Peritoneal lavage with hydrogen-rich saline can be an effective and practical procedure for acute peritonitis
概要
㢟ྡ㸸Ỉ⣲ྵ᭷⏕⌮㣗ሷỈࡼࡿ⭡⭍ෆὙίࡣࠊᛴᛶ⭡⭷⅖࠾࠸࡚ࠊຠᯝⓗࡘᐇ⏝ⓗ࡞⒪
ἲ࡞ࡾᚓࡿࠋ
ᗈᓥᏛᏛ㝔 ་ṑ⸆ಖᏛ◊✲⛉ ᾘჾ࣭⛣᳜እ⛉Ꮫ
బ⏣ ᶞ
ᗎㄽ㸸
ᛴᛶ⭡⭷⅖ࡣᮍࡔ⮴Ṛⓗᝈ࡛࠶ࡾࠊṚᅉࡢከࡃࡣᩋ⾑ࡀᘬࡁ㉳ࡇࡍከ⮚ჾ࡛࠶ࡿࠋࡑࡢ
ᶵᗎࡣᵝࠎ࡞ᅉᏊࡀ㛵ࡍࡿࡀࠊࡑࡢ୰࡛ࡶάᛶ㓟⣲ࡀᘬࡁ㉳ࡇࡍ㓟ࢫࢺࣞࢫࡀ⒪ᶆⓗ
ࡋ࡚ὀ┠ࡉࢀ࡚࠸ࡿࠋ ᖺ⃝ࡽࡀࠊỈ⣲ศᏊࡀ⏕యෆ࡛㞀ᐖᛶࡢ㧗࠸άᛶ㓟⣲✀ࢆ㑅
ᢥⓗ㑏ඖࡍࡿሗ࿌ࡋ࡚௨㝆ࠊỈ⣲࢞ࢫࡢ྾ධࠊỈ⣲ྵ᭷⏕⌮㣗ሷỈࡢ㣧Ỉࡸ⭡⭍ෆὀධࡢຠ
ᯝࡀሗ࿌ࡉࢀࠊᩋ⾑ᑐࡋ࡚ࡶ᭷ᮃ࡞⒪ἲ⪃࠼ࡽࢀ࡚࠸ࡿࠋ୍᪉࡛ࠊỈ⣲ࡢᢞ᪉ἲࡣ
ㄢ㢟ࢆせࡋ࡚࠸ࡿࠋ⭡⭷⅖ࡢ⒪ࡣᡭ⾡ࢆせࡍࡿࡇࡀከࡃࠊࡑࡢ㝿ࡣ⭡⭍ෆὙίࢆ⾜࠺ࡇ
ࡀከ࠸ࠋࡑࡇ࡛ࠊᡃࠎࡣࠊỈ⣲⒪ἲࢆࡼࡾᑟධࡋࡸࡍ࠸᪉ἲࡋ࡚ࠊỈ⣲ྵ᭷⏕⌮㣗ሷỈ࡛⭡
⭍ෆὙίࢆ⾜࠺ࡇࡀ᭷ຠ࡛࠶ࡾࠊࡘᏳ࡛࠶ࡿࢆ᳨ウࡋࡓࠋ
᪉ἲ㸸
ձ ▷㛫࡛㧗⃰ᗘࡢỈ⣲ྵ⏕⌮㣗ሷỈࡢ⢭〇ჾࡢస〇ࠋ
ղ ᛴᛶ⭡⭷⅖ᑐࡍࡿỈ⣲ྵ᭷⏕⌮㣗ሷỈ⭡⭍ෆὙίࡢࠊࣛࢵࢺࢆ⏝࠸ࡓ᭷ຠᛶ࣑ࢽࣈࢱࢆ
⏝࠸ࡓᏳᛶᐇ⏝ᛶࡢ᳨ドࠋ
$ ))LVKHU ࣛࢵࢺ 㐌㱋㸸┣⭠⤖⣻✸่ࣔࢹ࡚ࣝ⭡⭷⅖ࢆㄏⓎࡋࠊ㏻ᖖࡢ⏕⌮㣗ሷỈ
⭡⭍ෆὙίࢢ࣮ࣝࣉ㸦16 ⩌㸧Ỉ⣲ྵ᭷⏕⌮㣗ሷỈ⭡⭍ෆὙίࢢ࣮ࣝࣉ+56 ⩌ศࡅࠊẚ
㍑ࡍࡿࠋ┣⭠⤖⣻✸่ࡣ┣⭠ቨࢆ ࢤ࣮ࢪࡢ㔪࡛ ᅇ✸่ࡍࡿࡇ࡛㔜ᩋ⾑ࡍࡿࠋ
㛢⭡ᚋ㸴㛫࡛ࠊቯṚ┣⭠ࢆษ㝖ࡋࠊ⭡⭍ෆὙίࢆ P/ ࡢ ࠸ 16 ࡲࡓࡣ +56 ࡛⾜࠸ࠊ
⭡⭍ෆ PO ࡢ 16 ࡲࡓࡣ +56 ࢆ‶ࡓࡋࡓᚋࠊ㛢⭡ࡋࡓࠋ
ホ౯㡯┠
㸧 ⏕Ꮡᮇ㛫
㸧 㛢⭡ᚋ㸱㛫࠾ࡅࡿ
D⫢⭈ᶵ⬟㞀ᐖ㸸$67ࠊ$/7ࠊ%81ࠊ&UH ࠾ࡼࡧ⌮Ꮫⓗᡤぢ
Eᢠ㓟ຠᯝ㸸య㔜࠶ࡓࡾࡢᒀ୰ 2+G*
Fᢠ⅖ຠᯝ㸸:%&ࠊ3/7ࠊ71)Șࠊ,/
Gᢠ࣏ࢺ࣮ࢩࢫຠᯝ㸸⤌⧊࠾ࡅࡿ %FO㸦⭈࣭⫢㸧࠾ࡼࡧ %D[㸦⭈㸧ࡢⓎ⌧
%࣑ࢽࣈࢱ㸸 㢌⏝ࡋࠊ┣⭠✸Ꮝࣔࢹ࡚ࣝ⭡⭷⅖ࢆㄏⓎࡍࡿࠋ㛤⭡ࡋࠊᅇ┣ᘚࡢୗࡢ┣⭠
ቨ FP ࡢษ㛤ࢆ⾜࠺ࠋ⭡⭍ෆᡠࡋࠊᅽ㏕ࡋ࡚⣅౽≀㉁ࢆ⭡⭍ෆᢲࡋฟࡋࡓᚋࠊ㛢⭡ࡍ
ࡿࠋ 㛫ᚋࠊ㛤⭡ࡋࠊ✸Ꮝࡋࡓ┣⭠ࢆ㝖ཤࡍࡿࠋ⭡⭍ෆὙίࢆ / ࡢ 16 +56 ࡛⾜ࡗࡓᚋ
ࠊ/ ࡢ 16 ࡲࡓࡣ +56 ࢆ⭡⭍ෆṧࡋ㛢⭡ࡋࠊ 㛫ᚠ⎔ືែࢆࣔࢽࢱ࣮ࡍࡿࠋ
ホ౯㡯┠
㸧ᚠ⎔ືែ㸸ᚰ㟁ᅗࠊື⬦ᅽࠊ㓟⣲㣬ᗘࠊᒀ㔞ࠊ࠾ࡼࡧᚰᢿᩘ
㸧ື⬦⾑࢞ࢫ ᐃ㸸 㛫ࡈࡢ S+ ࠾ࡼࡧ 3D2ࠊ3D&2$EERWW3RLQWRI&DUH,QF
3ULQFHWRQ1-
㸧ᢠ㓟ຠᯝ㸸య㔜࠶ࡓࡾࡢᒀ୰ 2+G*
⤫ィศᯒ㸸ࢹ࣮ࢱࡣᖹᆒsᶆ‽೫ᕪࡋࠊࡍ࡚ࡢ⤫ィศᯒࡣࠊ-03 ࢆ⏝ࡋࡓࠋ
⤖ᯝ㸸
ձ Ỉ⣲ྵ᭷⏕⌮㣗ሷỈࡢ‽ഛ
Ỉ⣲࢞ࢫࢆ㧗ᅽ㸦3D㸧ࡢỈ㐣㣬ࣞ࣋ࣝࡲ࡛⁐ゎࡉࡏ࡚ࠊ 㛫࡛Ỉ⣲ྵ᭷⏕⌮㣗ሷỈ
㸳/ ࢆ⏕ᡂࡍࡿ⨨ࢆ㛤ⓎࡋࠊࡑࡢỈ⣲⃰ᗘࡢᖹᆒࡣ SSP ࡛࠶ࡗࡓࠋ
ղ ࣛࢵࢺ㸸
⏕Ꮡᮇ㛫㸸+56 ⩌࡛⭡⭷⅖ᚋࡢ⏕Ꮡᮇ㛫ࡀ᭷ពᘏ㛗ࡋࡓ+56 YV 16 PHGLDQ VXUYLYDO +56
KYV16KS 㸧ࠋ
⫢⭈ᶵ⬟㞀ᐖ㸸+56 ⩌࡛᭷ព⫢⭈ᶵ⬟㞀ᐖࢆᢚไࡋࡓ+56YV16$67s8/
YVs8/Sࠊ%81sPJG/YVsPJG/
S ࠊ&UHsPJG/YVsPJG/S 㸧ࠋ
⤌⧊⌮Ꮫⓗศᯒ㸸16 ⩌࡛ࡣ✵⬊ࢆక࠺⫢⣽⬊ኚᛶࡸࠊᛴᛶᒀ⣽⟶ቯṚࡋ࡚㏆ᒀ⣽⟶
㧗ዲ㓟⌫ᛶ≀㉁ࢆㄆࡵࡓࠋ୍᪉࡛ࠊ+56 ⩌࡛ࡣࡑࡢᵝ࡞ᡤぢࢆㄆࡵ࡞ࡗࡓࠋ
ᢠ㓟ຠᯝ㸸+56 ⩌ࡢయ㔜࠶ࡓࡾࡢᒀ୰2+G* ࡣ 16 ⩌ࡼࡾࡶ᭷ពపࡗࡓ㸦+56YV16
sYVsSJNJKS 㸧
ࠋ
ᢠ⅖ຠᯝ㸸+56 ⩌࡛ 71)Ș࡛᭷ព࡞ῶᑡࡀぢࡽࢀࡓ㸦+56YV16sYVs
SJP/S 㸧
ࠋ୍᪉࡛ࠊ,/㸦+56YV16sYVs
SJP/S 㸧:%&3/7 ࠾࠸࡚ࡣ᭷ព࡞ᕪࢆㄆࡵ࡞ࡗࡓࠋ
ᢠ࣏ࢺ࣮ࢩࢫຠᯝ㸸+56 ⩌ࡣ⭈࡚ %FO ࡢⓎ⌧ࡀୖ᪼ࡋࠊ⭈࠾ࡼࡧ⫢࠾ࡅࡿ %D[ ࡢⓎ⌧ࢆ
ῶᑡࡉࡏࡓࠋ+56YV16㸹୰➼ᗘ௨ୖࡢⓎ⌧ẚ⋡%FO㸰㸸⭈ s㸣YVs㸣ࠊ
S %D[㸸⭈㸸s㸣YVs㸣S ࠊ⫢⮚㸸sYV
s㸣S 㸧
ࠋ
࣑ࢽࣈࢱ㸸16 +56 ࡢ࣑ࢽࣈࢱࡶࠊྠᵝࡢ⾑ᅽ್ S+ࠊ3D2ࠊ3D&2 ࡢ᥎⛣ࢆ♧ࡋࡓࠋᒀ
୰2+G* ࡣ +56 ᢞࡢ࣑ࢽࣈࢱ࡚ᢞ᪩ᮇὙίᚋ 㛫࠾࠸࡚ 16 ᢞ࣑ࢽࣈࢱࡼࡾప࠸
್࡛࠶ࡗࡓࡀࠊὙίᚋ 㛫࡛ࡣ ࡘࡢ࣑ࢽࣈࢱ࠾ࡅࡿᒀ୰2+G* ࡣࡰྠࡌ್ࢆ♧ࡋࡓࠋ
⪃ᐹ㸸
+56 ࡼࡿ⭡⭍ෆὙίࡣࠊ⏕Ꮡ⋡ࡢྥୖࠊ⫢࠾ࡼࡧ⭈ᑐࡍࡿಖㆤຠᯝࠊᢠ㓟స⏝ࠊ
ᢠ⅖స⏝ࠊ࠾ࡼࡧᢠ࣏ࢺ࣮ࢩࢫస⏝ࢆㄆࡵࡓࠋࡉࡽࠊᆺື≀㸦࣑ࢽࣈࢱ㸧ࣔࢹ࡛ࣝᐇ⾜
ྍ⬟࡛ᚠ⎔ືែᙳ㡪ࢆ࠼࡞࠸ࡇࢆ☜ㄆࡋࡓࠋ
ᩋ⾑ࡀᘬࡁ㉳ࡇࡍከ⮚ჾࡣࠊ⮚ჾ࠾ࡅࡿ࣑ࢺࢥࣥࢻࣜ㞀ᐖࡀ㛵ࡋ࡚࠸ࡿሗ࿌
ࡉࢀ࡚࠸ࡿࠋࡇࢀࡣάᛶ㓟⣲ࡼࡾ㞀ᐖࡉࢀࡿࡀࠊỈ⣲ࡀࡇࢀࢆ㑅ᢥⓗ㝖ཤࡍࡿሗ࿌ࡉࢀ࡚
࠾ࡾࠊ᪂ࡓ࡞ᢠ㓟⒪ἲࡀᩋ⾑⒪ࡋ࡚ὀ┠ࡉࢀ࡚࠸ࡿࠋ
ᡃࠎࡣ⭡⭍ෆὙίࢆỈ⣲ྵ᭷⏕⌮㣗ሷỈ࡛⾜࠺ࡇ࡛ࠊ⮚ჾ㞀ᐖࢆᢚไࡍࡿࡇࢆࣛࢵࢺ
࠾࠸࡚♧ࡋࡓࠋᶵᗎࡢ୍ࡘࡋ࡚ࡣࠊ ᖺ -LH/L ࡽࡀሗ࿌ࡋࡓάᛶ㓟⣲ࡀᘬࡁ㉳ࡇࡍ⣽⬊
ࡢ࣏ࢺ࣮ࢩࢫࢆࠊỈ⣲ࡀᢚไࡍࡿࡇࡀᡃࠎࡢ⮚ჾࡢචᰁⰍࡽ⪃࠼ࡽࢀࡓࠋ୍᪉࡛ࠊᡃࠎ
ࡢᐇ㦂ࡣື≀ᐇ㦂ᩘࡀᑡ࡞࠸ࡇࠊヲ⣽࡞࣓࢝ࢽࢬ࣒ゝཬ࡛ࡁ࡚࠸࡞࠸ࡇࠊࣃ࣓࣮࣮ࣛࣛࡀ
ᑡ࡞࠸ࡇ࡞ࠊ࠸ࡃࡘࡢㄢ㢟ࢆせࡋ࡚࠸ࡿࠋ
ᡃࠎࡢ◊✲ࡢ┠ᶆࡣࠊ⭡⭷⅖ᑐࡍࡿ᪂ࡓ࡞Ỉ⣲⒪ἲࡢ⮫ᗋᛂ⏝࡛࠶ࡿࠋỈ⣲ࡣ⭡⭷㏱ᯒ
࠾ࡼࡧ⾑ᾮ㏱ᯒࠊ㣧⏝ࠊ㟼⬦ෆ࠾ࡼࡧ࢞ࢫ྾ධࡼࡿࣄࢺ⮫ᗋ◊✲ࡀ㏆ᖺ⾜ࢃࢀ࡚࠸ࡿࠋᚋࠊ
ᡃࠎࡣ⭡⭷⅖ᑐࡍࡿ +56 ࡼࡿ⭡⭍ෆὙίࡀࠊࣄࢺᛂ⏝࡛ࡁࡿࠊࡉࡽ࡞ࡿ⮫ᗋヨ㦂ࡀᚲせ
ᛮࢃࢀࡿࠋ