外傷患者における冷汗の意義

• Published in: Journal of the Japanese Association for the Surgery of Trauma Vol. 30; no. 1; pp. 1 - 8
• Main Authors: 湯本 哲也, 塚原 紘平, 飯田 淳義, 寺戸 通久, 佐藤 圭路, 鵜川 豊世武, 氏家 良人, 西村 哲郎, 定光 大海, 土谷 飛鳥, 植木 浜一, 高間 辰雄, 真弓 俊彦
• Format: Journal Article
• Language: Japanese
• Published: 一般社団法人 日本外傷学会 2016; The Japanese Association for the Surgery of Trauma
• Subjects: physical examination; shock; subjective assessment; ショック; 主観的評価; 身体所見
• ISSN: 1340-6264; 2188-0190
• DOI: 10.11382/jjast.30.1

We performed a multicenter prospective observational study on the importance of cold sweat as a skin-related finding for the early recognition of shock in trauma patients. Patients with shock were defined as those who required interventions to resolve hemorrhagic or obstructive shock. Cold sweat was evaluated at 4 sites on both the left and right sides by 2 physicians. Cold sweat was defined present when observed at a minimum of １ site by both physicians. Shock was present in 54 (13%) and cold sweat in 36 (9%) of 411 trauma patients. The sensitivity, specificity, and positive and negative predictive values of cold sweat for shock were 35, 95, 53, and 91%, respectively. Patients with cold sweat in shock showed a significantly higher incidence of tachycardia, lower base excess, and higher lactic acid level compared with patients without cold sweat. The sensitivity of cold sweat for shock was not high, but its specificity was high. Therefore, for the early recognition of shock, it is important to actively determine the presence or absence of cold sweat, and combine this with other findings. ショックを早期に認知するための皮膚所見の１つとして，外傷患者における冷汗の意義を多施設共同前向き観察研究にて検証した．出血性あるいは閉塞性ショックを離脱するためにinterventionを要した症例をショックと定義，冷汗は２人の観察医師が左右それぞれ４ヵ所を別々に評価し，少なくとも１ヵ所でも一致した場合を冷汗ありと定義した．来院時心肺停止，熱傷，転院搬送例を除外した外傷患者411例のうちショックは54例（13％），冷汗は36例（９％）に認めた．ショックで冷汗ありの症例は19例（35％）で，ショックに対する冷汗の感度，特異度，陽性・陰性的中率はそれぞれ35，95，53，91％であった．また，ショックで冷汗ありの症例はなしの症例と比較し，有意に頻脈で，Base excess（BE）が低く，乳酸値が高値であった．ショックに対する冷汗の特異度は高く，冷汗を認めれば介入が必要なショックと認識できる．また，早期認知のためには積極的に冷汗の所見をとりにいくことが重要である．