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エイズ患者の重症室でのケア
R M Wachter1, J M Luce, P C Hopewell
1Medical Service, San Francisco, General Hospital Medical Center, University of California 94143-0862.
JAMA
|January 22, 1992
まとめ
既得免疫不全症候群 (AIDS) 患者,特に肺胞性肺炎 (PCP) と呼吸器不全の患者を対象とした重症治療は,生存率の改善を示しています. 生命維持装置に関する決定は,個々の臨床状態と患者の希望を考慮する必要があります.
科学分野:
- クリティカルケア・メディシン
- 感染症 感染症は感染症です.
- 公衆衛生は公衆衛生である.
背景:
- 既得免疫不全症候群 (AIDS) は,集中治療施設で複雑な課題を提示しています.
- Pneumocystis pneumonia (PCP) に起因する呼吸器不全は,エイズ患者の集中治療のための一般的な指示です.
研究 の 目的:
- エイズ患者の重症治療における臨床的および倫理的な問題を検討する.
- 集中治療を必要とするエイズ患者の治療結果と治療戦略を評価する.
主な方法:
- エイズ患者の重症治療に関する公表された研究と要約の体系的なレビュー.
- HIV/AIDSを記録した結果に関する研究を含み,推定症例を除外した.
- フィールドエキスパートとの協議.
主要な成果:
- PCPによる呼吸不全のエイズ患者の生存率は,0~14%から36~55%に大幅に改善されました.
- PCPの効果的な治療には,静脈内トリメトプリム-スルファメトキサゾールまたはペンタミジンと補助的なコルチコステロイドが含まれます.
- 他の疾患のために重症治療を必要とするエイズ患者は,一般的に,よりよい予後を示します.
結論:
- エイズ患者,特にPCP患者に対する重症治療は,無駄ではありません.
- 治療の決定は,臨床的状況と患者の好みに基づいて個別化されるべきです.
- 生存傾向の改善を理解し,予測要因を特定するためにさらなる研究が必要です.
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