合理的な臨床検査について. この患者さんは低血圧症ですか?
S McGee1, W B Abernethy, D L Simel
1Department of Medicine, University of Washington, Seattle-Puget Sound VA Health Care System, 98108, USA.
JAMA
|March 23, 1999
まとめ
成人における低血圧症の診断は,重要な姿勢の脈動の変化や,失血による重度のめまいに依存する. 他の理由で,物理的な兆候はほとんど信頼できないため,確実性を確かめるために実験室での検査が必要になります.
科学分野:
- 緊急医療 緊急医療
- 内科内科は,内科の内科である.
- クリニカル診断士
背景:
- 低血圧症は,血量減少の状態であり,成人では診断上の課題を提示します.
- 正確な身体診断は,迅速かつ効果的な患者管理に不可欠です.
研究 の 目的:
- 成人患者における低血量症の診断のための身体検査の結果を体系的に検討する.
- 異なるヒポボレミア病因における様々な身体的徴候の診断的有用性を評価する.
主な方法:
- MEDLINEやその他の情報源 (1966-1997) の体系的な文献検索を行った.
- 健康なボランティアの骨髄切除術後の体姿勢の生命徴候と毛細血管補充時間に関する10件の研究を含めた.
- 疑似低血量症で救急治療室に通院した患者に関する4つの研究を含めた.
主要な成果:
- 重度の姿勢のめまいが,または脈拍の上昇が≥30拍数/分であることは,著しい失血の重要な指標である (大きな失血に対して97%の感度).
- 副静脈低血圧と低心圧は,かなりの血液損失 (33%の感度) にもかかわらず,しばしば欠けています.
- 非出血性低血圧症では,乾燥した下が診断を支持し,湿った粘膜と滑らかな舌がそれに反対する.
結論:
- 失血による低血量症の臨床診断には,重要な姿勢の生命体記号の変化が必要であり,中等度の症例では欠席することがあります.
- 嘔吐,下痢,または不十分な摂取による低血量症の場合,物理的な発見は限られた有用性を持っています.
- 血清電解質,BUN,およびクレアチニンは,非出血性低血量症の診断の確実性にとって不可欠です.
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