急性血液浄化における各種重症度スコアの評価と予後の検討  [in Japanese] The evaluation of four scoring systems for critical care during acute blood purification therapy  [in Japanese]

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Abstract

急性血液浄化において治療前に重症度スコアを算出し,患者の予後を推測することは治療選択や医療資源の有効利用の点から非常に重要であり,患者家族へのインフォームドコンセント(IC)にも有用と思われる.今回われわれは2005年12月から2006年5月までの6か月間で緊急透析の依頼をうけた症例28例を生存群14例と死亡群14例に分け,APACHEIIスコア,SOFA,MODS,日本救命医療学会臓器障害度指数(以後,救命指数と略す)の4つを用いて評価し,予後判定の精度や有用性,経済性について検討した.その結果,APACHEIIスコアより算出された院内予測死亡率においては生存率と死亡率の間で有意差を認めず,SOFAが9点以下,MODSが5点以下,救命指数が6点以下の10例で生存率100%であった.また,単独のスコアでは救命指数が予後を最も正確に反映する重症度スコアであると思われた.急性血液浄化療法は多臓器不全や重症患者において有効な治療法であるが,その反面,他の治療法と比較して1回あたりの費用も非常に高く医療コストもかかるため,適応は科学的根拠に基づいてより厳選すべきであると思われる.

During acute blood purification, it is very important to estimate the severity and prognosis precisely in order to select the appropriate treatment and manage medical resources efficiently. Such a precise estimate can be also useful for explaining the situation to a patient and family during the informed. Twenty-eight patients who needed acute dialysis in our hospital between December 2005 and May 2006 were divided into two groups. The first group of 14 patients died after treatment and the second group of 14 patients survived. The prognosis was assessed by 4 scales : APACHEII, SOFA, MODS, and the Japanese organ severity score, and the appropriateness of the treatment and uses of medical resources were also evaluated. APACHEII score did not show any significant difference between the two groups. However, when scores were under 9 points by SOFA, under 5 by MODS, and under 6 by Japanese organ severity score, the patient survival rate was 100%. Especially, the Japanese organ severity score was the most reliable of the four scales in estimating the prognosis precisely. Blood purification treatment is an effective treatment, but its medical cost is extremely high. Therefore, we have to select the treatment and patient appropriately.

Journal

  • Nihon Toseki Igakkai Zasshi

    Nihon Toseki Igakkai Zasshi 42(10), 761-767, 2009-10-28

    The Japanese Society for Dialysis Therapy

References:  14

Codes

  • NII Article ID (NAID)
    10026315548
  • NII NACSIS-CAT ID (NCID)
    AN10432053
  • Text Lang
    JPN
  • Article Type
    ART
  • ISSN
    13403451
  • NDL Article ID
    10481452
  • NDL Source Classification
    ZS39(科学技術--医学--皮膚科学・泌尿器科学)
  • NDL Call No.
    Z19-1413
  • Data Source
    CJP  NDL  J-STAGE 
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