The Japanese Society of Intensive Care Medicine最新文献_第10页

The Japanese Society of Intensive Care Medicine Pub Date : 2019-01-01 DOI: 10.3918/jsicm.26_43

康二細川, 伸朗志馬

引用次数: 0

Airway obstruction caused by acute transient thyroid swelling following fine needle aspiration biopsy of thyroid gland 甲状腺细针穿刺活检后急性短暂性甲状腺肿胀引起气道阻塞

The Japanese Society of Intensive Care Medicine Pub Date : 2018-05-01 DOI: 10.3918/JSICM.25_195

A. Hashimoto, H. Kinoshita, H. Isobe, Kensuke Sakakibara, Y. Fujita, N. Hatakeyama, Y. Fujiwara

引用次数: 1

Efficacy of nebulized gentamicin in acute exacerbation of bronchiectasis: a case report 庆大霉素雾化治疗支气管扩张急性加重1例疗效观察

The Japanese Society of Intensive Care Medicine Pub Date : 2018-05-01 DOI: 10.3918/JSICM.25_185

Y. Takeda, Takayuki Toki, K. Hoshino, H. Saito, Y. Yanagida, Y. Morimoto

{"title":"Efficacy of nebulized gentamicin in acute exacerbation of bronchiectasis: a case report","authors":"Y. Takeda, Takayuki Toki, K. Hoshino, H. Saito, Y. Yanagida, Y. Morimoto","doi":"10.3918/JSICM.25_185","DOIUrl":"https://doi.org/10.3918/JSICM.25_185","url":null,"abstract":"Bronchiectasis is a chronic progressive disease and represents irreversible morphological changes of the bronchi as a result of inflammation, mainly caused by recurring infection. Acute exacerbation of bronchiectasis can cause potentially life-threatening respiratory complications. However, the optimal treatment remains controversial. We treated a 59-year-old woman with acute exacerbation of bronchiectasis, who complained of respiratory distress. The chest computed tomography scan showed fluid-filled swollen bronchi, suggesting a large volume of sputum. In the ICU, mechanical ventilation, drug therapy including intravenous antibiotics, and postural drainage were performed. However, they did not have sufficient clinical effect in the patient. Therefore, we administered nebulized 120 mg gentamicin every 12 hours. A reduction in purulent sputum and improved respiratory status were observed after a few days, and 34 days after commencing the administration of nebulized gentamicin, we eventually succeeded discontinuing mechanical venti-lation. On the 98th day of hospitalization, the patient was discharged. Treatment with nebulized gentamicin might be effective for patients with acute exacerbation of bronchiectasis.","PeriodicalId":22583,"journal":{"name":"The Japanese Society of Intensive Care Medicine","volume":"30 1","pages":"185-189"},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81226534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

血漿交換によりトシリズマブの除去が疑われたTAFRO（thrombocytopenia, ascites, fever, renal dysfunction, organomegaly）症候群の一症例 TAFRO (thrombocytopenia, ascites, fever, renal dysfunction, organomegaly)综合征的一个病例，被怀疑通过血浆交换去除妥丽珠单抗。

The Japanese Society of Intensive Care Medicine Pub Date : 2018-05-01 DOI: 10.3918/JSICM.25_211

祐介内藤, 聡己井上, 奨太園部, 昌彦川口

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国内初のOriGen® VVDLを用いて救命し得た急性呼吸不全に対するVV-ECMOの一例報告国内首例使用OriGen®VVDL抢救急性呼吸衰竭的VV-ECMO病例报告

The Japanese Society of Intensive Care Medicine Pub Date : 2018-05-01 DOI: 10.3918/JSICM.25_201

崇志居石, 修治齊藤, 勇樹長井, 渡邉伊知郎, 誠一本村, 健裕新津, 拓司吉田, 直樹清水

引用次数: 0

A pediatric case of shoshin beriberi with clinical presentations like septic shock 小儿胫性脚气病例，临床表现为感染性休克

The Japanese Society of Intensive Care Medicine Pub Date : 2018-05-01 DOI: 10.3918/JSICM.25_215

M. Taniguchi, M. Motomura, Yuki Nagai, T. Sueishi, I. Watanabe, T. Niitsu, O. Saito, N. Shimizu

{"title":"A pediatric case of shoshin beriberi with clinical presentations like septic shock","authors":"M. Taniguchi, M. Motomura, Yuki Nagai, T. Sueishi, I. Watanabe, T. Niitsu, O. Saito, N. Shimizu","doi":"10.3918/JSICM.25_215","DOIUrl":"https://doi.org/10.3918/JSICM.25_215","url":null,"abstract":"8ヶ月,女児。身長64 cm(-2.7 SD),体重4.96 kg (-3.6 SD)。既往歴:蛋白漏出性胃腸症。現病歴:生後5ヶ月時に人工乳開始とともに下痢, 下腿浮腫,低アルブミン血症(1.8 g/dl)を認めたため当院に紹介され,ミルクアレルギーに伴う蛋白漏出性胃腸症と診断された。中心静脈栄養,ステロイドで加療され全身状態は改善傾向であった。入院60日目に誘因なく多呼吸,著明な陥没呼吸,頻脈を認めたため PICUに入室した。現症:呼吸数50 /min,SpO2 100% (酸素10 l/ min),血圧100/45 mmHg,心拍数180 /min(洞性頻脈),意識レベルE3V4M4(GCS 11),明らかな神経学的異常所見を認めず,体温36.0°C,四肢末梢冷感は著明であった。検査所見:血液凝固系検査で白血球数が12,900 /μl と軽度上昇,CRPは0.29 mg/dlと低値であり,動脈血液ガス分析ではpH 7.279,PaCO2 16.3 Torr,PaO2 182 Torr,HCO37.4 mmol/l,BE-18.3 mmol/l,乳酸19.0 mmol/l,glucose 376 mg/dlと著明な乳酸アシドーシスと高血糖を認めた。胸腹部X線,心電図,心臓超音波検査で有意な異常所見を認めなかった。 ICU入院後経過(Fig. 1):気管挿管を行い人工呼吸管理を開始した。末梢血管抵抗上昇を伴うショックを考える中で,輸液負荷が脈拍数低下に寄与せず,心臓超音波検査結果から心原性ショックも考え難かったため,敗血症性ショックに伴うcold shockを考えた。末梢血管を開存させつつ血圧を維持するため,ミルリノン0.5μg/kg/minとアドレナリン0.02μg/kg/minを開始し,抗菌薬(ピペラシリンナトリウム200 mg/kg/ day,バンコマイシン40 mg/kg/day)も投与した。入室2時間でヒドロコルチゾン100 mg/m2/day,入室6 時間でγグロブリン150 mg/kg/doseも投与したが, ショックは遷延し高度頻脈および乳酸アシドーシスは改善に乏しかった。遷延するcold shockの原因として衝心脚気を考え, 入室後13時間でビタミンB1を2 mg/kg投与したところ,数時間の経過でバイタルサインと乳酸アシドーシスの改善を認めた。ビタミンB1投与前の血中濃度は 18 ng/ml (正常値24〜66 ng/ml)と低値であり、入室前の中心静脈栄養にビタミンB1が含有されていなかったことが判明した。入室翌日に抜管し,5日目に一般病棟へ転棟した。敗血症性ショック様の臨床像を呈した小児衝心脚気の一例","PeriodicalId":22583,"journal":{"name":"The Japanese Society of Intensive Care Medicine","volume":"27 1 1","pages":"215-216"},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82705780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A case of acute kidney injury and coma possibly due to a massive xylitol infusion for nephrogenic diabetes insipidus 肾源性尿崩症患者因大量木糖醇输注所致急性肾损伤及昏迷1例

The Japanese Society of Intensive Care Medicine Pub Date : 2018-05-01 DOI: 10.3918/JSICM.25_199

Masahiro Akaishi, E. Hashiba, Daichi Ota, Erika Amanai, Tomoyuki Kudo, T. Niwa, K. Hirota

引用次数: 0

A case of severe hyponatremia caused by cisplatin chemotherapy 顺铂化疗致重度低钠血症1例

The Japanese Society of Intensive Care Medicine Pub Date : 2018-05-01 DOI: 10.3918/JSICM.25_213

Hisashi Dote, Y. Ishida, H. Ueda, S. Takayama, Kenji Mineta, Koichi Ohsugi, T. Atsumi, Shigeru Tanaka

{"title":"A case of severe hyponatremia caused by cisplatin chemotherapy","authors":"Hisashi Dote, Y. Ishida, H. Ueda, S. Takayama, Kenji Mineta, Koichi Ohsugi, T. Atsumi, Shigeru Tanaka","doi":"10.3918/JSICM.25_213","DOIUrl":"https://doi.org/10.3918/JSICM.25_213","url":null,"abstract":"63歳,女性。身長146 cm,体重37.5 kg 。既往歴:2型糖尿病(食事療法)。病歴:約5週間前に不正性器出血の精査により子宮頸癌(stageIVa)と診断され,2週間前から同時化学放射線療法が開始された。CDDPの副作用対策としてデキサメタゾン,フロセミドが併用され飲水励行を指導されていた。1日前に3クール目のCDDPが投与され, 同日はNa 125 mmol/lとやや低値だった。来院当日は放射線治療を受け,その際嘔気を自覚していた。一旦帰宅し2時間後に意識障害を呈し救急搬送された。搬送中に1分程度の強直性痙攣を起こした。来院時,呼吸数18 /min,SpO2 93%(室内気),BP 116/73 mmHg,HR 69 /min,GCS E2V1M4 。瞳孔は正円同大(3 mm)で正中,対光反射はあり,四肢の麻痺はなかった。身体所見,心エコーで明らかな脱水は認めなかった。血液検査でBUN 12 mg/dl,Cr 0.63 mg/dl,Na 102 mmol/l,Cl 72 mmol/l,K 3.2 mmol/l, 尿酸2.9 mg/dl,血糖213 mg/dl,浸透圧218 mOsm/ kg 。尿浸透圧450 mOsm/kg,尿中Na 68 mmol/l,尿中K 43.6 mmol/l,尿中Cl 63 mmol/lであった。頭部 CTで異常は認めず,高度の低Na血症による症状と判断しICUへ入室した。入室後は1〜2時間ごとにNaの値を確認しつつ補正を行った。経過中尿量が増加し予想以上のNa補正速度となったため一時的に輸液を5%ブドウ糖液へ変更,抗利尿作用を期待しバソプレシンを併用した。血糖は来院9時間後を最大として454 mg/dlまで上昇したが,前後の時間帯は200 mg/dl前後で推移した。25 時間後の時点でNa 113 mmol/lまで上昇,従命可能となった(Fig. 1)。その後Naは第5病日に124 mmol/l まで上昇,ICUを退室した。後日,第1病日の検査結果が判明し,antidiuretic hormone(ADH)2.5 pg/ml (基準値:2.8 pg/ml以下),血漿レニン活性 0.4 ng/ ml/hr,甲状腺機能や副腎機能は正常であった。ADH は第5病日に0.9 pg/ml,第16病日に測定感度以下(同日Na 137 mmol/l)と低下した。また本人から病歴聴取したところ,入院前の飲水量は1 l/day前後とのことであった。放射線治療を継続し第20病日にNa 136 mmol/lで軽快退院した。","PeriodicalId":22583,"journal":{"name":"The Japanese Society of Intensive Care Medicine","volume":"11 1","pages":"213-214"},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75686685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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A case of superior vena cava syndrome and airway obstruction as a complication of ascending aortic aneurysm 升主动脉瘤并发上腔静脉综合征及气道阻塞1例

The Japanese Society of Intensive Care Medicine Pub Date : 2018-05-01 DOI: 10.3918/JSICM.25_203

Yoshiaki Sekiya, H. Yamada, Yuichi Araki, N. Matsumiya

{"title":"A case of superior vena cava syndrome and airway obstruction as a complication of ascending aortic aneurysm","authors":"Yoshiaki Sekiya, H. Yamada, Yuichi Araki, N. Matsumiya","doi":"10.3918/JSICM.25_203","DOIUrl":"https://doi.org/10.3918/JSICM.25_203","url":null,"abstract":"62歳,男性。身長168 cm,体重57 kg 。既往歴なし。 3ヶ月前から呼吸困難と喘鳴を認めたため近医を受診し,気管支喘息の診断で加療されていた。某日,仰臥位で増悪する呼吸困難に耐えられず,救急要請した。側臥位でも症状は改善せず,救急隊接触時は立位の状態で,意識清明,血圧219/130 mmHg, 脈拍数160 /min,呼吸数36 /min,SpO2 70%(室内気),喘鳴あり,頸静脈と胸壁静脈,腹壁静脈が著明に怒張していた(Fig. 1a)。顔面の浮腫は認めなかった。前医に救急搬送され,酸素10 l/min投与でもSpO2 80%台と低値であったため,気管挿管が施行された。 CT検査を施行したところ,上行大動脈に径88 mmの大動脈瘤を認め,上大静脈と両側気管支を圧排していた(Fig. 1b)。これより,一連の症状は喘息によるものではなく,上行大動脈瘤による上大静脈症候群と気道圧排の症状と診断され,手術目的として当院に転院搬送された。転院後,同日中に上行大動脈瘤切除,人工血管置換術を施行した。搬送から手術までの間,仰臥位になると用手換気困難,酸素化の増悪を認めたため,継続して頭高位で管理した。術後経過は良好で,第19病日, 独歩で退院した。","PeriodicalId":22583,"journal":{"name":"The Japanese Society of Intensive Care Medicine","volume":"46 1","pages":"203-204"},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85596328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Postoperative atrial fibrillation in thoracic surgery 胸外科术后心房颤动

The Japanese Society of Intensive Care Medicine Pub Date : 2018-05-01 DOI: 10.3918/JSICM.25_171

Taisuke Yokota

{"title":"Postoperative atrial fibrillation in thoracic surgery","authors":"Taisuke Yokota","doi":"10.3918/JSICM.25_171","DOIUrl":"https://doi.org/10.3918/JSICM.25_171","url":null,"abstract":"④risk factors, ⑤non-cardiac surgery Abstract New-onset atrial fibrillation is a common complication in the intensive care unit. The incidence of postoperative atrial fibrillation (POAF) is high, especially after cardiac surgery. Compared with cardiac surgery, the information on POAF occurring in non-cardiac surgery is not sufficient. In non-cardiac surgery, POAF occurs mainly on the postoperative day 2, which prolongs hospital stay and increases mortality rate. Medical prophylactic agents may effectively reduce POAF. After POAF onset, rate-control or rhythm-control is used, but it is unknown whether these treatments are truly effective. In perioperative management, the incidence of POAF differs depending on the type of pulmonary resection surgery. Patients taking statins and beta-blockers before the operation should continue to take them, and patients with POAF should take magnesium sulfate when serum magnesium concentration is low. The definition of POAF differs depending on each study, and there are many uncertain points. In this paper, we discuss POAF epidemiology, risk factors, prophy-laxes, and treatments mainly for pulmonary resection, esophagectomy, and lung transplantation.","PeriodicalId":22583,"journal":{"name":"The Japanese Society of Intensive Care Medicine","volume":"47 1","pages":"171-177"},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84724158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0