昏睡の可逆的な原因の診断
Jonathan A Edlow1, Alejandro Rabinstein2, Stephen J Traub3
1Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Rochester, MN, USA.
Lancet (London, England)
|April 29, 2014
まとめ
コマの診断には,回復可能な原因を迅速に特定し,治療するための構造的なアプローチが必要です. これには,患者の安定化,病歴,検査,および,必要に応じて脳イメージングなどの標的型調査が含まれます.
科学分野:
- 神経学 神経学とは
- 緊急医療 緊急医療
背景:
- 昏睡は様々な病因を呈し,体系的な診断戦略を必要とします.
- 構造的な脳損傷,拡散神経機能障害,精神病学的原因を含む昏睡のメカニズムを理解することは極めて重要です.
研究 の 目的:
- コーマの可逆的な原因の迅速な診断と治療のための構造化されたアルゴリズム的アプローチの概要を述べる.
- 脳イメージングなどの診断介入に関する意思決定を医師に指導するためです.
主な方法:
- 生命を脅かす状態に対処する患者の初期安定化.
- 患者の病歴,身体検査,検査結果を用いて診断する.
- 構造的病変が疑われる場合,脳画像検査 (CT) を採用し,さらに高度な画像検査または非診断CTのための特定のチェックリストを使用します.
主要な成果:
- 構造的なアプローチでは,安定化が優先され,その後に病因学的調査が行われます.
- 脳イメージングは,外傷後の昏睡状態や,構造的病変が起こり得る場合に推奨されます.
- 非診断的なCTでは,チェックリストが,中毒,感染症,発作,内分泌病,チアミン欠乏症などの治療可能な状態のさらなる評価をガイドします.
結論:
- コマの迅速な診断と管理には,体系的でアルゴリズム的なアプローチが不可欠です.
- ターゲットを絞った調査を通じて,回復可能な原因を早期に特定することで,患者のアウトカムが改善されます.
- 定期的な再評価と診断チェックリストの使用は,初期調査が不確定である場合に不可欠です.
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