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セプシス の 回復 を 促進 する: レビュー
Hallie C Prescott1,2, Derek C Angus3,4
1Department of Internal Medicine and Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor.
JAMA
|January 4, 2018
まとめ
セプシスの生存者は 機能的,認知的,精神的な健康障害を含む 長期的な課題に直面します 病院後のケアでは,これらの問題に対処し,一般的な合併症をモニタリングして患者のアウトカムを改善する必要があります.
科学分野:
- クリティカル ケア 医療
- 感染症
- 公衆衛生
背景:
- セプシスは毎年世界中で1千9百万人以上が罹患し,約1千4百万人が病院から退院しています.
- セプシスの生存率は向上し,多くの場合長期的な健康被害を被る生存者の数が増加しています.
- 現在のセプシスガイドラインには,病院後のケアと患者の回復に関する具体的な勧告がありません.
研究 の 目的:
- セプシスの生存者が経験する 長期的な身体的,認知的,精神的健康障害を強調する
- セプシスの生存者に対する 総合的な病院後のケア戦略の必要性を強調する.
- セプシス入院後の悪い結果に関連する一般的な合併症とリスク要因を特定する.
主な方法:
- セプシスと病院後のケアに関する既存の文献と臨床ガイドラインのレビュー.
- セプシスの生存者における障害の発生率と再入院率に関するデータの分析
- セプシス治療後の有害な結果に関連する要因の検討
主要な成果:
- 敗血症の生存者はしばしば新たな機能的制限,認知障害,精神的健康問題 (不安,うつ,PTSD) を発症する.
- 感染症や慢性疾患の悪化のために,約40%のセプシス生存者が90日以内に再入院します.
- セプシスの生存者は,他の患者グループと比較して,再発性感染症,急性腎不全,および新たな心血管疾患のリスクが高くなります.
- 専門家の推薦は,死亡率の減少を示す観察データによって支持された,機能能力の改善のための物理療法の推薦を含みます.
結論:
- セプシスの生存者の病院後の管理には,身体的,精神的,認知的な問題のスクリーニングと治療が含まれなければなりません.
- 感染症や心不全などの 治療可能な疾患の定期的な薬剤検査と評価は 極めて重要です
- 症状の緩和に重点を置くのは,既往の健康状態が悪い患者では,セプシスの回復後に適切である.
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