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㗡ㇱᄖ்ᓟ㧘Ყセ⊛ᣧᦼߦ⊒∝ߒߚᘟᕈ⎬⤑ਅⴊ⣲ߩ 1
ࠛ࠼ࠠࠨࡃࡦߩ㑐ਈߦߟߡ
ࡁญ♿1㧕᧲ჽᄥ㇢2㧕ዊᎹᵏᒄ3㧕 1㧕ᕺኼ✚ว∛㒮 ⥃ᐥ⎇ୃක 2㧕ᕺኼ✚ว∛㒮 ⣖⚻ᄖ⑼ 3㧕ᕺኼ✚ว∛㒮 ᢛᒻᄖ⑼ ޣⷐᣦޤ ∝ߪ 62 ᱦᅚᕈޕㅢᄖ்ߦߡฝ೨㗵ㇱ㧘ฝ⣶ㇱࠍฃ்ߒᒰ㒮߳ᢇᕆ៝ㅍߐࠇߚޕ㗡ㇱ CT ᬌᩏߦߡᕆᕈ ⎬⤑ਅⴊ⣲㧘ᄖ்ᕈߊ߽⤑ਅⴊࠍ㧘⢆㑐▵ࡦ࠻ࠥࡦᬌᩏߦ߅ߡฝᄢ⣽㛽㗪ㇱ㛽᛬ࠍߚޕ㗡⬄ ౝⴊߦ㑐ߒߡߪ㧘シᓸߥⴊߢࠆߎߣ߆ࠄሽ⊛ട≮ࠍㆬᛯߒ㧘ᄢ⣽㛽㗪ㇱ㛽᛬ߦ㑐ߒߡߪ╙ 2 ∛ᣣߦ 㛽ធวⴚ߇ᣉⴕߐࠇߚޕⴚᓟߩ㕒⣂ⴊᩖ∝ߩ੍㒐ߣߒߡ㧘ᚻⴚ⠉ᣣߩ╙ 3 ∛ᣣ߆ࠄࠛ࠼ࠠࠨࡃࡦ 30mg/ᣣ߇ 1ㅳ㑆ᛩਈߐࠇߚޕⴚᓟߩ⚻ㆊߪ⦟ᅢߢߞߚ߇㧘╙ 11 ∛ᣣ߆ࠄ㗡∩߇ߒ㧘╙ 15 ∛ᣣߩ㗡ㇱ CT ᬌᩏ ߦ߅ߡᱜਛ⒖ࠍ߁ᘟᕈ⎬⤑ਅⴊ⣲ߩᚲࠍߚޕ㜞㦂⠪ߩᄖ்ᓟߦ⊒∝ߒߚᘟᕈ⎬⤑ਅⴊ⣲ߩ 1 ߢࠆ߇㧘ᄖ்ᓟ 11 ᣣߢߩᣧᦼ⊒∝ߢࠅ㧘ࠛ࠼ࠠࠨࡃࡦ߇⊒∝ߦ㑐ਈߒߚน⢻ᕈ߇㜞ߣ⠨߃ࠄࠇߚޕ᛫ ಝ࿕≮ᴺࠍⴚᓟߩ▤ℂߦߟߡ㧘೨ߦ⣖⚻ᄖ⑼ක㧘ᢛᒻᄖ⑼කߣߩ⼏⺰߇ᔅⷐߢߞߚߣ⠨߃ࠄࠇ ߚޕߐࠄߦ㧘කᏧ㑆ߩㅪ៤ߪ߽ߜࠈࠎߩߎߣ㧘⋴⼔Ꮷ㧘⮎Ꮷߥߤߩࠦࡔ࠺ࠖࠞ࡞ࠍᏎ߈ㄟࠎߛᖱႎ߿ ⋧⋙ⷞ㧘ߔߥࠊߜක≮࠴ࡓߣߒߡߩㅪ៤߇㊀ⷐߣ⠨߃ࠄࠇߚޕKey Words㧦chronic subdural hematoma, edoxaban, team medical care ޣߪߓߦޤ ᘟᕈ⎬⤑ਅⴊ⣲ߪ㧘ᄖ்㧘᛫ಝ࿕≮ᴺ㧘㐳ᦼㅘᨆ㧘 ⊕ⴊ∛㧘ᖡᕈ⣲≌ߩ⎬⤑ォ⒖㧘⣶ᬁ⓫ೝߥߤේ࿃ߪ ᄙጘߦࠊߚࠆ߇㧘ㅢᏱߪᄖ்ᕈߢࠅ㧘ᄖ்ᓟߩ 3 ㅳ㨪3 ࡨߩᦼ㑆ࠍ߅ߡߩ⊒∝߇ᄢඨࠍභ㧘߹ ߚ㧘∝ߩඨᢙએ߇ 60 ᱦએߢࠆ1)2)ޕ ࿁㧘㜞㦂ᅚᕈߢ㧘ฝ⢆㑐▵㛽ធวⴚᓟߦ᛫ಝ࿕ ≮ᴺࠍᣉⴕߒ㧘ᄖ்ᓟ 11 ᣣ⋡ߢᣧᦼߦ⊒∝ߒߚᘟ ᕈ⎬⤑ਅⴊ⣲ߩ৻ࠍ⚻㛎ߒߚߩߢ㧘⥃ᐥ⚻ㆊߣ↹ ᚲ㧘ߘߩ⊒∝ᯏᐨߦߟߡ⥄㛎ߩႎ๔ߦ⧯ᐓ ߩᢥ₂⊛⠨ኤࠍട߃ႎ๔ߔࠆޕ ޣ∝ޤ ᖚ⠪㧦62 ᱦᅚᕈޕਥ⸷㧦㗡ㇱᄖ்ޕᣢᓔᱧ㧦․⸥ 㗄ߥߒޕ ⮎ᱧ㧦ߥߒޕ ∛ᱧ㧦X X ᣣߩᦺߦ⥄ォゞߢⴕਛ㧘ᦛ߇ࠅ ⷺࠍᦛ߇ߞߡ߈ߚシ⥄ォゞߣធ⸅ߒォୟߒߚޕォୟ ᤨ㧘ฝ⣶ㇱߣฝ೨㗡ㇱࠍࠦࡦࠢ࠻ߩ㕙ߦᛂᠡ ߒฃ்ߒ㧘ᒰ㒮ߦᢇᕆ៝ㅍߐࠇߚޕ 㒮 ᤨ ∝ 㧦 ᗧ ⼂ ᷡ 㧘 ᷷ 36.4 ͠ 㧘 ⴊ 160/90mmHg㧘ᔃᜉᢙ 95 ࿁/ಽ㧘ๆᢙ 18 ࿁/ಽޕ ⣖⚻ቇ⊛ᚲߦ⇣Ᏹߪߕ㧘྾⢇ߦ㤗∽߿ߒ߮ ࠇ߽ߥ߆ߞߚޕฝ೨㗡ㇱ߆ࠄ㗡㗂ㇱߦ߆ߌߡ⊹ ਅⴊ⣲ࠍߚޕᔃ㖸㧘ๆ㖸ߣ߽ߦ⇣Ᏹߪߥ ߆ߞߚޕฝ⢆㑐▵ߩዮᦛ㧘ㅴዷ㧘ౝォ㧘ᄖォㆇേߥ ߤߩนേၞ㒢ߪߥ߆ߞߚ߇㧘−∩ߦࠃࠅᱠⴕ ߪਇน⢻ߢߞߚޕ 㒮ᤨᬌᩏᚲ㧦ⴊᶧ↢ൻቇ㧘ಝ࿕♽ߢߪ㧘WBC 12800/Ǵl, D-dimer 60.3Ǵg/ml ߩ㜞୯ࠍߚ߇㧘 ⽺ⴊߪߕߘߩઁ㔚⸃⾰㧘⢄ᯏ⢻㧘⣢ᯏ⢻㧘ಝ࿕ ⢻ߦ⇣Ᏹߪߥ߆ߞߚޕ 㒮ᤨ↹ᚲ㧦⢆㑐▵ࡦ࠻ࠥࡦᬌᩏߢߪ㧘ᄢ ⣽㛽㗪ㇱ㛽᛬ߩᚲࠍߚޕ㗡ㇱ CT ᬌᩏߢߪ㧘 ฝ೨㗡⪲㜞߮㗡㗂⪲ߩ⣖Ḵ߇ᶖᄬߒߡ߅ࠅ㧘ᄖ ்ᕈߊ߽⤑ਅⴊߩᚲࠍ㧔࿑ 1A㧕㧘ฝ೨㗡ㇱ ߦ᷆㜞ๆၞߩᕆᕈ⎬⤑ਅⴊ⣲ߩᚲࠍߚ 㧔࿑ 1B㧕ޕ 㒮ᓟ⚻ㆊ㧦㗡ㇱߩᕆᕈ⎬⤑ਅⴊ⣲㧘ᄖ்ᕈߊ߽ ⤑ਅⴊߦ㑐ߒߡߪ㧘ዋ㊂ߩⴊߢࠅ㧘߹ߚߘࠇ ߦࠃࠆ⥃ᐥ∝⁁ߪߥߎߣ߆ࠄሽ⊛ട≮߇ㆬ ᛯߐࠇᢛᒻᄖ⑼㒮ߣߥߞߚޕߚߛߒ㧘ᘟᕈ⎬⤑ਅ ⴊ⣲߳ߩ⒖ⴕߩน⢻ᕈ߇⠨߃ࠄࠇߚߚ㧘ቯᦼ⊛ߥ ⣖⚻ᄖ⑼ฃ⸻߇੍ቯߐࠇߚޕᄢ⣽㛽㗪ㇱ㛽᛬ߦ㑐 ߒߡߪ㧘ᚻⴚㆡᔕߢࠅ㧘㒮⠉ᣣߩ╙ 2 ∛ᣣߦ㛽 ធวⴚ߇ᣉⴕߐࠇߚޕⴚᓟߩ㕒⣂ⴊᩖ∝ߩ੍㒐ߣߒ ߡᚻⴚ⠉ᣣߩ╙ 3 ∛ᣣ߆ࠄࠛ࠼ࠠࠨࡃࡦ 15mg/ᣣࠍ ᛩਈߒ㧘หᣣ߆ࠄࡂࡆ࠹࡚ࠪࡦࠍ㐿ᆎߒ㧘ⴚ － 80 －
ᓟ⚻ㆊߪ⦟ᅢߢߞߚޕࠛ࠼ࠠࠨࡃࡦߪⴚᓟ 7 ᣣ⋡ ߩ╙ 9 ∛ᣣ߹ߢ⛮⛯ᛩਈߒߚޕ╙ 8 ∛ᣣߦ⣖⚻ᄖ ⑼ක߇⸻ኤߒ㧘㗡ㇱ∝⁁߿⚻ቇ⊛ᚲߪ․ߦ ࠄࠇߥ߆ߞߚޕ㗡ㇱ CT ߢ߽ᘟᕈ⎬⤑ਅⴊ⣲߳ߩㅴ ዷߪࠄࠇߥ߆ߞߚߚ╙ 15 ∛ᣣߦᰴ࿁⸻ኤࠍ ੍ቯߒߚޕ ߣߎࠈ߇㧘╙ 11 ∛ᣣ߆ࠄ㗡∩ࠍ⸷߃ߪߓ㧘ߘ ߩᓟᓢޘߦჇᒝߒ㧘╙ 13 ∛ᣣߦߪ㧘࠻ࠗᓟߦ⥄ ಽߩㇱደߦᏫࠇߥߊߥࠆߣߞߚ∝⁁߇ߒߚޕ ߘߩ⚻ㆊࠍ࿑ 2 ߦ␜ߔޕ╙ 15 ∛ᣣߦ⣖⚻ᄖ⑼ࠍ ౣ⸻ߒ㧘㗡ㇱ CT ᣉⴕߒߚߣߎࠈ㧘ฃ்ㇱߦ৻⥌ ߒߚᱜਛ⒖ࠍ߁ᘟᕈ⎬⤑ਅⴊ⣲ࠍߚޕ㧔࿑ 3㧕 ⣖⚻ᄖ⑼߳ォ⑼ߒ╙ 17 ∛ᣣߦ⓫㗡ⴊ⣲ᵞᵺⴚࠍ ᣉⴕߒߚޕ╙ 19 ∛ᣣߦ࠼ࡦࠍᛮߒ㧘หᣣ߆ ࠄࡂࡆ࠹࡚ࠪࡦࠍ㐿ᆎߒߚޕߘߩᓟߩ⚻ㆊߪ ⦟ᅢߢ㧘╙ 43 ∛ᣣߩ㗡ㇱ CT ᬌᩏߢߪࠊߕ߆ߦ⎬⤑ ਅ᳓⣲ࠍࠆߩߺߢࠅ㧔࿑ 4㧕㧘╙ 60 ∛ᣣߦ⥄ ቛㅌ㒮ߒߚޕ ࿑ 1 A: ฝ㗡㗂⪲࿐ߩ⣖Ḵ߇ᶖᄬߒߡ߅ࠅ㧘ᄖ்ᕈߊ߽⤑ਅⴊߩᚲࠍߚޕ B: ฝ೨㗡ㇱߩ⊹ਅⴊ⣲ߣ㧘᷆㜞ๆၞߩᕆᕈ⎬⤑ਅⴊ⣲ߩᚲࠍߚޕ A B ࿑ 2 㒮ᓟ⚻ㆊ
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䡰䢀䢚䡳䡷䢆䢚䢙㻝㻡㼙㼓㻛㼐㼍㼥
࿑ 3 ╙ 15 ∛ᣣߩ㗡ㇱ CTޕᕆᕈ⎬⤑ਅⴊ⣲ߣหߦᱜਛ⒖ࠍ߁ᘟᕈ⎬⤑ਅⴊ⣲ߩᚲࠍߚޕ
࿑ 4 ╙ 43 ∛ᣣߩ㗡ㇱ CTޕⴊ⣲ߪᶖᄬߒ㧘ࠊߕ߆ߥ⎬⤑ਅ᳓⣲ߩᚲࠍࠆߩߺߢࠆޕ
ޣ⠨ኤޤ ᄖ்ߦࠃࠆᘟᕈ⎬⤑ਅⴊ⣲ߩ⊒↢ᯏᐨߣߒߡߪ㧘 એਅߩࠃ߁ߦ⍮ࠄࠇߡࠆޕ㗡ㇱᛂᠡߩᄖജߦࠃࠅ ⎬⤑́ࠢࡕ⤑ធ⸅㗔ၞጀ߇ᢿⵚߒ㧘㜑ᶧ߇⎬⤑ਅ⣧ ߦ⾂⇐ߔࠆޕߘࠇࠍขࠅ࿐ࠃ߁ߦᰴ╙ߦⴊ▤ߦን ࠎߛ㕖․⇣⊛Ἳ∝ᕈ⡺⧘⣲⚵❱ߩᄖ⤑߇ᒻᚑߐࠇ㧘 ߐࠄߦᄖ⤑߇ౝ߳ㅴዷߒߡౝ⤑ࠍᒻᚑߒ㧘⎬⤑ਅ ᳓⣲߇ᒻᚑߐࠇࠆޕᄖ⤑ߪ⚵❱ቇ⊛ߦⴊ▤ߦንߺ ࡦࡄ㧘ᅢ㉄㧘ᒻ⾰⚦⢩ߥߤߩᶐẢ߇ᒝޕⴊ ᯏᐨߦߟߡߪ㧘ಝ࿕✢ṁ㕙ߦ߅ߡⴊ⣲ౝኈߩಝ ࿕㧘✢ṁߪߕࠇ߽⪺ฬߥᵴᕈㅴ⁁ᘒߦࠆ߇㧘 ✢ṁఝߣߥߞߡߡᱛⴊᯏ᭴߇߈ߠࠄߊ㧘߹ߚ ⎬⤑ਅߩಝⴊࠍๆߒࠃ߁ߣⵍ⤑ߩᵢ᭽᭴ㅧ߮Ძ ⚦ⴊ▤ౝ⊹ߢߩ t-PA ߩㆊ↥↢㧘ಽᴲㅴ߇ߎ ࠅ✢ṁㅴ㧘ᱛⴊ㓚ኂࠍߎߒⴊ⣲߇Ⴧᄢߔࠆߣߐ ࠇߡࠆ1)ޕ ᘟᕈ⎬⤑ਅⴊ⣲ߩ․ᓽߦߟߡߪએਅߩࠃ߁ߦႎ ๔ߐࠇߡࠆޕᐕ㑆⊒∝₸ߪ 1㨪2 ੱ/10 ਁੱߢࠅ 70ᱦઍߢߪ 7.4 ੱ/10 ਁੱߣᄙߊ㧘ᄖ்ᓟ 3 ㅳ߆ࠄ 3 ࡨߢߩ⊒∝߇߶ߣࠎߤߢࠆޕᕆᕈ㧘ᘟᕈߩౕ ⊛ߥቯ⟵ߪቯࠄࠇߡߥޕዊఽߢߪᄙߊ߇ 2 ᱦએਅߩ⊒∝ߢࠅ㧘㜑⤑Ἳ㧘ಽᇂᤨᄖ்߇ߘߩේ ࿃ߣߥࠆޕㅢᏱᄖ்ᕈߢࠆ߇㧘20㨪30㧑ߩ∝ߢ ߪᄖ்ߩᣢᓔࠍߕ㧘ᄖ்એᄖߩⷐ࿃ߣߒߡ㧘᛫ ಝ࿕≮ᴺ㧘⊕ⴊ∛㧘ⴊ∛㧘ITP㧘DIC㧘㐳ᦼㅘᨆ㧘 ⣶ᬁ⓫ೝᓟߩ㜑ᶧṳ㧘ᖡᕈ⣲≌ߩ⎬⤑ォ⒖ߥߤ߇ ߍࠄࠇߡࠆ 1)ޕ߹ߚ㧘⸻ᢿߦ㑐ߒߡ Gentry ࠄ 2) ߪଢᕈ㧘ㄦㅦᕈ߆ࠄ CT ᬌᩏࠍផᅑߒߡࠆ߇㧘 ࠄ߆ߦᘟᕈ⎬⤑ਅⴊ⣲߿ߘߩઁߩ㗡⬄ౝⴊࠍ⇼ ߁ߦ߽㑐ࠊࠄߕ㧘CT ߦߡࠄ߆ߥᚲ߇ᓧࠄࠇߥ ႐ว߇ࠆޕߘߩࠃ߁ߥ႐วߦ㧘CT ߢߩ╬ๆ ⴊ⣲ࠆߪ㗡⬄㛽ߩᓇ㗀߇ᒝ㗡㗂ㇱߢߩ⭯ⴊ ⣲߿ᓸዊ∛ᄌߩน⢻ᕈࠍ⠨߃ߡ㧘MRI ߩᓇࠍផᅑ ߒߡࠆޕ߹ߚᴦ≮ᴺߦߟߡ㧘⓫㗡ⴊ⣲ᵞᵺⴚ߇ ⴕߥࠊࠇࠆߎߣ߇৻⥸⊛ߛ߇ 1)㧘ࠬ࠹ࡠࠗ࠼߇ല ߢߞߚߣ߁ߊߟ߆ߩႎ๔߇ࠆ3) 4)ޕ ࠛ࠼ࠠࠨࡃࡦߦ㑐ߒߡ㧘Gras J ࠄ5)ߪᢛᒻᄖ⑼㗔 ၞߩੱญ⤒㑐▵ో⟎឵ⴚ߿ੱᎿ⢆㑐▵ో⟎឵ⴚߦ߅ ߡ 1 ᣣ 30mg ߩࠛ࠼ࠠࠨࡃࡦߩᛩਈߪ㧘ࠛࡁࠠࠨ ࡄࡦߥߤߩૐಽሶࡋࡄࡦߣᲧセߒߡᗧߦ ߡ㧘ᄖ்ᕈߩ㗡⬄ౝⴊߩㅴⴕ߇ࠄࠇߥߊߥߞ ߡ߆ࠄ 24 ᤨ㑆એ㒠ߩ᛫ಝ࿕≮ᴺߪ㧘㗡⬄ౝⴊߩ Ⴧᖡࠍߕߦ㕒⣂ⴊᩖ∝ߩ⊒∝ࠍᷫዋߐߖߚߣႎ ๔ߒߡࠆޕߒ߆ߒ৻ᣇߢ Rust T ࠄ7)ߪ㧘᛫ಝ࿕≮ ᴺਛߩᖚ⠪ߩ㗡ㇱᄖ்ߦ߅ߡ㧘․ߦࡢ࡞ࡈࠔࡦ ↪ਛߩᖚ⠪ߦ߅ߡߩᘟᕈ⎬⤑ਅⴊ⣲ߩ⊒∝ߩ ࠬࠢߪ 42.5 ߣߥࠅ㧘ߘߩઁࠕࠬࡇࡦߥߤߪᱜ⏕ ߥ⹏ଔߪߥߐࠇߡߥ߇㜞ࠬࠢߢߞߚߣㅀߴ ߡࠆޕ ᧄ∝ߢߪ㧘ᄖ்⠉ᣣߩ㗡ㇱ CT ᬌᩏߦ߅ߡᕆ ᕈ⎬⤑ਅⴊ⣲߿ᄖ்ᕈߊ߽⤑ਅⴊߩჇᖡߪߕ㧘 ᄢ⣽㛽㗪ㇱ㛽᛬ߦኻߔࠆ㛽ធวⴚ߇ᣉⴕߐࠇ㧘㕒⣂ ⴊᩖ∝ߩ੍㒐ࠍ⋡⊛ߦᚻⴚ⠉ᣣ߆ࠄࠛ࠼ࠠࠨࡃࡦ 15mg/ᣣ߇ 1 ㅳ㑆ᛩਈߐࠇߚޕߘߩᓟ㧘╙ 11 ∛ᣣ߆ ࠄ㗡∩㧘ਇ⌁㧘ⴕേ⇣Ᏹߣߞߚ∝⁁߇ᓢޘߦ ߒ㧘╙ 15 ∛ᣣߩ㗡ㇱ CT ᬌᩏߢᘟᕈ⎬⤑ਅⴊ⣲߇⏕ ߐࠇߚޕ৻ᣇ㧘ᘟᕈ⎬⤑ਅⴊ⣲ߩㅢᏱߩ⊒∝ߪ㧘 ᄖ்ᓟ 3 ㅳ㑆߆ࠄ 3 ࡨߣߐࠇߡࠆߩߢ㧝)㧘ᧄ∝ ߪᲧセ⊛ᣧᦼߦ⊒∝ߒߚᘟᕈ⎬⤑ਅⴊ⣲ߩ 1 ߢ ࠆߣ߃ࠆޕ⪺⠪ࠄ߇ᢥ₂ᷤ⁸ߒߚ㒢ࠅࠛ࠼ࠠ ࠨࡃࡦ↪ߦࠃࠆᘟᕈ⎬⤑ਅⴊ⣲ߩ⊒∝ࠬࠢߦ㑐 ߔࠆႎ๔ߪࠄࠇߥ߇㧘⊒∝ᤨᦼ߆ࠄߔࠆߣࠛ ࠼ࠠࠨࡃࡦ߇ᧄ∝ߩᘟᕈ⎬⤑ਅⴊ⣲ߩ⊒∝ߦ㑐ਈ ߒߡߚน⢻ᕈ߇㜞ߣ⠨߃ࠄࠇߚޕ ߹ߚ㧘ᧄ∝ߢߪฃ்ᒰೋ߆ࠄᘟᕈ⎬⤑ਅⴊ⣲߳ ߩㅴዷߩน⢻ᕈࠍᔨ㗡ߦ߅ߡ㧘ቯᦼ⊛ߥ⣖⚻ᄖ ⑼ฃ⸻ߣ㗡ㇱ CT ᬌᩏ߇੍ቯߐࠇߡߚޕᘟᕈ⎬⤑ ਅⴊ⣲߳ߩㅴዷߦ㓙ߒߡ߽ࠆ⒟ᐲ੍ᗐߐࠇߡߚ ߎߣߢߞߚߚ㧘ㄦㅦߦኻᔕߔࠆߎߣ߇ߢ߈㧘੍ ᓟߪ⦟ᅢߢߞߚޕߒ߆ߒߥ߇ࠄ㧘ࠛ࠼ࠠࠨࡃࡦᛩ ਈߦ㑐ߒߡ೨ߦ⣖⚻ᄖ⑼කߣᢛᒻᄖ⑼කߢߩච ಽߥᖱႎ߿⼏⺰߇ߥߐࠇߡߪߥ߆ߞߚߎߣ߇ 㗴ߢߞߚޕᧄ᧪ߥࠄ߫㧘ⴚᓟߩ㕒⣂ⴊᩖ∝ߩ੍ 㒐╷ߣߒߡߘߩઁߩᣇᴺ㧘߽ߒߊߪࠛ࠼ࠠࠨࡃࡦߩ ᛩਈ㊂㧘ᦼ㑆ߥߤࠍ㈩ᘦߔߴ߈ߢߞߚߣᕁࠊࠇࠆޕ ߐࠄߦ࿁ߩᢎ⸠߆ࠄ㧘කᏧ㑆ߩㅪ៤ߪ߽ߜࠈࠎߩ ߎߣ㧘⋴⼔Ꮷ㧘⮎Ꮷߥߤߩࠦࡔ࠺ࠖࠞ࡞ࠍᏎ߈ㄟ ࠎߛᖱႎ߿⋧⋙ⷞ㧘ߔߥࠊߜක≮࠴ࡓߣߒ ߡߩㅪ៤߇㊀ⷐߣ⠨߃ࠄࠇߚޕ
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