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<title>症状・症候別 POCUS実践活用術 | 株式会社文光堂</title>


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<meta name="description" content="安全，簡便で，医師自らが行える検査として，注目を集めているPoint-of-Care Ultrasound (POCUS) ．本書では，プライマリ・ケア医や在宅医の先生方の日々の診療に役立つよう，臓器・領域といった枠組みを外して，“症状・症候別”にPOCUS活用例を解説．「発熱」患者ではどういうときにエコーを使うのか，「悪心・嘔吐」ではエコーで何をみるのか，等々，診察の流れに沿って解説されているた">

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		<h1 class="catchCopy">発熱にエコー！食欲不振にもエコー！毎日の診療にエコーが役立つ！</h1>
		

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		<h1 class="title">症状・症候別 POCUS実践活用術<span class="version"></span></h1>
		

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					編集：畠　二郎（川崎医科大学教授）
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					<span class="transparent">編集</span>　平井都始子（奈良県立医科大学附属病院病院教授）
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				<ul class="property"><li class="disc">B5判・152頁・2色刷(一部4色刷)</li><li class="disc">ISBN&nbsp;978-4-8306-3759-9</li><li class="disc">2020年5月20日発行</li></ul>

				
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">安全，簡便で，医師自らが行える検査として，注目を集めているPoint-of-Care Ultrasound (POCUS) ．本書では，プライマリ・ケア医や在宅医の先生方の日々の診療に役立つよう，臓器・領域といった枠組みを外して，“症状・症候別”にPOCUS活用例を解説．「発熱」患者ではどういうときにエコーを使うのか，「悪心・嘔吐」ではエコーで何をみるのか，等々，診察の流れに沿って解説されているため，活用場面のイメージもしやすい．POCUSという言葉が気になっているけど前に踏み出せない先生にも，毎日の診療にエコーをもっと活用してみたいと思っている先生にも，明日からのPOCUS実践につながる一冊．</section><section class="preface">序　文<br><br>　奈良県立医科大学の平井都始子教授は覚えてはおられないだろう．学会会場の廊下ですれ違った際に平井先生からの「今度POCUSのテキストを出すことになったの」との一言，私は聞こえないフリをしたことを．そして「症候別のテキストにしたいの」というお言葉の直後に私が強引に話題を変えたことを．さらに「できれば先生に編集を手伝ってほしいの」と言われた時に全身からイヤイヤオーラを発散していたことを．疾患別のテキストは言ってみれば横糸の陳列，一方患者さんの訴えは縦糸，誰もが一度は「症候別のテキストがあれば便利だろうな」と思うであろう．しかしながらコトはさほど容易ではない．症候別に必要な疾患をできるだけ漏れなく盛り込み，それら全てにおいてPoint-of-care ultrasoundという本来は「パッと当てて，瞬時に判断する」というお手軽簡単な手法で解決するという難題をどう解決するか？ 私が考えたベストな解決法は，「この難題にかかわらないこと」であった．ところが気の弱い私は「Noと言えない日本人」，国際学会の質疑応答では何を聞かれても理解できぬままに「イエス」と微笑むヒトなのであった．<br>　一方で自治医科大学を卒業し，診療所を含む地域医療に長く従事した者として，POCUSの魅力や有用性も十分に理解しているつもりである．「診断の基本は丁寧な病歴の聴取と緻密な身体所見の把握にある」ことに異論を挟むつもりはない．問題はどこまで丁寧に，どこまで緻密に？ である．外来の時間を受診者数で割れば，1人に30分もかけるような「丁寧な」診察をすることは不可能であることは小学生だって分かる．そんなものは美しいテレビドキュメンタリーやドラマの世界である．もちろん経験を積むほどに効率の良い問診や診察が可能となるが，時に想定外の事態にも遭遇する．「まさかこの症状と身体所見でこの疾患だったとは！」のパターンである．「胃が痛い」→「カメラでは軽い胃炎でした，お薬を出しておきます」→帰宅後急変し結局心筋梗塞だった，などの話は決して珍しくはない（ただし学会報告されることはない）．このような時にPOCUSを用いることで患者さんのみならず担当医も救われることは（読者の方々が想像されるよりはるかに）多い．さらに「胃が痛い」→POCUSで胃壁が著明に肥厚している→「お刺身，食べました？」→「そういえば夕べ締めサバを」など，瞬時に診断の核心に迫ることができる（実際に心窩部痛で魚介類の生食が検査前に問診されていることはさほど多くない）．POCUSは安全で簡便であり，「やって大変になった」ことはなく，「やっててよかった！」ことが多い．この魅力を何とか伝えられないだろうか？ と常々思っていたことも事実である．<br>　ということで平井先生のプレッシャーに負け，POCUSの誘惑にも負け，編集のお手伝いを引き受けてしまったわけであるが，本の内容は編集者ではなく著者の力量次第であることは言うまでもない．そこで「エラく，カッコいい評論家」ではなく，日々の診療において実際にPOCUSを活用され，かつその有用性を痛感されている「デキる，アツいプレーヤー」の先生方のみにお願いし，熱く語って頂いたのがこのテキストである．本書を通読して頂くもよし，必要に応じて紐解いて頂くもまたよし，少しでも読者諸兄のお役に立つことができれば望外の幸せである．<br><br>2020年4月<br>畠　二郎</section><section class="indexes">Ⅰ章　POCUSを始める前に─超音波装置の使い方<br>　1　機器の使い方 <br>　　モニター <br>　　操作パネル <br>　　プローブ（探触子）<br>　　インデックスマークとスクリーンインディケーター<br>　2　ドプラ法の使い方<br><br>Ⅱ章　基本断面と正常像─腹部エコーと心エコーを中心に<br>　1　はじめに <br>　　押さえておきたい基本事項 <br>　　押さえておきたい基本操作 <br>　2　POCUSで必要な腹部エコーの基本走査と正常像 <br>　　上腹部正中縦走査 <br>　　右肋間走査<br>　　右肋骨弓下走査<br>　　右側腹部縦走査<br>　　右側腹部横走査<br>　　右下腹部横走査 <br>　　下腹部正中縦走査<br>　　左側腹部横走査<br>　　左側腹部縦走査<br>　　上腹部正中横走査 <br>　3　POCUSで必要な心エコーの基本断面と正常像<br>　　心窩部下大静脈縦断面 <br>　　心窩部四腔断面 <br>　　傍胸骨左縁長軸断面 <br>　　傍胸骨左縁短軸断面（乳頭筋レベル） <br>　　心尖部四腔断面<br><br>Ⅲ章　実践POCUS！─症状・症候からのアプローチ<br>　症候1　発　熱<br>　　発熱患者におけるPOCUSって？<br>　　どんな患者にエコーを当てるの？ <br>　　エコーでどこをみるの？<br>　　そのほか頭の片隅に置いておきたい疾患<br>　症候2　浮　腫 <br>　　浮腫をエコーでみると…<br>　　全身性浮腫<br>　　局所性浮腫<br>　症候3　食欲不振，悪心・嘔吐<br>　　食欲不振，悪心・嘔吐，POCUSでは何をみる？<br>　　3つのカテゴリーをチェック<br>　　食欲不振，嘔気・嘔吐のエコーチェック法<br>　　STEP1 ①腹腔内（消化管）＋膵臓<br>　　STEP1 ②腹腔内（実質臓器）<br>　　STEP1 ③胸腔内<br>　　STEP2 で診断に迫る！<br>　　番外編：小児の悪心・嘔吐<br>　症候4　便　秘 <br>　　便秘をエコーで診る？<br>　　慢性便秘の原因をエコーで探ろう！<br>　症候5　下　痢 <br>　　下痢をエコーで診る？<br>　　下痢の原因をエコーで探ろう！ <br>　症候6　腹部膨満<br>　　腹部膨満をエコーで診る？<br>　　腹部膨満の原因をエコーで探ろう！ <br>　症候7　胸　痛<br>　　胸痛の原因をエコーで探る<br>　　EASYエコーで3-killar chest painのスクリーニング <br>　　POCUSが役立つその他の胸痛疾患<br>　症候8　呼吸困難（息切れ） <br>　　呼吸困難（息切れ）の原因をエコーで探る <br>　　肺エコー法からのアプローチ<br>　　心エコー法（FoCUS）からのアプローチ<br>　　合わせ技（triple scan） <br>　症候9　黒色便 <br>　　黒色便をエコーで診る？ <br>　　黒色便の原因をエコーで探ろう！ <br>　症候10 血便（暗赤色便または鮮血便） <br>　　血便をエコーで診る意味があるの？ <br>　　血便の原因をエコーで探ろう！<br>　症候11　腹　痛 <br>　　「腹痛」にPOCUSを生かそう！<br>　　腹痛の性状を分類する<br>　　重症サインを見逃すな！─腹水とフリーエアー<br>　　各診療科をローテーション！<br>　　実際の検査─何分くらいで検査が終わるの？ <br>　症候12　血　尿<br>　　外来で腎尿路系エコーはどこまでみる？ <br>　　膀　胱<br>　　腎　臓 <br>　症候13　プライマリ・ケアで使える皮膚科領域POCUS<br>　　プライマリ・ケアでの皮膚科エコー <br>　　皮下腫瘤 <br>　　局所の発赤，腫脹<br>　症候14　プライマリ・ケアで使える整形外科領域POCUS<br>　　肋骨・肋軟骨骨折<br>　　小児が腕を動かさない<br>　　腰　痛<br>　　関節リウマチ（RA）の超音波診断 <br><br>索　引</section></article>
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