血管内長期留置抗菌性カテーテルの創生

ⴊ▤ౝ㐳ᦼ⇐⟎᛫⩶ᕈࠞ࠹࡯࠹࡞ߩഃ↢
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ߎߩ⹏ଔ♽ࠍ↪޿ߚᣂⷙ㐿⊒ࠞ࠹࡯࠹࡞ེ᧚ߩ᛫⩶ᕈ⹏ଔ㧕
଻ஜⅣႺ࠮ࡦ࠲࡯ᓸ↢‛ㇱ⥵ᷰᎹ࿻ᰴ ࿖┙࿖㓙ක≮࠮ࡦ࠲࡯ᗵᨴ∝೙ᓮㇱಾᦧᾖ㓶
⁛ᴺ‛⾰࡮᧚ᢱ⎇ⓥᯏ᭴↰ญືᔒ᧲ᶏᄢቇකቇㇱౝ⑼ቇ♽⣢ઍ⻢ౝ⑼ᢪ⮮᣿
⁛ᴺ↥ᬺᛛⴚ✚ว⎇ⓥᚲጊᩮ㓉ᔒ࿖┙ᓴⅣེ∛࠮ࡦ࠲࡯↢૕Ꮏቇㇱฎ⭽ീ
ⷐᣦ
ⴊ▤ౝ⇐⟎ࠞ࠹࡯࠹࡞ߪ㒮ౝᗵᨴߩᱴߤߦ㑐ਈߒߡ߅ࠅ‫ޔ‬
᛫⩶ᕈࠞ࠹࡯࠹࡞ߩ㐿⊒߇ᕆോߢ޽ࠆ‫ޕ‬
ᚒ‫ޔߦߢ߹ࠇߎߪޘ‬
᛫⩶ᵴᕈࠍઃਈߒߚࠕࡒࡁൻ࠽ࡁ㉄ൻ࠴࠲ࡦⶄว⚻⊹࠺ࡃࠗࠬ‫↢ޔ‬૕ⷫ๺ᕈធ⌕೷‫ޔ‬㌁ࠗࠝࡦࠪ࡝ࠦࡦࠞ࠹࡯࠹࡞ࠍ㐿
⊒ߒߚ‫ߩ᧚ེࠄࠇߎޕ‬᛫⩶ᵴᕈࠍ⏕⹺ߔࠆߚ߼ߦ‫⊹⚻ޔ‬ᗵᨴࡕ࠺࡞ࡑ࠙ࠬ
↢‛ቇ⊛⹏ଔ♽ࠍ⏕┙ߒ᛫⩶ᕈ⹏ଔࠍ⹜ߺ
ߚ‫⚿ߩߘޕ‬ᨐ‫↢ޔ‬૕ⷫ๺ᕈធ⌕೷ߣࠕࡒࡁൻ࠽ࡁ㉄ൻ࠴࠲ࡦⶄว⚻⊹࠺ࡃࠗࠬ෸߮㌁ࠗࠝࡦࠪ࡝ࠦࡦࠞ࠹࡯࠹࡞ࠍ⚵ߺ
วࠊߖࠆߣ‫ޔ‬ᕆᕈᦼ߆ࠄᘟᕈᦼߩోᦼ㑆ࠍㅢߒߡࠞ࠹࡯࠹࡞಴ญㇱ߆ࠄߩᗵᨴ㒖ᱛ‫࡞࠹࡯࠹ࠞޔ‬࿕⌕෸߮᛫ࡃࠗࠝࡈࠖ
࡞ࡓᒻᚑ⢻ࠍ㜞ᐲߦᜂ଻ߔࠆߎߣ߇᣿ࠄ߆ߣߥߞߚ‫ޕ‬
ࠠ࡯ࡢ࡯࠼㧦ⴊ▤ౝ⇐⟎ࠞ࠹࡯࠹࡞‫ࡁࡒࠕޔ‬ൻ࠽ࡁ㉄ൻ࠴࠲ࡦⶄว⚻⊹࠺ࡃࠗࠬ‫ࡦࡠࠢ࠳ޔ‬ਇ❱Ꮣ⚻⊹࠺ࡃࠗࠬ‫↢ޔ‬૕
ⷫ๺ᕈធ⌕೷‫ޔ‬㌁ࠗࠝࡦࠪ࡝ࠦࡦࠞ࠹࡯࠹࡞‫⊹⚻ޔ‬ᗵᨴࡕ࠺࡞ࡑ࠙ࠬ
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ⴊ▤ౝ⇐⟎ࠞ࠹࡯࠹࡞ߪ⮎೷ᛩਈ‫ޔ‬ᩕ㙃▤ℂ‫ޔ‬૕ᄖ
᧚ᢱ
ᓴⅣߥߤᐢߊ↪޿ࠄࠇࠆක≮ᯏེߢ޽ࠆ‫ߚ߹ޕ‬㒮ౝᗵ
ࠕࡒࡁൻ࠽ࡁ㉄ൻ࠴࠲ࡦⶄว⚻⊹࠺ࡃࠗࠬ㧔․
ᨴߩᱴߤ߇ߎߩᯏེߦ㑐ଥߒߡ߅ࠅ‫⿠ߦ࡞࠹࡯࠹ࠞޔ‬
⸵౏㐿 㧕㧢㧕㧣㧕㧤㧕
ࠕࡒࡁൻ㉄ൻ࠴࠲ࡦⶄวൻ㜞ಽሶ❫⛽ࠍ⚻⊹࠺ࡃ
࿃ߔࠆᗵᨴߢߪ‫⤏⊹࡞࠹࡯࠹ࠞޔ‬಴ญㇱ߆ࠄߩᳪᨴ߇
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ࠪ࡝ࠦࡦ⴫㕙ߦࡈࡠ࠶ࠢടᎿߒߡ‫❱⚵ޔ‬ធ
ࠫࠚࠢ࠻ߪ⚻⊹ᗵᨴ㒖ᱛࠍ⋡⊛ߦ‫࡞࠹࡯࠹ࠞޔ‬ၒᬀ⋥
⌕ᕈߣ᛫⩶ᕈࠍઃᏪߐߖߚࠗࡦ࠹࡝ࠫࠚࡦ࠻ဳࠗࡦࡊ
ࡂࠗ࡝ࠬࠢߣ⠨߃ࠄࠇߡ޿ࠆ‫ޕ‬
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⇐⟎
࡜ࡦ࠻ࠍ૞ᚑߒߚ‫ߦࠄߐޕ‬േ‛ታ㛎ߩߚ߼ߦࡑ࠙ࠬ↪
߇ ㅳ㑆ࠍ⿥߃ߡ߽಴ญㇱࠍኽ㎮ߔࠆߎߣ߇น⢻ߥࠕ
ୃᱜེ᧚㧔ࡑ࠙ࠬ↪ࡊࡠ࠻࠲ࠗࡊ㧕ࠍᣂߚߦ૞ᚑߒ‫ޔ‬
ᓟߦ಴ญㇱࠍኽ㎮ߔࠆ↢૕ⷫ๺ᕈធ⌕೷‫ޔ‬
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෸߮▤
ߎࠇࠍࡑ࠙ࠬߦၒᬀߒߚ
౮⌀‫ޕ‬
ოઃ⌕⚦⩶ߦ᛫⩶ᵴᕈࠍ␜ߔ㌁ࠗࠝࡦࠪ࡝ࠦࡦࠞ࠹࡯
࠳ࠢࡠࡦਇ❱Ꮣ⚻⊹࠺ࡃࠗࠬ
ࡒࡁൻ࠽ࡁ㉄ൻ࠴࠲ࡦⶄว⚻⊹࠺ࡃࠗࠬ
࠹࡞ࠍ㐿⊒ߒߚ߇‫ߩ᧚ེࠄࠇߎޔ‬᛫ᗵᨴᕈࠍ⏕⹺ߔࠆ
ታ㛎♽߇⊝ήߢ޽ߞߚ‫੹ߢߎߘޕ‬࿁‫⊹⚻ޔ‬ᗵᨴߩ᦭ή
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ᣢ⵾⚻⊹࠺ࡃࠗࠬߢ‫ޔ‬േ‛ታ㛎ߩߚ߼ߦࡑ࠙ࠬ↪ࡊ
ࡠ࠻࠲ࠗࡊࠍᣂߚߦ૞ᚑߒߚ‫ޕ‬
ࠍࡑ࠙ࠬߩ↢ᱫߢ್ቯߢ߈ࠆ⚻⊹ᗵᨴࡕ࠺࡞ࡑ࠙ࠬ
↢૕ⷫ๺ᕈធ⌕೷㧔․⸵౏㐿 㧕㧟㧕
ࠍ⏕┙ߒ‫ߦߢ߹ࠇߎޔ‬㐿⊒ߒߚེ᧚ߩ᛫⩶ᵴᕈ⹏ଔࠍ
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ⴕ޿‫↪᦭ޔ‬ᕈࠍ᣿ࠄ߆ߦߒߚߩߢႎ๔ߔࠆ‫ޕ‬
ሶ
ࡅ࠻ⴊᷡࠕ࡞ࡉࡒࡦࠍធ⌕ᚑಽߣߔࠆ㧞ᚑಽ♽ߩ
ක≮↪ធ⌕೷ࠍ૞ᚑߒߚ‫ޕ‬
ᒰ⹥ធ⌕೷ߪႣ᛹ᓟ ಽߢ
ᦨᄢធ⌕ᒝᐲ
҈M2Cߦ೔㆐ߒ‫ ޔ‬ㅳ㑆ᓟߦߪ૕ౝ
ߦๆ෼ߐࠇࠆ‫ޕ‬ᒰ⹥ធ⌕೷ߪᒝ޿ធ⌕ᒝᐲߣ㜞޿↢૕
ⷫ๺ᕈࠍ᦭ߒߡ޿ࠆ‫ޕ‬
㌁ࠗࠝࡦࠪ࡝ࠦࡦࠞ࠹࡯࠹࡞
࠯ࠝ࡜ࠗ࠻ߩᩰሶౝߦ㌁ࠗࠝࡦ㧝㧜㧕ࠍ൮ၒߒߚ㌁ࠗ
ࠝࡦ࠯ࠝ࡜ࠗ࠻ࠍࠪ࡝ࠦࡦࠧࡓߦ 㧑ߩỚᐲߢ✵ࠅㄟ
ߺ‫ࠍࠇߎޔ‬኿಴ᚑဳߒߡ㌁ࠗࠝࡦࠪ࡝ࠦࡦࠞ࠹࡯࠹࡞
ࠞ࠹࡯࠹࡞಴ญㇱ࡮࠺ࡃࠗࠬㇱ ࡑ࠙ࠬ↪ࡊࡠ࠻࠲ࠗࡊࠞ࠹࡯࠹࡞
ࠍ૞ᚑߒߚ‫ޕ‬
౮⌀ ࡑ࠙ࠬ↪ࡊࡠ࠻࠲ࠗࡊࠞ࠹࡯࠹࡞ߩࡑ࠙ࠬ߳ߩၒᬀ 㧙㧙
⚻⊹ᗵᨴࡕ࠺࡞ࡑ࠙ࠬ㧔․⸵౏㐿 㧕
ࡑ࠙ࠬߦ⇐⟎ߒ ᣣᓟߦ‫ޔ‬5'( ᩣ
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ͰOQWUGࠍ಴ญㇱߦធ⒳ߒߡ‫ ޔ‬ㅳ㑆↢ᱫⷰኤ㧔㧝㧝㧕
⚻⊹ᗵᨴߦࠃࠅࡑ࠙ࠬࠍᱫ੢ߐߖߚߩߪ
ࠍታᣉߒߚ‫ޕ‬
5CNOQPGNNC'PVGTKVKFKU0Q( ᩣ
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ࡑ࠙ࠬ↪ࡊࡠ࠻࠲ࠗࡊ⚻⊹࠺ࡃࠗࠬࠍࡑ࠙ࠬߦၒ
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⩶ߩᳪᨴ߇⚿ᨐߦᓇ㗀ࠍ෸߷ߐߥ޿‫⊹⚻ޔ‬ᗵᨴߩ᦭ή
ࠞ࠹࡯࠹࡞಴ญㇱߦႣ᛹ߒߡ⚻⊹࠺ࡃࠗࠬߩ᛫⩶ᕈࠍ
ࠍࡑ࠙ࠬߩ↢ᱫߢ⹏ଔߢ߈ࠆ㜞ᗵᐲߩ⹏ଔ♽ߢ޽ࠆ‫ޕ‬
Ყセߒߚ‫ࡦࡠࠢ࠳ޕ‬ਇ❱Ꮣ⚻⊹࠺ࡃࠗࠬ
ᣢ⵾ຠࠍ⇐
⴫‫⊹⚻ޓ‬ᗵᨴߐߖߚ5'(ᩣ‫ޔ‬5CWTGWU ߅ࠃ߮'*'%
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⟎ߒߚࡑ࠙ࠬߪ‫ ޔ‬඘ਛ ඘ߩ↢ᱷߢ޽ߞߚ
࿑ߩ
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ࠕࡒࡁൻ࠽ࡁ㉄ൻ࠴࠲ࡦⶄว⚻⊹࠺ࡃࠗࠬ
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࿑㪄㪈㩷㩷䉼䉺䊮䊂䊋䉟䉴䋨㐿⊒ຠ䋩䈫䉻䉪䊨䊮䊂䊋䉟䉴ၒᬀᓟ
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↢૕ⷫ๺ᕈធ⌕೷ߦࠃࠆലᨐ
↢૕ⷫ๺ᕈធ⌕೷ࠍࠕࡒࡁൻ࠽ࡁ㉄ൻ࠴࠲ࡦⶄว
⚻⊹࠺ࡃࠗࠬㇱ‫࡞࠹࡯࠹ࠞޔ‬಴ญㇱ‫ࠬࠗࡃ࠺ޔ‬ㇱߣࠞ
࠹࡯࠹࡞಴ญㇱߦႣ᛹ߒ‫ᤨ ޔ‬㑆ᓟ5'( ᩣ
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↢૕ⷫ๺ᕈធ⌕೷ߩ⚻⊹ᗵᨴߦ෸߷ߔᓇ㗀ࠍ⷗ߚ‫↢ޕ‬
ࠕࡒࡁൻ࠽ࡁ㉄ൻ࠴࠲ࡦⶄว⚻⊹࠺ࡃࠗࠬ
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࠺ࡃࠗࠬㇱធ⌕೷Ⴃ᛹⟲ߪ⩶ធ⒳ ᣣᓟߦోߡᱫ੢ߒ
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