{"created":"2023-06-19T11:23:33.229909+00:00","id":4117,"links":{},"metadata":{"_buckets":{"deposit":"2f11f08b-ddae-44b9-bc46-9e981006859e"},"_deposit":{"created_by":3,"id":"4117","owners":[3],"pid":{"revision_id":0,"type":"depid","value":"4117"},"status":"published"},"_oai":{"id":"oai:asahikawa-med.repo.nii.ac.jp:00004117","sets":["7","7:23"]},"author_link":["12562","12563","12564","12565","12566","12567","12568","12569","12570","12571","12572"],"item_5_biblio_info_21":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2012-04-01","bibliographicIssueDateType":"Issued"},"bibliographicIssueNumber":"4","bibliographicPageEnd":"483","bibliographicPageStart":"479","bibliographicVolumeNumber":"44","bibliographic_titles":[{"bibliographic_title":"心臓"}]}]},"item_5_description_33":{"attribute_name":"抄録","attribute_value_mlt":[{"subitem_description":"66歳、女性。突然の左上腹部痛を主訴に近医を受診し、CTにより脾動脈瘤切迫破裂と診断され当院に救急搬送された。血管造影にて最大径3cmの脾動脈瘤に対してコイル塞栓術を施行した。塞栓術後、血液検査上、炎症反応が高値であったため、sulbactam/cefoperazoneを継続投与するも炎症反応の改善を認めず、第13病日に突然呼吸不全が出現した。心エコー検査で僧帽弁前尖および後尖に疣腫を認めたため、感染性心内膜炎(僧帽弁閉鎖不全症)による急性心不全と診断した。血液培養は陰性であったが、同日のCTで脾膿瘍および肝膿瘍が疑われ、感染源コントロール目的に脾摘出術、肝膿瘍ドレナージを施行した。抗生物質は経験的にimipenem/cilastatin+gentamicinを投与したが、炎症反応が改善傾向になくvancomycin+gentamicinに変更した。開腹術後侵襲を考慮し弁膜症手術を緊急で行うことを回避し、保存的に心不全感染コントロールをした後、第28病日に僧帽弁置換術を施行した。術後経過は良好であった。疣贅の培養検査および病理検査でも菌体は検出されなかった。本例は、感染性心内膜炎による急性心不全症例であるが、心不全コントロールが可能であり、明らかな感染部位に対して緊急弁膜症手術に先駆けて感染コントロールをしたことで、良好な経過を得たため報告する。","subitem_description_language":"ja","subitem_description_type":"Abstract"}]},"item_5_description_36":{"attribute_name":"注記","attribute_value_mlt":[{"subitem_description":"雑誌掲載版","subitem_description_type":"Other"}]},"item_5_description_37":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"subitem_description":"text","subitem_description_type":"Other"}]},"item_5_description_41":{"attribute_name":"フォーマット","attribute_value_mlt":[{"subitem_description":"application/pdf","subitem_description_type":"Other"}]},"item_5_source_id_22":{"attribute_name":"ISSN","attribute_value_mlt":[{"subitem_source_identifier":"0586-4488","subitem_source_identifier_type":"PISSN"}]},"item_5_text_44":{"attribute_name":"ID(XooNIps)","attribute_value_mlt":[{"subitem_text_value":"2012237633"}]},"item_5_text_54":{"attribute_name":"閲覧数(XooNIps)","attribute_value_mlt":[{"subitem_text_value":"912"}]},"item_5_text_55":{"attribute_name":"ダウンロード数(XooNIps)","attribute_value_mlt":[{"subitem_text_value":"709"}]},"item_5_text_7":{"attribute_name":"著者 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