134 33-3-1Ǥ ä ¥ Ɩ ś Ƣ Ż ǡCBCǢ
QvfbRutƈ28Txavztƈ3ŃƱ%1(E7Ǘũ61?īĊ5 Ú·8=BE5/,ǡƙ4-lǢ
3-3-2Ǥ Ɩ ŋ · â Ļ ĵ A : Ǔ Ơ Ʈ Ļ ĵ
QvfbRutƈ28Txavztƈ3ŃƱ%1(E7Ǘũ61?īĊ5 Ú·8=BE5/,ǡƙ4-mǢ
3-4Ǥ Ɩ Ñ Ļ ĵ
QvfbRutƈ28SAPMAPA:DAP(E61?Txavztƈ 3ŃƱ%1(E7Ǘũ61?īĊ5Ú·8=BE5/,ǡƙ4-nǢ
135 R2Cƌƒ2CYP6ADƫGÀ"ADPÀè7{02DP2Y12Àè6Ǖ ÂƵŧ6ſÆ'D#32ADP6ADƖëIJ¨ǑGŞǃáć6ē'Dǡ106, 107Ǣ
<,Ɩż6ê'DŞ5!ƖëIJ6ƽĖŧ6Ş'D#3ūBE1D*7
2QvfbRut87ĕƖëIJƕ3ŃƱ%1ƖķŤņť61ĈƋ7ŝáĬNJ LJ!±Ş?ì5#3ơFE1Cňũ$E1Dƕ°2Dǡ107Ǣ Ì7QvfbRutĔƈ7ŭŶ28QvfbRutĔāAR]^i6 1ăďƖ3ĭĺƖ7½Ħ2®ŏ1Ƹũǎ{ƭ%1ŬƆ¢ÈGŰ%Txavz tƈ3Çļ7ĠŴGŰ%ƈNJ6īĊï8ƨ>BE5/,*7,>ƖķÿĎ¢È Gē'D#3©İ5/,3ƊBE,Ÿ ŷ7ČćĬ7ŭŶ618ăď Ɩ7AR]^i611ƸũBīĊ5ŬƆƨ>BE,,>AfĪ7¨Ðʼnć7 Ú·3%18¨ÐľƎ3ƖëIJľƎ7½ĦNj%1D#3ƊBEQvfb Rutě0ĕƖëIJŞ7=7ƕŜŞ28ƖķÿĎ6"Dĕ¨ÐŞGđ.Ŋ '#3©İ5/,,>2D3ŰÊ$E,
{ĦƖëIJľƎGƦ'DPL]^i28ĭĺƖ61Txavztƈ3Ń Ʊ%1®ŏ1ƸũǎīĊ6úLJ%ĞƖĪ61?ĿƖŢòƨ>BE,,>
ĭĺƖ618QvfbRut7ĕƖëIJŞ8ƨ>BEƕŞǃ3%1?¹ª2 D3ƊBE,%%ÇĪ6ÌŞ%,ƕŞǃ28©Ɩ7sYQ?áÒ'D#
3?ŠĊ%5"E95B53ƊBE,7AfĪ7QvfbRutĔĪ6 1?Ý©Ɩ7sYQ8áÒ%ĕƖëIJƕº°AC?2°|2<,ĕ¨ÐƕŞ }2Ý©Ɩ7ǚø8Ù³'D#3ª/1Dǡ115Ǣ
{ĦăďƖ7PL]^i618Txavztƈ3ŃƱ%1úLJ¢Èƨ>B E,?77īĊ5Ú·8ƨ>BE(QvfbRutě0ĕƖëIJŞ7´Ĵ=
BE5/,#3«ĩ%,#7Ŝş3%1Ìæħ%,ǝǚøăď®ŏ6AC ăď¦7/Ɩ5B:6ăď¦ŨǏçǂø2CƖëIJʼnćŝ&,ſĴQvf bRutºŗ28AfĪ7Ɩŋ¨ÐƹŖċGđ.Ŋ'ŵ7þĕ¨ÐŞG?,B '#3©İ5/,3ŰÊ$E,$B6Ʒò7Af7ƓöŤ8£óûLjdž~
136
¥Ť@ęýÔ㟍547ă~¥6/1ŝ&D#3Ü!æǜĪ7ăď¦ŨǏçA C?ŏ%#3Ü3ĉ$ED
7AfĈƋ2§µƏţĈGŦ%1DƖķsYQǝĈƋ618ĕ¨Ð ƕ3ĕƖëIJƕ2DJYfsx@QvfbRut7ŞťŇĄƛ35Dׯ?
Dǡ ǢŸ ŷ7ăďƖ71w7AR61\t_dsx7ĕ¨ÐŞŰ$E ,#3GƊč'D3QvfbRut37Ş6ACăď¦7ĕ¨ÐƎ3ĕƖëIJľ Ǝ7½Ħ7ē6ACƖķÿĎGnj2 DÂƎć?ƊBE,
¸ť61QvfbRut8Ćć§Ťƈ7ņť5461ǂƛ5ƕ°2 Dǡ116Ǣƴõ*7´Ĵ~¹ª2DQvfbRutėĕć7áÒūBED A65/,#7»Í3%18QvfbRut8ivbr^R2Cƌƒ27
ƫGÀ"ʼnć6Úġ$ED,>ƌƒ6"D]aQvznP450 2C19ǡCYP2C19Ǣ 7ƫƎ²ƾàÜÔGě0ĈƋ6ê%18*7´Ĵ~¹ª2D#3Ĝ ģ$E1Dǡ117, 118Ǣ*7,>Ĕ¯6ƾàÜÔƠijGæħ'Dׯ?D ŕ6"DQvfbRut7ƾàÜÔ6ADÖÉ8ƨ>BE5ĮŭŶ2Ş%
,p`tŕ61ƾàÜÔƠijGæħ%15,>QvfbRutėĕć6 ADQvfbRut7´ĴG¹ªŦĢ2 5/,ÂƎć?ƊBE,
|7ſĴACAf Ī7QvfbRutºŗ7Ĕ8ƓöąŞ3%18~¹ª2 D3ƊBE,%%ăďƖ7PL61Txavztƈ3ŃƱ%úLJ¢È ƨ>BE,,>ā8\t_dsx@wzgIsxŹ7ĕ¨Ðƕ7ŞĔ<, 8ŪğžÁĕ¨ÐƕǡDOACǢ6"DĕƖķņť*7ăďľƎ7ĤËG¶Ĺ%
,ņťGŞ'DĄƛD3ſƪ",
137
5. ëĚ
ظť7ƓöŚ×2ńŞ$E1DĕƖëIJƕ2DQvfbRutGƩĵêƬƕ 3%1ƽĖ%ǣAfp`tŕ6ê%3ƸNJ6F,CĔ%ǣƖŋ¨ÐƎ7Ú·GƟé%
,*7ſĴƖëIJľƎGƦ'DPL]^i28ĭĺƖ61Txavzt ƈ3ŃƱ%1®ŏ1ƸũǎīĊ6úLJ%ĞƖĪ61?ĿƖŢòƨ>BE, ,>ĭĺƖ618QvfbRut7ĕƖëIJŞ8ƨ>BEƕŞǃ3%1?¹ ª2D3ƊBE,
%%ăďƖ7PL]^i618Txavztƈ3ŃƱ%1īĊ5Ú·8ƨ
>BE5/,#7Ŝş3%1Ìæħ%,ǝǚøăď®ŏ6ADăď¦7/Ɩ 5B:6ăď¦ŨǏçǂø2CQvfbRutºŗ7Ş28AfĪ7Ɩķÿ ĎƹŖċGđ.Ŋ'ŵ7þĕ¨ÐŞG?,B'#3©İ5/,3ŰÊ$E ,
ăďƖ3ĭĺƖ7AR]^i61®ŏ1Ƹũǎ{ƭ%1ŬƆ¢ÈGŰ%
ƈNJ6īĊï8ƨ>BE(ƖķÿĎ¢ÈGē'D#3©İ5/,#E8Qv fbRut7ƕŜ´ĴÛ2D¨ÐÍàē´Ĵ8Ɯ©)5/,,>2D3Ɗ BE,
|ACŕ7 Af Ī7Ɩķnjyņť3%1QvfbRut547ĕƖëIJƕº ŗĔ-"28~¹ª2Cĕ¨Ðƕ7Ş@ŪğžÁĕ¨ÐƕǡDOACǢ6"D ĕƖķņťA:ăďľƎ7ĤËG¶Ĺ%,ņťGŞ'DĄƛD3ſƪ",
138
6. Q
Q4-f.^²/9&;7 :&9;7u¥k<o9,'871; :¬YOr¡²@ 9,'87´9,'87¨Wª/5+%!®ª75 mg : )-zeBwAµ4 mg/kg, SID´16 rµMk?k¬Yg³±dhjHI (Pre)H¬Y1¦g (1w)2¦g (2w)3¦g (3w) NrT-TAS|yGR~|y|y^p139
Q4-g¶hjAR$%/OTrXJ N]DcTD± }Eb Cont: :&9;7´n=8µClopido: 9,'87´n=7µpre: ³±dhjHI1w: hjH1 ¦g2w: hjH2 ¦g 3w:hjH3 ¦gAR:OT:«Vr
0 100
200
300
400 pre 1w 2w 3w
(sec) Cont Clopido
140
Q4-h¶hjPL$%/OTrXJ N]DcTD± }Eb Cont: :&9;7´n=8µClopido: 9,'87´n=7µpre: ³±dhjHI1w: hjH1 ¦g2w: hjH2 ¦g 3w:hjH3 ¦gPL:OT:«Vr
0 100
200
300
400
500 pre 1w 2w 3w
(sec) Cont Clopido
141
Q4-i¶v{AR$%/OTrXJ N]DcTD± }Eb Cont: :&9;7´n=8µClopido: 9,'87´n=7µpre: ³±dhjHI1w: hjH1 ¦g2w: hjH2 ¦g 3w:hjH3 ¦gAR:OT:«Vr
0 100
200
300
400 pre 1w 2w 3w
(sec) Cont Clopido
142
Q4-j¶v{PL$%/OTrXJ N]DcTD± }Eb::&9;7¤p<0.01tib Cont: :&9;7´n=8µClopido: 9,'87´n=7µpre: ³±dhjHI1w: hjH1 ¦g2w: hjH2 ¦g 3w:hjH3 ¦gPL:OT:«Vr
0 100
200
300
400
500
600 pre 1w 2w 3w
(sec) Cont Clopido
143
4-h¶hjT-TASrXJ N]DcTD ± }Eb T10 : «V¬YrOT :«VrAUC :S=qs>§C°U¯PL:AR: pre: ³±dhjHI1w: hjH1¦g2w: hjH2¦g3w·hjH3¦g
144
4-i¶v{T-TASrXJ N]DcTD ± }Eb::&9;7¤p<0.01tib T10 : «V¬YrOT :«VrAUC :S=qs>§C°U¯PL:`AR: pre: ³±dhjHI1w: hjH1¦g2w: hjH2¦g3w·hjH3¦g
145
4-j.hj GR~|yrXJ N]DcTD ± }Eb PT: r (KD, 7.4-8.8 s)APTT:r (KD, 12.0-28.8 s)Fibn: d (KD, 150-350 mg/dl)D-dimer: D- (KD< 2.0 μg/dl)AT: lGRPZ(KD, 102-156 %)pre: ³±dhjHI1w: hjH1¦g 2w: hjH2¦g3w·hjH3¦g
146
4-k.v{ GR~|yrXJ N]DcTD ± }Eb PT: r(KD, 7.4-8.8 s)APTT:r(KD, 12.0-28.8 s)Fibn:(KD, 150-350 mg/dl)pre: ³±dhjHI1w: hjH1¦g2w: hjH2¦g3w·hjH3¦g
147
4-l. v{ \F ´CBCµrXJ N]DcT ± }EbWBC:nRBC:£nHGB:049+: dHCT:02&6%&DMCV:cT£ _MCH:cT£049+:©MCHC:cT£049+: dPLT: `xnpre: ³±dhjHI1w: hjH1¦ g2w: hjH2¦g3w·hjH3¦g
148
4-m.v{ J[|y®¢|yrXJ N]DcTD ± }EbBUN:8$(: dCre:a dALT:5(:3)&5:!-5;" dTP:#:* dAlb:7.3: dpre: ³±dhjHI1w: hjH1¦g2w: hjH2¦g3w·hjH 3¦g
149
4-n. SrXJ N]DcTD ± }Eb SAP: LuS (KD:144 ± 27 mmHg), MAP: cTS (KD:110 ± 21 mmHg), DAP: mfuS (KD:91 ± 20 mmHg)pre: ³±dhjH I1w: hjH1¦g2w: hjH2¦g3w·hjH3¦g
150
Ƈ 5 ƆƕĎ
151
1. æÚŜƙ0> T-TAS 1úŦǮƇ 1 Ɔǯ
Ʃķòąħ0>Łê2ƩÜIJ-ÂÀÑŹu0Ŧ">Ƭµŵ/1¯ú
,=œǚo +=ƩķòąƝBƳ
ij">&802-ƚ<?+>šªÓǨÅ 0>õİ1ƩÜIJŁƝgÂƝ1Ƹŋ2#?9ƩķòąƝ%191BƸ"
>91,2/6&ƩÜIJŁƝ-ÂƝB¶ħ0ŔÔ*¯Ħ$>91,2/
)&6&ƣéţÈ0+9Ʃķůů0Ú">ċƩķűŋ1ĊoME]fG :ĊoǓ0ǚ +Ĭ'ĤŽ0?+/
NjèƩƩķòąƲŔJKQ^ǮTotal Thrombus-formation Analysis SystemDzT-TASǯ -ƩķŃƩļĶŁ¾;=ť0Njį~m,ƩÜIJŁƝ-ÂÀÑŁƝBŔ Ô">-Bŷŵ- +ªűŦ0ǘŲ?&T-TASļĶ2ŎnjBË©$/<
ÂŤ &ƩBĿęƩƋ,>\EFdŎdž0Ŏ"-,Ŏdž1I`hHf:
ƏƗÀÑļ1iǑBōý©$%?ïǔ-/=ť,Dž>;/ťŤ ŵ/ƩķòąBïDž"-³Ɲ/ƩķŃƩļĶŁ¾,>?0;=ƩŎm ,1ƩķòąBĝŵgưƱŵ0;=ƺƍ0Ƹ">-³Ɲ-/)+>Įżƅ ,2xªű0>ļĶŁ¾,>T-TASBş0Ú +ƣéŦ,>¸B
æVhGbşBÚƿ§Ş- +åǙå;3ħǙå/.0*+ļƵ Bƪ)&6&T-TASBş0Ú">Ŧį~0ěƥ &ô0æş0>Ʃķò ąħǙ1ÆŕBą &%1ƑĴ¶i0+ǫţýö<?Ĕňô ŔÔħǙ0óǥ?/ǮǤƘħǙ1ħǙ2æ0ùƮǯ-Ĥ ǰǙ1ǫ
ţý-Æŕ1ňÔƪA?&1-0;=ş,9T-TAS BŦ³Ɲ,>-Ƒƽ|&
ǫǩëøĆ řşBŦ&øĆŁƝ1ƸǮƇ Ɔǯ
Įżƅ,2ǫǩëøĆ řşBŦ>-0;=Ʃķů1ŲůƮÀ,>Virchow
152 13ƮÀ1(1i*,>ƩŎ1Ë©Bđ>-Bŷŵ- &Įżƅ_Rbş, 1øĆ řq1øÖȧ2330390 bpm,=øǣÁl0+øĆƍ§ǮAfǯ ÿDž?+>-BŽƻ &Af ħ02øĆŁƝ1i*,>YhKMhŁƝ*
6=øĆ<1Ɲ§ŵČŁƝÏA?>%1ƑĴøČ¦Ţ2 ǭm"
>-?+>Įżƅ,2øĆ1YhKMhŁƝ,>LA active EF ř1Ǎ ŷ<ĩĀ0m 6&čðĭīçííLjnjë
a’1m9Žƻ?&1-<ǐ1ǹ-¶ľ0AfŲţħ02øĆƉƍ§BDž AfŲţ1Ǎŷ;=
äưƖŁƝ1mDž=%1ô9ƒħŵ0ŁƝ1mť!>-Ĥ<-/
)&6&øĆ1čÎ9ƻ8<?&-<ƩőøĆ0ŗū ĥ/>--Ĥ<-/)&"/A(AfǘÐô1øĆ°ƖŁƝ1m0;)+øĆ
0Ʃő)ŗïDž?&-<Virchow13ƮÀ1(1i*,>ƩŎ1 Ë©ť!>-Žƻ,&
6&Afħ02øĆ1¬Ƽŵ/°ƖÏA?>ƑĴƏƗTZ`ŋǮTDIǯ0
>a’ ;3AŌľŌò2ƶǖ?/-ƴA?+>Įżƅ,2AfŲţħ1ø ĆƉ-øÖƉ18ć+1Ɗć0+a’ƻ8<?øĆƉ-øÖƉ¶īŵ0 Ǐ§ +>-ž¼?&1ŤŨ- +äĆ1Ɲ§ŵ°ƖŐÏ">ƍ§Š Ă,)+9äÖIfZ`EDfK>ƃëńÒ +>&8čðī0+
øĆƉøÖƉ0ï)ð<?>-0;)+±§ŵ0øĆ1°ƖƝ,>a’ƻ8<
?>91-ĖØ &