- 関
- 深部静脈血栓症、肺血栓塞栓症
- 0 点：低リスク、1 または2：中等度リスク、3 点以上：高リスク
- 癌 +1
- 麻痺あるいは最近のギプス装着 +1
- ベット安静＞3 日または手術後＜4 週 +1
- 深部静脈触診で疼痛 +1
- 下肢全体の腫脹 +1
- 下腿直径差＞3cm +1
- 患肢のpitting edema +1
- 患肢の表面静脈拡張 +1
- 診断がDVT らしくない -2
- 0－1：低リスク、2－6：中等度リスク、7 以上：高リスク
2 分法：4 点以上ならPE らしい
- 以前にPE かDVT の既往 +1.5
- 心拍＞100 +1.5
- 最近の手術または固定 +1.5
- 臨床的にDVT の症状がある +3
- 診断がPE らしい +3
- 喀血 +1
- 癌 +1
simplifed Wells 検査前確率
- 活動性の腫瘍 1
- 下肢の麻痺、半麻痺、最近の不動化 1
- ベット臥床3日以上、12週以内の手術 1
- 深部静脈系に沿った痛みの局在 1
- 完全な下肢の腫脹 1
- 明かなpitting edema 1
- 側副表在表脈(非静脈瘤) 1
- 他の診断の存在 -2
WordNet
- write a musical score for
- a slight surface cut (especially a notch that is made to keep a tally) (同)scotch
- a number that expresses the accomplishment of a team or an individual in a game or contest; "the score was 7 to 0"
- an amount due (as at a restaurant or bar); "add it to my score and Ill settle later"
- the act of scoring in a game or sport; "the winning score came with less than a minute left to play"
- grounds; "dont do it on my account"; "the paper was rejected on account of its length"; "he tried to blame the victim but his success on that score was doubtful" (同)account
- a written form of a musical composition; parts for different instruments appear on separate staves on large pages; "he studied the score of the sonata" (同)musical score
- a set of twenty members; "a score were sent out but only one returned"
- the facts about an actual situation; "he didnt know the score"
- gain points in a game; "The home team scored many times"; "He hit a home run"; "He hit .300 in the past season" (同)hit, tally, rack_up
- make underscoring marks (同)mark
- make small marks into the surface of; "score the clay before firing it" (同)nock, mark
- get a certain number or letter indicating quality or performance; "She scored high on the SAT"; "He scored a 200"
- prolific English writer best known for his science-fiction novels; he also wrote on contemporary social problems and wrote popular accounts of history and science (1866-1946) (同)H. G. Wells, Herbert George Wells
PrepTutorEJDIC
- (ゲーム・競技の)『スコア』,得点記録 / (ゲーム・競技の)『得点』 / (試験の)点数,評点 / 《おもに文》20[の単位] / 《複数形で》多数(の…)《+『of』+『名』》 / 《まれ》勘定,借金 / 《単数形で》理由,根拠,原因 / (また『score mark』)刻み目,線,印 / 総譜,楽譜 / (ゲーム・競技で)〈点数〉‘を'『得点する』 / 〈競技〉‘の'得点を記録する / 〈得点〉‘を'〈人〉‘に'与える《+『名』〈人〉+『名』〈得点〉=+『名』〈得点〉+『to』(『for』)+『名』〈人〉》 / 〈試験〉‘を'採点する;(試験で)…‘の'点をとる《+『名』+『on』+『名』》 / (…で)…‘に'刻み目(印)をつける,線をひく《+『名』+『with』+『名』》 / 《米話》…‘を'こきおろす,酷評する / 《通例受動態で》(…のために)〈音楽〉‘を'作曲(編曲)する《+『for』+『名』》 / (ゲーム・競技で)『得点する』 / 優勢となる,成功する / 《俗》〈男が〉(女を)くどき落とす《+『with』+『名』》 / 《俗》麻薬を売う
Wikipedia preview
出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/12/03 15:09:32」(JST)
[Wiki en表示]
The Wells score or Wells criteria can refer to one of two clinical prediction rules in clinical medicine
- DVT probability scoring for diagnosing deep vein thrombosis
- Pulmonary embolism probability scoring for diagnosing pulmonary embolism
UpToDate Contents
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English Journal
- Impact of IL-1 inhibition on fatigue associated with Autoinflammatory syndromes.
- Efthimiou P, Yadlapati S.
- Modern rheumatology / the Japan Rheumatism Association.Mod Rheumatol.2015 Jul 3:1-22. [Epub ahead of print]
- Cryopyrin associated periodic syndromes (CAPS) is a rare group of autoinflammatory disorders that includes familial cold autoinflammatory syndrome (FCAS), Muckle-wells syndrome (MWS), and Neonatal onset multisystemic inflammatory disease (NOMID) . CAPS is caused by a mutation in the NLRP3 (NOD like
- PMID 26140469
- Comparison of eotaxin-3 biomarker in patients with eosinophilic oesophagitis, proton pump inhibitor-responsive oesophageal eosinophilia and gastro-oesophageal reflux disease.
- Moawad FJ1, Wells JM2, Johnson RL2, Reinhardt BJ3, Maydonovitch CL1, Baker TP2.
- Alimentary pharmacology & therapeutics.Aliment Pharmacol Ther.2015 Jul;42(2):231-8. doi: 10.1111/apt.13258. Epub 2015 May 24.
- BACKGROUND: Proton pump inhibitor-responsive oesophageal eosinophilia (PPI-REE) is a recently described entity which resembles oeosinophilic oesophagitis (EoE), yet responds to acid suppressive treatment.AIM: To determine whether EoE shares similar staining features with PPI-REE or with gastro-oesop
- PMID 26011446
- Percutaneous Pharmacomechanical Thrombectomy Offers Lower Risk of Post-thrombotic Syndrome than Catheter-directed Thrombolysis in Patients with Acute Deep Vein Thrombosis of the Lower Limb.
- Huang CY1, Hsu HL2, Kuo TT2, Lee CY3, Hsu CP4.
- Annals of vascular surgery.Ann Vasc Surg.2015 Jul;29(5):995-1002. doi: 10.1016/j.avsg.2015.01.014. Epub 2015 Mar 9.
- BACKGROUND: Despite optimal anticoagulant therapy, patients with proximal deep vein thrombosis (DVT) will often develop post-thrombotic syndrome (PTS). Early thromboreduction can potentially decrease the risk of PTS by restoring venous patency and preserving valvular function. This study was underta
- PMID 25765634
- A prognostic score to identify low-risk outpatients with acute deep vein thrombosis in the upper extremity.
- Rosa-Salazar V, Trujillo-Santos J, Díaz Peromingo JA, Apollonio A, Sanz O, Malý R, Muñoz-Rodriguez FJ, Serrano JC, Soler S, Monreal M; RIETE Investigators.
- Journal of thrombosis and haemostasis : JTH.J Thromb Haemost.2015 Jul;13(7):1274-8. doi: 10.1111/jth.13008. Epub 2015 Jun 15.
- BACKGROUND: No studies have identified which patients with upper-extremity deep vein thrombosis (DVT) are at low risk for adverse events within the first week of therapy.METHODS: We used data from Registro Informatizado de la Enfermedad TromboEmbólica to explore in patients with upper-extremity DVT
- PMID 25980766
Japanese Journal
- 溝渕 膺彦,斎藤 和夫
- 環境科学会誌 6(4), 343-347, 1993
- … Water qualities of 221 domestic wells were analyzed during February 1990 and December 1991. … Groundwater quality was evaluated on the basis of the idea of SCORE and was worse in almost central area of the Nara Basin compared to the neighboring area of the Basin. …
- NAID 130004304370
- 荻野 敏
- 日本耳鼻咽喉科学会会報 86(2), 144-148, 1983
- … On each slide, 20μl of enriched cell suspension and 10μl of the allergen or, as a contaol, 10μl of buffer solution were placed in wells. … When numbers of basophil decreased more than 35% in allergen wells, HBDT was determined as positive.In the present report, five allergens were included, namely house dust (HD), mites (mixture of Dermatophagoides pteronyssinus and D. … There was also good correlation between the results of HBDT and RAST score. …
- NAID 130000809686
Related Links
- Advice Some advocate using the Wells’ score over clinician gestalt to predict who is low-risk and then applying the PERC rule to stop workup for PE. As with all clinical decision aids, the physician must first have a suspicion of the ...
- これは有名な「Well’s Criteria (score)」です。 Well’s criteria ・深部静脈血栓症の症状がある 3.0 ・他の疾患より肺塞栓症が疑わしい 3.0 ・心拍数100以上 1.5 ・4週間以内の手術か安静（3日以上）1.5 ・肺塞栓症や深部静脈血栓症の ...
- Management Patients can be divided into “DVT unlikely” and “DVT likely” groups based on Wells score. An additional moderate risk group can be added based on the sensitivity of the d-dimer being used. A score of 0 or lower is ...
★リンクテーブル★
[★]
- 英
- deep venous thrombosis DVT, deep vein thrombosis
- 同
- 深部静脈血栓、静脈血栓症
- 関
- 末梢静脈疾患、下肢深部静脈血栓症
概念
リスクファクター
- リスク評価はWells scoreを使う。
PHD.366
-
SAN.378
- 血栓性素因
- 静脈血栓症の既往
- 肺塞栓症の既往
- 年齢(60歳以上)
- 長期臥床(4日以上)
- 肥満(肥満度BMI25以上)
- 悪性腫瘍
- 下肢静脈瘤
- 多発外傷
- 全身麻酔
- 3時間以上の手術
- 開腹術
- 人工股関節置換術、膝関節置換術
- 気腹手術、開腹下骨盤手術
- 静脈還流を阻害する体位(骨盤低位、側臥位など)
- 血栓性素因：後天性抗リン脂質抗体症候群、先天性アンチトロンビン欠損、プロテインC欠損、プロテインS欠損、第V因子異常、プラスミノゲン以上、異常フィブリノゲン血症、第XII因子欠損、組織プラスミノゲン活性化因子インヒビタ増加、トロンボモジュリン異常など
- 参考2
- 疾患別に見るとDVTでもPTEでも卵巣癌が最多で、子宮体癌がこれに次ぐ。術前発症では卵巣癌が最多である。卵巣癌の術前にDVTがおおいのは多量腹水による脱水、自宅での安静、腫瘍細胞数が非常に多い、腫瘍細胞が放出する組織因子が多いなどによる。卵巣後の術後では、根治術では手術時間が長く、侵襲度が高い、リンパ節郭清を要する、多量の輸血が必要なことが多い、また長期にわたる化学療法を要するなどによる。
リスク評価
ＤＶＴの検査前確率
- 活動性の癌
- 麻痺、足が動かない
- ベット上臥床(＞3日)、または大手術(＜4週)
- 静脈に沿い限局した疼痛
- 大腿/腓腹筋の腫脹
- 無症状側と比較して＞3cmの腓腹筋腫脹
- ＤＶＴの家族歴(第一度近親者で≧2人)
- 60日以内の症状ある足への外傷
- 有症状の下肢における圧痕性浮腫
- 有症状の下肢のみの表在静脈拡張
- 最近6ヶ月以内の入院
- 紅斑
高確率85%
- 大項目≧3+他の診断なし
- 大項目≧2+小項目≧2+他の診断なし
中等度の確率33%
低確率5%
- 大項目１＋小項目≧２＋他の診断あり
- 大項目１＋小項目≧１＋他の診断なし
- 大項目０＋小項目≧３＋他の診断あり
- 大項目０＋小項目≧２＋他の診断なし
身体所見
- evidence-based physical diagnosis 3rd edition p.473
予防
産婦人科
- 参考2
- 早期離床、ベッド上での下肢挙上・膝の屈伸・足の背屈運動、弾性ストッキング着用、間欠的空気圧迫法、脱水予防
- 未分画ヘパリン5,000単位を術後6～12時間以内に(止血を確認できたら術直後からでも可)1日2回皮下注/静注、3-5日投与
ガイドライン
- 肺血栓塞栓症および深部静脈血栓症の診断、治療、予防に関するガイドライン（2009年改訂版）
- http://www.j-circ.or.jp/guideline/pdf/JCS2009_andoh_h.pdf
参考
産婦人科
- 1. 学際領域の診療 Interdisciplinary Practice 肺血栓塞栓症・深部静脈血栓症 - 日産婦誌
- http://www.jsog.or.jp/PDF/56/5610-382.pdf
- 2. E．婦人科疾患の診断・治療・管理 10．10）深部静脈血栓症・肺塞栓症 - 日産婦誌61巻11号
- http://www.jsog.or.jp/PDF/61/6111-591.pdf
[★]
- 英
- Wells score
- 同
- Wellsスコア
- 関
- 肺血栓塞栓症 PE
| PEあるいはDVTの既往
|
＋1.5
|
| 心拍数＞毎分100
|
＋1.5
|
| 最近の手術あるいは長期臥床
|
＋1.5
|
| DVTの臨床的徴候
|
＋3
|
| PE以外の可能性が低い
|
＋3
|
| 血痰
|
＋1
|
| 癌
|
＋1
|
判定基準
- スコア： ：肺塞栓の確率
- ＜2 ：低い ：12％
- 2～6：中等度：40％
- ＞6 ：高度 ：91％
[★]
- 関
- scoring
[★]
- 関
- score