɁ۰ӦՒɆʚɮʉʵɿɮʽɁ ۰ӦȻȗșႆျޙᄑ۰ԇȾژȸȗȹΙȬɞȲ ɔᜊॴȟȕɝᴩ۹ஃᜫᩖȺɁᢎȽȼɕ߁ ȾႊȗɞȦȻȟҋ఼ɞᴫȦɁൈɂʣʍʒɿɮ ʓȺጽᄑȾგৰɥʃɽɬʴʽɺȬɞȲɔȾͽ ȨɟȲɕɁȺȕɞȲɔAPACHEʃɽɬȾ ɌɞȻ೫౼ᬱᄻɁ࣊ɗ࿑Ⴑ࣊ɂɗɗӐɞȟᴩ ᚐȬɞᒨب᪩Ɂდ࣊ɥɛȢՕȪȹȗ ɞᴫȦɁʁʃʐʪȺɂ6ᒨبጕᴥᑐᴩᑷᒨᴩᑄ ᒨᴩैၥᴩᚌᴩᇘጽᴦɁᒨب᪩Ɂሌ࣊ɥ0 ᵻ4ȺɁ5᪡ȺཟୣԇȪᴩȰɁ፱նཟȺდ
࣊ɥΙȪȹȗɞᴫȰɁ࿑ौɂैၥɁΙȾ
PAR ᴥpressureadjusted heart rateᴦȟႊȗɜɟ
ȹȗɞཟȺȕɞᴫPARȻɂ॑ઍୣx˹॑ᑩ ٢/ࢲ٫Ӧᑩ٢ȺአȨɟɞ۰ୣȺȕɝᴩ॑ᚌ ከጕɁൡᑤɥୖȾՕȬɞȻɢɟȹȗɞᴫ ȪȞȪ˹॑ᑩ٢ȟລްȺȠȽȗდɗˢɁ დȺ˹॑ᑩ٢ϏȟඩᆬॴɥඑȢکնɕȕ ɝᴩȦɁൈɁᫍཟȺɕȕɞᴫ ǽMODsȻȽɜɦȺఊɕႊȽ۹ᒨبΙɁ ȲɔɁʃɽɬʴʽɺʁʃʐʪȻȪȹSOFA ʃɽ ɬȟȕȥɜɟɞ5) ᴫSOFAʃɽɬɂɕȻɕȻɂ sepsisȾɛɞMODSɁΙɁȲɔȾ૬כȨɟ Ȳȟᴩsepsis͏۶Ɂ۹ᒨب˪пɁΙศȻȪȹ ɁႊॴȟᝓɔɜɟᴩటᤳȺɕࢿȢΈႊȨɟɞ ɛșȾȽȶȲᴫSOFAʃɽɬɁ۾ȠȽ࿑ौɂै ၥبጕɁΙȾȕɝᴩɵʐɽʳʩʽɁੵ˫ȟ ΙژໄȾֆɑɟȹȝɝᴩɛɝးᄑȽΙศ ȟႊȨɟȹȗɞᴫ ǽSOFAʃɽɬɂʣʍʒɿɮʓȺ1ஓȾͷوȺ ɕΙժᑤȺȠᴩյᒨبɁൈɂᣵፖ۰ୣȺȕ ɞȲɔผჵɁफᬭɥՙȤȾȢȢგৰɁሉɥੰ ૱ȪɗȬȗɛșȾͽȨɟȹȗɞᴥᝊጯȽአҋ ศȻΙȾȷȗȹɂऻᣖȬɞᴦᴫ ǽɑȲᒨب˪пɥյᒨبɥढȬɞጯᑛɁൡᑤ ˪пɁ፱֪ȻȻɜțᴩጯᑛ᪩࣊ɥΙȬɞ
CIS ᴥcellular injury scoreᴦȻȗșდ࣊Ҝްศ
ȟ1998ࢳȾOdaɜȾɛɝᐎಘȨɟȲ6)ᴫȦɁ ൈɂጯᑛ᪩ɥऀȠᠭȦȬՁىȻȽɞൈȻ ጯᑛ᪩ɁፀȻȪȹႆȫɞ۰ԇɥΙȬɞɕ ɁȺȕɞᴫȦɁΙศɂ۹ᒨب˪пɁటৰȺȕ ɞጯᑛ᪩ɥreal timeȾΙȺȠᴩൈɁ ױȟผჵᄻൈȻȽɝीɞȦȻȞɜࢠȾႊȽ დ࣊ΙศȺȕɞᴫȦɁʃɽɬʴʽɺʁʃʐ ʪȺɂᑄᚌํɁͲ˩ɗᑄጯᑛൡᑤ᪩ȾɛɝͲ ˩ȬɞAKBR ᴥӦᑩᚌ˹ɻʒʽͶᴦᴩ᪩Ȩ ɟȲጯᑛȞɜํҋȪȲ unmeasurable solute Ɂ ᦀɥՕȪȹȗɞOsmolality Gap ᴥOGᴦᴩᒨبᘑ ᚌȾɛɞጸᎥͲᥣጨɥՕȬɞᚌ˹̓ᥣϏɁ3 ᬱᄻɥʃɽɬʴʽɺȪȹΙȪȹȗɞᴥ表1ᴦᴫ ጯᑛ᪩ɂᚌდɥܿɔᴩდॲॴᒛཕᴩ۶ Ͼᴩਖ਼ᚓΞᛰȽȼȾɛȶȹɕᄉდȬɞȲɔᴩȦ ɁʃɽɬʴʽɺʁʃʐʪɂপɁሗ᭒Ⱦᩜɢɜ ȭდ࣊ɥΙȺȠɞᴫCISʃɽɬɂგৰɁ ױȾͧȗʃɽɬȟͲ˩ȬɞȲɔผჵᄻᄑȾɕҟ ႊȺȠɞཟȺҟႊΙϏȟᯚȗȻȨɟȹȗɞ7)ᴫ ȦɁʃɽɬʴʽɺɁᫍཟɂᚌ˹ɁɻʒʽͶȟ ஃᜫȾɛȶȹɂȬȣȾລްȺȠȽȗȦȻȺȕɞᴫ ǽඒȾȦɟɜɁʃɽɬʴʽɺʁʃʐʪɁ˹Ȟɜ छʅʽʉ˂ȺΈႊȪȹȗɞAPACHE IIȻSOFA ʃɽɬȾȷȗȹȨɜȾᝊጯȽአҋศȻȰɁΙ ȾȷȗȹᜓᝢȬɞᴫ ・APACHE IIスコア ǽɑȭȌAȍᴥ表2-1ᴦɁܩȢᴩ12Ɂႆျᄑʛʳ ʫ˂ʉȾȷȗȹผჵɁफᬭɥՙȤȽȗდ࣊ɥ ҜްȬɞȲɔᴩICUоऻ24ᩖ͏юɁఊম
ϏᴥAPS: acute physiology soreᴦɥᝩɌᴩඩࢠɁ
0ʧɮʽʒȞɜȼɟȳȤᫌɟȹȗɞȞɥፏߦϏ ȺʧɮʽʒԇȬɞᴫȰɟȾȌBȍࢳᳮɁʧɮʽ ʒᴩȌCȍ΄ސ৻ॴপɁʧɮʽʒᴥ表2-2ᴦɥ ԨጠȾ፱ȪȹAPACHE IIʃɽɬɥአҋȬɞᴫ ࢲ٫Ӧᑩ٢ȟ˪ȺՖ᎔ఙՒɆછएఙᚌ٢ȪȞ ᜤ᧸ȾȽȗکնɂᴩࢲ٫ᚌ٢ᴥBPᴦᴺȈ2Xછए ఙ٢ᴨՖ᎔ఙ٢Ć3ȉȻȪȹአȬɞᴫӦᑩᚌ ᥣጨ༟࣊ȾȷȗȹɂFiO2ȟ0.5ఝȺȕɟɃ PaO2ϏɁɒȺΙȺȠɞȟᴩFiO2ȟ0.5͏˨ ɁکնᴩAaDO2ɥɔɞ॒ᛵȟȕɞᴫAaDO2 ɥአҋȬɞکնᴩఊɕɝɗȬȗɁɂʨʃɹੵ ˫˩ȺɁFiO2ϏɁᜫްȺȕɞᴫᄻާȻȽɞ ൈɥ表3ȾᇉȪȲᴫ ǽឧʶʣʵɁΙȺɂJCSʶʣʵɁɒɁষ
表1ǽCellular Injury Score (CIS) አҋɁʧɮʽʒ
AKBR >0.7 0.7䌾0.41 0.40䌾0.26 <0.25 Osmorality Gap䇭 (mOsm/kg䊶H2O) 䋼2.3 2.3䌾10.0 10.1䌾20..0 >20.1 ⴊਛLactate (mg/dl) 䋼17 17䌾25 26䌾50 >51 䋰 䋱 䋲 䋳 Point
ȌAȍᴷAPSʃɽɬᴺ˨ᜤ12ൈɁཟୣն ȌBȍᴷࢳᳮʧɮʽʒᴸ0ཟᴷƿ44දᴩ1ཟᴷ45ᵻ54දᴩ3ཟᴷ55ᵻ64දᴩ5ཟᴷ 65ᵻ74දᴩ6ཟᴷǀ75ද ȌCȍᴷ৻ॴপʧɮʽʒᴥኹȽᒨبൡᑤ˪пɑȲɂе˪пɁஒऱɁȕɞȻȠᴦ ǽaᴷਖ਼ᚓɑȲɂ፯ॲਖ਼ᚓऻᴸ5ʧɮʽʒ ǽbᴷްఙਖ਼ᚓऻᴸ2ʧɮʽʒ ᴹ৻ॴপɁްᏲᴻ ǽǽḧᑄᴸႆ೫ȾȹᆬᝓȨɟȲᑄᆕ۰ᴩᩌᑩ٢̫დȝɛɆᩌᑩ٢̫Ⱦɛɞ˨ԇከҋᚌɁஒऱᴩɑȲɂᑄ˪пˁ ᑄॴᑲდˁᑄॴᅙɁȕɞȦȻ ǽǽḨ॑ᚌከጕᴸNYHA classIV ǽǽḩ֣بᴸ৻ॴકశॴˁᩐڸॴɑȲɂᚌከপȺ࣊ɁᤆӦ᪩ᴥ᪡ɥ˨ȟɟȽȗᴩ̜ȟȺȠȽȗȽȼᴦȟ ȕɞȦȻᴩ৻ॴͲᥣጨდᴩᯚཚᥣɶʃᚌᴩ̝ඒॴ۹ᚌდᴩდᑐᯚᚌ٢დᴥᴻ40mmHgᴦᴩɑȲɂ̷ࡾ֣ب ᫌᑱ˪ᑤ ǽǽḪе˪пᴸ౫ɋɁӌɥੱҤȬɞผჵᴥеੱҤҷᴩჹԇޙჵศᴩߪ፷ྃߪᴩᩋఙɑȲɂး٣Ɂ۾ᦀɁ ʃʐʷɮʓੵ˫ȽȼᴦɥՙȤȹȗɞᐐᴩɑȲɂ౫ɋɁӌɥᕻȾນȫɞপᴥᄌᚌგᴩʴʽʛᒀɑȲɂ AIDSȽȼᴦȾᏠপȪȹȗɞᐐ
ڨȪȞȽȗکնȟȕɝᴩGCSʃɽɬȾ૰አȬ ɞ॒ᛵȟȕɞᴫ表4ȾɂJCSʶʣʵȻGCSʃ ɽɬɁዊȽ૰አ᚜ɥᇉȪȲᴫAPACHE IIʃ ɽɬɂ0ᵻ71ཟȻȽɝᴩʃɽɬɁۄӏȾͧȗ Ⱦඳ̪လɂ˨Ȫᴩʃɽɬ30ᵻ34Ⱥɂඳ ̪လ73%ᴩ35͏˨Ⱥɂ84ᴢȾɕՒɉᴫю̙ ລඳ̪လȾȷȗȹɂICUоɁՁىপɁ ɒȸȤɥᚐȗᴩ̙ඳ̪လRȟአҋȨɟɞᴫ አࣻȻȪȹɂᴩkᴺ3.517ᴨ0.146ąAPACHE II scoreᴨ0.603ąᴥ፯ॲਖ਼ᚓᴺ1ᴩȰɟ͏۶ᴺ 0ᴦ + পҝɁɒ͇ȤୣϏɥአȪᴩ̙ລඳ ̪လɂR=eK/ ᴥ1+eKᴦȻȪȹአҋȨɟɞᴫ۶ ߦ៎ɂ16දఝᴩྒϾᴩўӦᑩপɁপᐐȺ ȕɞᴫȪȞȪ˨ᜤɁܩȢᴩ̙ລඳ̪လɁአࣻ ɂአȟ॒ᛵȻȽɝᴩ྄᫆ȺȕɞȲɔ͏˩Ⱦᇉ Ȭɮʽʉ˂ʗʍʒ˨ɁAPACHEᒲӦአɁʥ ˂ʪʤ˂ʂɥҟႊȬɞศɕȕɞᴫᴥhttp://www. sfar.org/scores2/apache22.htmlᴦᴫ ・SOFAスコア ǽȦɁʃɽɬʴʽɺʁʃʐʪȺɂᴩ֣ൡᑤˁ Ѽِൡᑤˁ॑ᚌከˁឧʶʣʵˁᑄൡᑤˁᑷൡ ᑤɁ6ᬱᄻȾȷȗȹᒨب᪩Ɂሌ࣊ɥ5᪡ 表3ǽᥣጨੵ˫ɁFiO2૰አ᚜ 表4ǽJCSȻGCSɁ૰አ᚜ ⚻㥦䉦䊇䊤 ㉄⚛䊙䉴䉪 䊥䉱 䊷䊋䊷䊙䉴䉪
1L
2L
3L
4L
5L
6L
7L
8L
9L
10L
0.24
0.28
0.32
0.36
0.40
0.44
0.4
0.45
0.5
0.55
0.6
0.65
0.6
0.7
0.8
0.9
0.35
0.3
0.9
0.5
JCS
GCS
0 䇭 ⥄⊒⊛䈮䋨䋴䋩䇭䇭䇭ᒰ⼂䈱䈅䉎ળ䋨䋵䋩䇭䇭䇭䈮ᓥ䈉䋨䋶䋩䇭䇭䇭 䋱䋵䇭䇭 1 2 3 䇭ᒰ⼂䈱䈭䈇ળ䋨䋴䋩䇭䇭 䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭 䋱䋴 䋱䋰 䈶䈎䈔䈮䉋䉍䋨䋳䋩䇭䇭䇭䇭 䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭 䋱䋳 䋲䋰 䇭ᷙੂ䈚䈢⸒⪲䋨䋳䋩䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭 䋱䋲 䋳䋰 ∩䉂䈮䉋䉍䋨䋲䋩䇭 䇭ℂ⸃ਇ⢻䈱㖸ჿ䋨䋲䇭䋩 䇭 −∩ㇱ⼂䋵䋩䇭䇭 䇭䋹 䋱䋰䋰 䉁䈦䈢䈒䈭䈇䋨䋱䋩䇭 䉁䈦䈢䈒䈭䈚䋨䋱䋩䇭䇭䇭䇭䇭䇭䇭䇭 䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䋷 䋲䋰䋰 䇭䇭ㅏㆱዮᦛ䋨䋴䋩䇭䇭 䇭䋶 䇭⇣Ᏹዮᦛ䋨䋳䋩䇭䇭 䇭䋵 䇭િዷ䋨䋲䋩䇭䇭䇭䇭䇭 䇭䋴 䋳䋰䋰 䇭 䇭䉁䈦䈢䈒䈭䈚䋨䋱䋩 䇭䋳I
II
III
㐿⌒䋨E㪀
⸒⺆䋨V㪀
ㆇേ䋨M㪀
⸘
ᢥ₂䋱䋷䋩䉋䉍ෳᾖȺΙȪᴩյᒨبුɁཟୣɁ፱֪Ⱥდ࣊ɥ
ΙȬɞᴥ表5ᴦᴫ֣بɂᥣጨԇୣȺΙȨ
ɟᴩALI ᴥacute lung injuryᴦȾᄾछȬɞPaO2ᴬ
FiO2ᴹ300ȟʃɽɬ2ᴩARDS ᴥacute respiratory
distress syndromeᴦȾᄾछȬɞᴹ200ȟʃɽɬ 3ᴩ֣ᛃӒɥᚐțɃʃɽɬ3͏˨ȻȪȹȗɞᴫ ȦɁʃɽɬɁɒɂյᒨبᩖȺᢎȺȠɞɛș ȾȰɠțȹȕɝᴩʃɽɬ1ᴩ2ɂᒨب᪩ᴩʃ ɽɬ3ᴩ4ɂᒨب˪пɁްᏲȾᄾछȬɞᴫѼِ ጕɂᚌߴୣȺΙȨɟՀႆᅁDICᜱژໄ ɁᚌߴୣɁᬱᄻɁ3ཟȾᄾछȬɞᚌߴ5 ˥͏˩ȟ3ཟ͏˨ȻᜫްȨɟȹȗɞᴫ˹ᇘጽ
ጕ Ⱥ ɂGlasgow Coma Scale Ⱥ Ι Ȩ ɟ ɞ ȟᴩ ᨕҷੵ˫ɂΙȺȠȽȗᴫᑷൡᑤɂɹʶɬ ʋʕʽȻ1ஓࠇᦀȾȹΙȨɟɞᴫᑄൡᑤȾȷ ȗȹɂ࣊ȟͲȗȻଊȨɟȹȗɞȟʝʴʵʝ ʽϏȺΙȪȹȗɞᴫ॑ᚌከጕɁΙȺɂᴩɵ ʐɽʵɬʩʽɁΈႊᄻᄑȾɛɝཟୣԖґȟȽȨ ɟȹȗɞᴫɵʐɽʵɬʩʽɁΈႊᩒܿɂʃɽ ɬ2ཟȻȨɟᴩᚌ٢Ɂ፟ધɥᄻᄑȻȪȲɵʐɽ ʵɬʩʽɁੵ˫ȾȽɟɃᴩȰɁੵ˫ᦀȾख़ȫȹ 3ᴩ4ȻӏཟȨɟɞᴫȦɁศɂᔌࢱᜊॴȾ එȤɞȦȻɂքްȺȠȽȗȟᴩ᪨Ɂᒱࣂးک ȺɂΈႊȪɗȬȗᴫȦɁʃɽɬʴʽɺʁʃʐʪ ɂICUоȞɜʣʍʓɿɮʓȺ߁Ⱦоਖ਼ ȺȠɞລްᬱᄻȾژȸȗȹጽᄑȾአҋժᑤȺ ȕɞཟȾȝȗȹࢠȾԨጠԇȨɟȲӛလᄑȽ ൈȺȕɞᴫ ǽʃɽɬʴʽɺɁඩᆬॴȾȷȗȹɂᴩᇘጽޙᄑ ΙȻ֣ൡᑤΙɁʃɽɬʴʽɺɁᩖᤏȗȟ ఊɕ۹ȗȻȨɟȹȗɞȲɔ8) ᴩJCS ൈɁ૰አ ᚜ȻFiO2ɁϏɥඩᆬȾҜްȬɞȦȻȟ۾ҒȺ ȕɞᴫ ǽSOFAʃɽɬɥᆬȪȲVincentɜɂඔࡻɁ ۹ஃᜫ೫ȾȹSOFA ʃɽɬȻ̙ऻȻɁᯚȗᄾ ᩜॴɥᜳȪȹȗɞ5) ᴫDIC পᐐɁ̙ऻȾȝȤ 表5
ɞ೫ȺɕႆސᏰȺSOFAʃɽɬȟႆސᏰɛ ɝȾᯚϏɥᇉȪȹȝɝᴩඳ̪ᏰȻSOFAʃ ɽɬɁᩖȾᄾᩜᩜΡȟᝓɔɜɟȲ9) ᴫICUо ऻ48ᩖ͏юȾSOFAʃɽɬȟນߵȪȲপᐐ ᏰɂʃɽɬȟۄӏȪȲপᐐᏰȾߦȪᕻȪȢඳ̪ လȟͲ˩ȪȹȗɞȦȻȟڨ֖ȨɟᴩSOFAʃɽ ɬɁፕፖΙɁႊॴȟᜳȨɟȹȗɞ10ᴦ ᴫɑ
ȲICUᣝҋऻɁ̙ऻȻICUᣝҋɁSOFAʃ
ɽɬɁᩜᣵɥᝩɌȲፀᴩSOFAʃɽɬȟ5ཟ ɥᠯțȲکնᴩ5̷Ⱦ1̷ɂඳ̪ȪȹȗȲȻɁ ڨ֖ɕȕɝᴩგɋɁ࢜ҜȾɕᛵȽൈ ȻȽɞȦȻȟᇉȨɟȹȗɞ11ᴦᴫ ǽյᒨب᪩ɁᄉႆఙȾᩖࢃȟȕɞȦȻȞ ɜյລްஓȧȻɁSOFA ʃɽɬȺɂপᐐȟᏠপ ఙᩖ˹Ⱦɞᒨب᪩ɗ˪пɁሌ࣊ɥᤈߴΙ ȬɞঃɟȟȕɞȻȨɟᴩSOFAʃɽɬɥε᭰Ȫ
ȲTotal maximum SOFA score ᴥTMSᴦȟᇉȨɟ
Ȳ12ᴦᴫTMSɂΙఙᩖ˹ɁյᒨبʧɮʽʒɁ ఊᯚϏɥնȪȹीɜɟɞɕɁȺᴩপᐐɁ̙ऻ ̙ລɁඩᆬॴȟտ˨ȪȲᴫȨɜȾҰوአҋȨɟ ȲʃɽɬȻɁࢃᴥ∆SOFA ʃɽɬᴦɥᝩɌɞȦ ȻȾɛɝᴩผჵȾߦȬɞՕख़ॴɥᜊᄑȾੰ૱ ȺȠɞȦȻȟᇉȨɟȲᴫ ǽ͏˨ȾᇉȪȲAPACHEᴩ SOFAʃɽɬʴʽɺ ʁʃʐʪɁᒲӦአʇʟʒɂɮʽʉ˂ʗʍʒ˨ ȺуᩒȨɟȹȝɝᴩ͏˩ɁɿɮʒɋፖȬɟɃ ΈႊȺȠɞᴫᴥhttp://www.sfar.org/s/article.php3?id article=60ᴦᴫ 新しい臓器障害の指標 ǽᣋࢳᴩյሗʫʑɭɲ˂ʉɁमҾȾᩜȬɞᆅሱ ȟґފႆ࿎ޙᄑਖ਼ศɁᩒᄉȻᄾɑȶȹ᭣ᡮᄑȾ ඬȪȹȝɝᴩMODSɁఙᜱȻผჵɁȲ ɔ࣊ɁᯚȗႊȽൈȟڨ֖Ȩɟȹȗɞᴫ ᚌდɁґȾȝȗȹɂᴩ౫დᄉდɁՁىȻȽ ɞ߂˿Ɂ౫᩻ॅൡᑤȞɜఙɁ̙ລىފɥᝩ ɌɞศȻȪȹԨ္ȾȝȤɞHLADRɁᄉး ᦀȟລްȨɟᴩ۶ϾɗsepsisɁপᐐɁ̙ऻȻ ᄾᩜȬɞȦȻȟᇉȨɟȲ13ᴦ ᴫImaiɜɂ॑ᚌከਖ਼ ᚓপᐐɁᑑю̝ᥣԇཚጨ٢˨ȟᚓऻɁն΄დ ɁൈȻȽɞȦȻᴩSOFAʃɽɬȻɁȽᄾ ᩜȟȕɞȦȻɥڨ֖Ȫȹȗɞ14ᴦ ᴫɑȲࠇ˹ɋɁ ॊᦀɬʵʠʩʽҋȟᑷൡᑤ᪩ᴩ۹ᒨب᪩ Ɂ̙ລىފȻȪȹႊȺȕɞȻɁڨ֖ɕȕɞ15ᴦ ᴫ ǽɑȲᘑᚌˁѓํᴩ౫ᴩ۶ϾɁȗȭɟɁΞ ᛰȾȝȗȹɕཕდॴɿɮʒɵɮʽȾӏțȹ࿑ ႱᄑȾʒʷʽʝʽȟႇႆȨɟȹȝɝᴩᒨب˪п ɁᄉდȾѼِ፷໎Օख़ȻཕდɁᩜᣵȟᩜ˫Ȫȹ ȗɞȦȻȟҜȪȹȝɝᴩᒨب᪩ɁൈȻȪ ȹɁDICɁᛵॴȟᯚɑȶȹȠȹȗɞᴫ2005 ࢳȾஓటୗॲԗޙ͢Ȼஓటඨᚌޙ͢ȟԦպȪȹ ͽȪȲॲॴఙDICژໄɂᴩDICɁდ࣊Ҝ ްȻȪȹҟႊժᑤȺȕɞȻպȾผჵᦉȻȪ ȹɕΈႊȺȠɞȦȻȟڨ֖Ȩɟȹȝɝ16)ᴩȦɟ ȞɜɁMODSɁდ࣊ΙศȾɕफᬭȬɞɕ ɁȻ९ɢɟɞᴫ おわりに ǽటሟȺɂMODSɁდ࣊ΙศȾȷȗȹᜓ ᝢȪȲᴫȪȞȪյȁɁʃɽɬʴʽɺʁʃʐʪȾ ɂᒨب࿑ႱॴɁץᭉɗյᒨبɁผჵՕख़ॴɁᄾ ᤏȽȼ۹ȢɁץᭉȟරȨɟȹȗɞᴫးཟȺɂ ȰɟȱɟɁʃɽɬʴʽɺʁʃʐʪɁ࿑ौɥੰ૱ ȪᴩᄻᄑȾख़ȫȹ΄ႊȬɞȦȻȟఊᓦȻ९ɢɟ ɞᴫȦșȪȲး٣Ɂʃɽɬʴʽɺʁʃʐʪɥᄉ ࠕȨȮᴩᣋȗ఼߬ᴩᒨبൡᑤ᪩Ɂდ࣊Ι ȾӏțȹᒱࣂးکȺ߁ȾລްȺȠᴩȞȷผჵ ӛɁҜްɕȺȠɞȪȗʃɽɬʴʽɺʁʃʐ ʪȟ૬כȨɟɞȦȻȟఙशȨɟɞᴫ 文 献
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16ᴦ˽ᗵǽᴩߪکୖᴩՠǽៈᴩɎȞᴷॲॴఙDICᜱ
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17ᴦߴۢᴷდψȾߦȬɞқఙผჵᴸឧ᪩ᴫࠞ๕ᴩ
៹ॎᴩᑲᇘጽ۶ᇼͶጕ5ǽᑲᇘጽ۶ᇼୗॲ˹ࠞం
