n.

悩み、嘆き。悩みの種
苦痛。極度の疲労
貧苦、困窮、難儀、災難、不幸

WordNet

cause mental pain to; "The news of her childs illness distressed the mother"
a state of adversity (danger or affliction or need); "a ship in distress"; "she was the classic maiden in distress"
extreme physical pain; "the patient appeared to be in distress"
the seizure and holding of property as security for payment of a debt or satisfaction of a claim; "Originally distress was a landlords remedy against a tenant for unpaid rents or property damage but now the landlord is given a landlords lien" (同)distraint
psychological suffering; "the death of his wife caused him great distress" (同)hurt, suffering
with pain or distress or bitterness; "he took the rejection very hard"
(of light) transmitted directly from a pointed light source (同)concentrated
with firmness; "held hard to the railing" (同)firmly
very strong or vigorous; "strong winds"; "a hard left to the chin"; "a knockout punch"; "a severe blow" (同)knockout, severe
causing great damage or hardship; "industries hit hard by the depression"; "she was severely affected by the banks failure" (同)severely
being distilled rather than fermented; having a high alcoholic content; "hard liquor" (同)strong
unfortunate or hard to bear; "had hard luck"; "a tough break" (同)tough
(of speech sounds); produced with the back of the tongue raised toward or touching the velum; "Russian distinguished between hard consonants and palatalized or soft consonants"
dispassionate; "took a hard look"; "a hard bargainer";
dried out; "hard dry rolls left over from the day before"
earnestly or intently; "thought hard about it"; "stared hard at the accused"
into a solid condition; "concrete that sets hard within a few hours"
resisting weight or pressure
slowly and with difficulty; "prejudices die hard"
to the full extent possible; all the way; "hard alee"; "the ship went hard astern"; "swung the wheel hard left"
very near or close in space or time; "it stands hard by the railroad tracks"; "they were hard on his heels"; "a strike followed hard upon the plants opening"
with effort or force or vigor; "the team played hard"; "worked hard all day"; "pressed hard on the lever"; "hit the ball hard"; "slammed the door hard"
to cause inconvenience or discomfort to; "Sorry to trouble you, but..." (同)put_out, inconvenience, disoblige, discommode, incommode, bother
cause bodily suffering to and make sick or indisposed (同)ail, pain
an unwanted pregnancy; "he got several girls in trouble"
an effort that is inconvenient; "I went to a lot of trouble"; "he won without any trouble"; "had difficulty walking"; "finished the test only with great difficulty" (同)difficulty
a source of difficulty; "one trouble after another delayed the job"; "whats the problem?" (同)problem
an event causing distress or pain; "what is the trouble?"; "heart trouble"
a condition or state of affairs almost beyond ones ability to deal with and requiring great effort to bear or overcome; "grappling with financial difficulties"
the quality of being difficult; "they agreed about the difficulty of the climb" (同)difficultness
a factor causing trouble in achieving a positive result or tending to produce a negative result; "serious difficulties were encountered in obtaining a pure reagent"
difficult to accomplish; demanding considerable mental effort and skill; "the arduous work of preparing a dictionary"
characterized by effort to the point of exhaustion; especially physical effort; "worked their arduous way up the mining valley"; "a grueling campaign"; "hard labor"; "heavy work"; "heavy going"; "spent many laborious hours on the project"; "set a punishing pace" (同)backbreaking, grueling, gruelling, hard, heavy, laborious, operose, punishing, toilsome
taxing to the utmost; testing powers of endurance; "his final, straining burst of speed"; "a strenuous task"; "your willingness after these six arduous days to remain here"- F.D.Roosevelt (同)straining, strenuous
an internationally recognized signal sent out by a ship or plane indicating that help is needed (同)distress call
with distress; "`Doctor Rother says its his only chance, she added distressfully"
facing or experiencing financial trouble or difficulty; "distressed companies need loans and technical advice"; "financially hard-pressed Mexican hotels are lowering their prices"; "we were hard put to meet the mortgage payment"; "found themselves in a bad way financially" (同)hard-pressed, hard put, in a bad way
causing distress or worry or anxiety; "distressing (or disturbing) news"; "lived in heroic if something distressful isolation"; "a disturbing amount of crime"; "a revelation that was most perturbing"; "a new and troubling thought"; "in a particularly worrisome predicament"; "a worrying situation"; "a worrying time" (同)distressful, disturbing, perturbing, troubling, worrisome, worrying

PrepTutorEJDIC

〈U〉(肉体的・精神的な)『激しい苦しみ』,苦痛,苦悩,非嘆 / 《a~》(…にとっての)悩みの種《+『to』+『名』》 / 〈U〉『貧苦』,窮乏 / 〈U〉『危険状態』,難儀 / (精神的・肉体的に)〈人〉‘を'『苦しめる』,苦悩させる
(物体が)『堅い』,(手触りが)堅固な,しっかりした / 『難しい』,努力を要する / 《名詞の前にのみ用いて》(人が)『精力的な』,勤勉な / 激しい,猛烈な / (生活などが)耐え難い,つらい / (季節・天候などが)厳しい;(雨・風などが)激しい / (人が)厳格な;(行為などが)容赦しない,無情な / (方針・条件などが)妥協(譲歩)しない,厳しい / (感情が)うらみを含む,憤然とした / (体が)筋肉質の,がんじょうな / (紙幣に対して)硬貨の,(小切手などに対して)現金の;(貨幣が)容易に兌換(だかん)できる / (子音が)硬音の(c,gがcome, goのように[k],[g]と発音される) / アルコール分の多い / (水が)硬質の / (エックス線が)透過能力が大きい / 一生懸命に,『熱心に』 / 『強く』,激しく,大いに / やっと,かろうじて / 『堅く』 / ひどく悲んで / 接近して
〈U〉『苦難』,心配,悩み / 〈C〉『苦労の種』,心配事,悩みの種 / 〈U〉危険[な状態],困難 / 〈U〉『骨折り』,手数,めんどう,迷惑 / 〈C〉〈U〉(政治的・社会的)紛争,騒動 / 〈U〉(機械などの)故障 / 〈C〉〈U〉病気 / 〈事が〉〈人・自分〉‘を'『悩ます』,心配させる,苦しめる / 《物事を頼むときていねいに》〈人〉‘を'『わずらわす』,じゃまする / 〈水・空気など〉‘を'かき乱す / 《おもに疑問文・否定文で》心配する,気を遣う;骨を折る
〈U〉『難しさ』,困難 / 〈C〉『困難なこと』,難事,障害 / 〈C〉《通例複数形で》『困難な状況』,(特に)財政困難 / 〈C〉〈U〉(…との)不和,仲たがい《+『with』(『between』)+『名』》 / 〈C〉苦情,反対
骨の折れる,困難な / (山などが)登りにくい,けわしくて骨の折れる / (努力などが)しんぼう強い,奮闘する(strenuous)
(精神的・肉体的に)苦しみを引き起こす;苦しそうな
=distressful

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/05/19 00:44:22」(JST)

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UpToDate Contents

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1. 急性呼吸窮迫症候群：臨床的特徴および診断 acute respiratory distress syndrome clinical features and diagnosis
2. 急性呼吸窮迫症候群における機械的人工換気 mechanical ventilation in acute respiratory distress syndrome
3. 新生児呼吸促迫の概要：移行の障害 overview of neonatal respiratory distress disorders of transition
4. 新生児における胸水の病因、臨床症状、診断および評価 etiology clinical manifestations diagnosis and evaluation of pleural effusions in the neonate
5. 乳幼児および小児における心不全の病因および診断 etiology and diagnosis of heart failure in infants and children

English Journal

Moral distress and its contribution to the development of burnout syndrome among critical care providers.

Fumis RRL1, Junqueira Amarante GA2, de Fátima Nascimento A3, Vieira Junior JM2.
Annals of intensive care.Ann Intensive Care.2017 Dec;7(1):71. doi: 10.1186/s13613-017-0293-2. Epub 2017 Jun 21.
PMID 28639161

Etiologies, diagnostic work-up and outcomes of acute respiratory distress syndrome with no common risk factor: a prospective multicenter study.

de Prost N1,2,3, Pham T4,5,6,7, Carteaux G8,9, Mekontso Dessap A8,9, Brun-Buisson C8,9, Fan E10, Bellani G11,12, Laffey J13,14, Mercat A15, Brochard L7, Maître B8,9; LUNG SAFE investigators; ESICM trials group; REVA network.
Annals of intensive care.Ann Intensive Care.2017 Dec;7(1):69. doi: 10.1186/s13613-017-0281-6. Epub 2017 Jun 19.
PMID 28631088

Frequency, associated factors and outcome of multi-drug-resistant intensive care unit-acquired pneumonia among patients colonized with extended-spectrum β-lactamase-producing Enterobacteriaceae.

Razazi K1,2, Mekontso Dessap A3,4, Carteaux G3,4, Jansen C5, Decousser JW6, de Prost N3,4, Brun-Buisson C3,4.
Annals of intensive care.Ann Intensive Care.2017 Dec;7(1):61. doi: 10.1186/s13613-017-0283-4. Epub 2017 Jun 12.
PMID 28608133

Nasal high flow in management of children with status asthmaticus: a retrospective observational study.

Baudin F1,2, Buisson A3, Vanel B3, Massenavette B3, Pouyau R3, Javouhey E3,4.
Annals of intensive care.Ann Intensive Care.2017 Dec;7(1):55. doi: 10.1186/s13613-017-0278-1. Epub 2017 May 22.
PMID 28534235

Japanese Journal

障がい児・者をきょうだいにもつ若者たちの意識 : 「きょうだいフォーラム」を通して見えてくるもの (特集障害児のきょうだいへの支援と発達保障)

土岐邦彦,障がい児・者の自立と共生をサポートする会「ひまわり」
障害者問題研究 40(3), 215-220, 2012-11
NAID 40019490302

広汎性発達障害児の母親が経験する育児ストレス : 児童の知的水準との関連をめぐって

鈴村俊介
精神医学 54(11), 1135-1143, 2012-11
NAID 40019487356

障がい児・者をきょうだいにもつ若者たちの意識:「きょうだいフォーラム」を通して見えてくるもの

土岐邦彦/障がい児・者の自立と共生をサポートする会「ひまわり」
障害者問題研究 40(3), 55-66, 2012-11
NAID 110009490565

Psychological distress and its correlates of Japanese Brazilian workers residing in Japan

Takashi ASAKURA
東京学芸大学紀要. 芸術・スポーツ科学系 64, 169-189, 2012-10-31
NAID 110009485750

Related Pictures

★リンクテーブル★

リンク元	「急性呼吸促迫症候群」「intractable」「afflict」「trouble」「困難」
拡張検索	「newborn respiratory distress syndrome」「neonatal respiratory distress syndrome」「respiratory distress syndrome」「infantile respiratory distress syndrome」「emotional distress」
関連記事	「distressed」「distressing」

「急性呼吸促迫症候群」

　　[★]

distress
英: acute respiratory distress syndrome, ARDS
同: 急性呼吸窮迫症候群、成人呼吸促迫症候群 adult respiratory distress syndrome
関: 肺水腫

概念

様々な原因に続発する急性の肺損傷であり、その本態は血管内皮細胞が傷害されて生じた透過性肺水腫
侵襲により肺の非特異的炎症と肺微小血管内皮の透過性が亢進した非心原性肺水腫
心不全は除外する必要がある

病因

IMD.743

直接肺障害

胃内容物の誤嚥：22-36%
肺挫傷：17-22%

間接肺障害

敗血症：35-45%
頻回の輸血：5-36%
多発性長管骨骨折：-%

ICU.364

頭蓋内圧亢進、血液製剤・カテーテル関連敗血症・薬物、肺炎・肺挫傷、人工心肺、膵炎、bacterial translocation、エンドトキシン血症、尿路感染症からの敗血症、羊水塞栓、長管骨骨折

ARDSの原因と死亡率

ICU.364

	発生率(%)	死亡率(%)
敗血症	41	50
大量輸血	36	35
肺挫傷	22	12
胃内容誤嚥	22	21
多発骨折	11	9
薬物過量	9	4
全ての高リスク状態	26	19

疫学

病理

病理学的にはびまん性肺胞障害(DAD)である。

肺胞隔壁の損傷　←　炎症による

血管内皮

血管透過性亢進　→　肺水腫

血管内皮細胞の障害による血管透過性の亢進

症状

診断

診断基準

1. 急性発症，
2. 胸部X線写真で両側浸潤影，
3. PaO2/FIO2≦200　　50%O2を吸入させてもPaO2 100 mmHgにしかならないというイメージか
4. 左心不全の否定

上記を満たし、PaO2/FIO2≦300の軽症例は急性肺損傷 ALI acute lung injury、

ARDSとALI

	経過	酸素化	単純胸部X線	肺動脈楔入圧
ALI	急性	PaO2/FIO2≦300mmHg	両側性の浸潤影	≦18mmHg or 理学的に左房圧上昇を認めない
ARDS	急性	PaO2/FIO2≦200mmHg	両側性の浸潤影	≦18mmHg or 理学的に左房圧上昇を認めない

鑑別診断

検査

治療

ICU.368- YN.I-121 参考3

呼吸管理：気管挿管し人工呼吸管理とする。　⇔　急性肺障害ではNIPPVでよい(低いPEEPで良いから。ARDSの場合はは高いPEEPが要求されるのであろう)。

低容量換気とする(機能している肺は減少しており、高用量換気では過膨張による末梢の肺胞を破壊しうる)。
管理目標：予測体重を利用した6ml/kgの一回換気量を維持する。30cmH2O未満の呼気終末プラトー圧を維持する。重症呼吸性アシドーシスを避ける。
高二酸化炭素許容：Paco2が60-70mmHgで動脈血pH 7.2-7.25ならば大多数の患者で安全。
PaO2=50-80 or SpO2=88-95%となるように管理。
PEEP：5-7cmH2Oを付与。

Oxygenation will be maintained in the target ranges using the following PEEP/FiO2 combinations:
FiO2	0.3	0.4	0.4	0.5	0.5	0.6	0.7	0.7	0.7	0.8	0.9	0.9	0.9	1	1
PEEP(cmH2O)	5	5	8	8	10	10	10	12	14	14	14	16	18	18	20-24