{"created":"2023-05-25T05:26:34.099140+00:00","id":5377,"links":{},"metadata":{"_buckets":{"deposit":"f88d2ef8-deee-4415-80af-3554781c6851"},"_deposit":{"created_by":17,"id":"5377","owners":[17],"pid":{"revision_id":0,"type":"depid","value":"5377"},"status":"published"},"_oai":{"id":"oai:yamagata.repo.nii.ac.jp:00005377","sets":["29:31:355:356"]},"author_link":["16155","16152","16151","16156","16159","16160","16161","16163","16150","16158","16162","16157","16164","16154","16153"],"item_3_alternative_title_18":{"attribute_name":"その他の言語のタイトル","attribute_value_mlt":[{"subitem_alternative_title":"A case reaffirming the importance of screening CT before ambulation in patients with high risk of pulmonary thromboembolism"}]},"item_3_alternative_title_19":{"attribute_name":"タイトル（ヨミ）","attribute_value_mlt":[{"subitem_alternative_title":"ハイケッセン ソクセンショウ ハイリスク　ショウレイ　ニ　オケル　リショウ　マエ　スクリーニング　CT　ノ　ジュウヨウセイ　オ　サイニンシキ　シタ　イチレイ"}]},"item_3_biblio_info_6":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2022-02-22","bibliographicIssueDateType":"Issued"},"bibliographicIssueNumber":"1","bibliographicPageEnd":"31","bibliographicPageStart":"27","bibliographicVolumeNumber":"40","bibliographic_titles":[{"bibliographic_title":"山形大学紀要. 医学 : 山形医学"},{"bibliographic_title":"Bulletin of the Yamagata University. Medical science : Yamagata medical journal","bibliographic_titleLang":"en"}]}]},"item_3_description_42":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"subitem_description":"論文(Article)","subitem_description_type":"Other"}]},"item_3_description_5":{"attribute_name":"内容記述","attribute_value_mlt":[{"subitem_description":"【背景】肺血栓塞栓症（PTE）の症状は非特異的であり、また重症度においてはショックや突然死に至るものから無症候症例まで幅広く存在する。離床前に行う血栓検索の重要性を再認識した無症候性PTE症例について報告する。\n【臨床経過】患者は40歳女性、身長166 cm、体重124 kg（BMI 45）であった。10日ほど前からの発熱・呼吸困難を主訴に救急外来を受診した。単純CTで両側浸潤影を認め、間質性もしくは細菌性肺炎と診断された。呼吸不全を認め、気管挿管し集中治療室へ入室した。抗菌薬・ステロイド投与により呼吸状態は徐々に改善し、第6病日に抜管した。ICU入室後より予防的ヘパリン投与を行っており、この時点ではPTEを疑う明かな徴候は認めなかった。D-dimerは入院時に約10 μg/mLであり、いったん低下したが再上昇を示し、第7病日には約30 μg/mLと著明高値であった。加えて患者は高度肥満、長期臥床といった血栓症リスク因子を複数認めたため、離床前の確認として第7病日に造影CTを撮影した。CTでは両肺動脈に広範なPTEが確認された。呼吸状態、循環動態は安定しており、離床を延期しヘパリンによる抗凝固療法を強化した。しかし同時期より血小板が減少傾向となり、その後の検査でHIT抗体陽性となった。ヘパリン起因性血小板減少症（HIT）の関与を疑い、抗凝固薬をリバーロキサバンに変更し、呼吸循環悪化なく第14病日に一般病棟へ転出した。\n【考察】今回、症状からは積極的に疑う所見はなかったが、離床前にスクリーニングで施行したCTで診断に至ったPTEの一例を経験した。PTEの約9割は症状からその存在を疑われるが、自覚症状は呼吸困難、胸痛、発熱等の非特異的なものが多い。また院内発症のPTEの場合、18.2％にしか前駆症状がなかったとする報告もあり、PTEは症状のみならず、リスク因子や検査所見から積極的に疑って精査に進む必要がある。\n本症例は血栓症リスク、検査前確率、D-dimerなど複数の因子を用いて、患者の血栓検索必要性について評価し、PTEの診断に至ることができた。\n【結論】院内発症のPTE症例では前駆症状が出にくいことを念頭に置き、注意深い患者観察はもとより、血栓症リスク、PTEの検査前臨床的確率、D-dimer等を評価し、適切に血栓検索を行う必要がある。","subitem_description_type":"Other"}]},"item_3_full_name_2":{"attribute_name":"著者(ヨミ)","attribute_value_mlt":[{"nameIdentifiers":[{"nameIdentifier":"16160","nameIdentifierScheme":"WEKO"}],"names":[{"name":"ソエカワ, キヨタカ"}]},{"nameIdentifiers":[{"nameIdentifier":"16161","nameIdentifierScheme":"WEKO"}],"names":[{"name":"クロキ, マサヒロ"}]},{"nameIdentifiers":[{"nameIdentifier":"16162","nameIdentifierScheme":"WEKO"}],"names":[{"name":"ナリサワ, アユカ"}]},{"nameIdentifiers":[{"nameIdentifier":"16163","nameIdentifierScheme":"WEKO"}],"names":[{"name":"クロタ, ミサト"}]},{"nameIdentifiers":[{"nameIdentifier":"16164","nameIdentifierScheme":"WEKO"}],"names":[{"name":"カワマエ, カネユキ"}]}]},"item_3_full_name_3":{"attribute_name":"著者別名","attribute_value_mlt":[{"nameIdentifiers":[{"nameIdentifier":"16155","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Soekawa, Kiyotaka"}]},{"nameIdentifiers":[{"nameIdentifier":"16156","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Kuroki, Masahiro"}]},{"nameIdentifiers":[{"nameIdentifier":"16157","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Narisawa, Ayuka"}]},{"nameIdentifiers":[{"nameIdentifier":"16158","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Kurota, Misato"}]},{"nameIdentifiers":[{"nameIdentifier":"16159","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Kawamae, 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University"}]},"item_3_text_43":{"attribute_name":"資源タイプ・ローカル","attribute_value_mlt":[{"subitem_text_value":"紀要論文"}]},"item_3_text_44":{"attribute_name":"資源タイプ・NII","attribute_value_mlt":[{"subitem_text_value":"Departmental Bulletin Paper"}]},"item_3_text_45":{"attribute_name":"資源タイプ・DCMI","attribute_value_mlt":[{"subitem_text_value":"text"}]},"item_3_text_46":{"attribute_name":"資源タイプ・ローカル表示コード","attribute_value_mlt":[{"subitem_text_value":"2"}]},"item_creator":{"attribute_name":"著者","attribute_type":"creator","attribute_value_mlt":[{"creatorNames":[{"creatorName":"添川, 清貴"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"黒木, 雅大"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"成澤, あゆ香"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"黒田, 美聡"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"川前, 金幸"}],"nameIdentifiers":[{}]}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_date","date":[{"dateType":"Available","dateValue":"2022-02-22"}],"displaytype":"detail","filename":"kiyoum-40-1-27to31.pdf","filesize":[{"value":"910.1 kB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"kiyoum-40-1-32to35","url":"https://yamagata.repo.nii.ac.jp/record/5377/files/kiyoum-40-1-27to31.pdf"},"version_id":"4272a963-cb87-4e75-b7e9-0ce16f6f42e3"}]},"item_keyword":{"attribute_name":"キーワード","attribute_value_mlt":[{"subitem_subject":"肺血栓塞栓症（PTE)","subitem_subject_scheme":"Other"},{"subitem_subject":"スクリーニング","subitem_subject_scheme":"Other"},{"subitem_subject":"CT","subitem_subject_scheme":"Other"},{"subitem_subject":"D-dimer","subitem_subject_scheme":"Other"},{"subitem_subject":"ヘパリン起因性血小板減少症（HIT）","subitem_subject_scheme":"Other"},{"subitem_subject":"pulmonary thromboembolism（ PTE）","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"screening","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"CT","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"D-dimer","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"heparin-induced thrombocytopenia（ HIT）","subitem_subject_language":"en","subitem_subject_scheme":"Other"}]},"item_language":{"attribute_name":"言語","attribute_value_mlt":[{"subitem_language":"jpn"}]},"item_resource_type":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"resourcetype":"departmental bulletin 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