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{"sheet":"病院＆患者情報","index":0,"n_rows":18,"n_cols":7,"rows_kept":18,"cut":false,"hidden":false,"merged":[],"flags":["formulas_cached_only"]}
[]
["病院・患者情報"]
[]
["　病院名：","　"]
[]
["　患者年齢：",null,null,null,"発症時体重：","　","kg"]
[]
["　入院日・時刻：","20　　  /        /              　　 時　　　　分           "]
[]
["　ICU入室日：","20　　  /        /                          ","　",null,"ICU退出日：","20　　  /        /   "]
[]
[]
["　他院からの転院患者ですか？　　　いいえ　　はい  施設名："]
[]
[]
["症例の要約"]
[]
["　出血発生日・時刻:","20　  /        /         ","時　　　分    "]

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[]
["産科出血"]
[]
["　妊娠/出産の詳細：",null,null,"　",null,"　","　"]
[]
["妊娠回数：","回",null,"分娩回数：","回"]
[]
["妊娠週数：","週",null,"胎児数：　 ","単胎児　　　双生児　　　3児以上"]
[]
["陣痛発来：","　　自然　　　　誘発"]
[]
["分娩方法：","　　通常経腟分娩"]
[]
[null,"　　吸引・鉗子分娩"]
[]
["　","　　帝王切開　　　　緊急　　　　待機的　　　　頚部横切開　　　　体部切開"]
[]
["　　　　　　　子宮内胎児死亡",null,null,"　　　　　　　　　　　羊水塞栓症"]
[]
["　　　　　　　子宮弛緩症",null,null,"　　　　　　　　　　　腟血腫/外陰血腫",{"$nulls":7}," "," "," "]
[]
["　　　　　　　子宮破裂/不全子宮破裂",null,null,"　　　　　　　　　　　子宮内反症",{"$nulls":7}," ",null," "]
[]
["　　　　　　　前置胎盤/癒着胎盤",null,null,"　　　　　　　　　　　頚管妊娠/子宮外妊娠"]
[]
["　　　　　　　常位胎盤早期剥離",null,null,"　　　　　　　　　　　胞状奇胎"]
[]
["　　　　　　　子癇/妊娠高血圧症候群",null,null,"　　　　　　　　　　　敗血症"]
[]
["　　　　　　　その他　　　　　　　　　　　　　　１"]
[]
[]
[]
["　止血を目的とした子宮収縮薬および止血薬：",{"$nulls":8}," ",null," "]
[null,null,null,"　"]
[" ","薬剤名 ",null,"１日投与量"," ","投与期間 "]
[null,null,null,"　"]
["    オキシトシン"," ",null,"　",null,"20　　  /        /              ","～","20　　  /        /              "," ",null,"　　"]
["（アトニン-O) "]
[]
[" 　　　麦角アルカロイド"," ",null,"　"," ","20　　  /        /              ","～","20　　  /        /              "," "]
["　　　（エルゴメトリン、メテナリン等）"]
[]
["　　　プロスタグランジン"," ",null,"　"," ","20　　  /        /              ","～","20　　  /        /              "," "]
["　　　（プロスタルモン等）"]
[]
["　　　トラネキサム酸"," ",null,"　"," ","20　　  /        /              ","～","20　　  /        /              "," "]
[]
[]
["　　　その他"," ",null,"　"," ","20　　  /        /              ","～","20　　  /        /              "," "]
[]
[]
[]
["　止血を目的とした処置・手術：",{"$nulls":8}," ",null," "]
[]
["　","　",null,"施行日"," ","施行時間"]
[]
["　　　子宮動脈塞栓術","　",null,"20　　  /        /              ","　","　　　 時　　 分"]
[]
["　　　子宮動脈結紮 ","　",null,"20　　  /        /              ","　","　　　 時　　 分"]
[]
["　　　内腸骨動脈結紮 ","　",null,"20　　  /        /              ","　","　　　 時　　 分"]
[]
["　　　B-Lynch 縫合","　",null,"20　　  /        /              ","　","　　　 時　　 分"]
[]
["　　　子宮摘出術","　",null,"20　　  /        /              ","　","　　　 時　　 分"]
[]
["　　　balloon occlusion","　",null,"20　　  /        /              ","　","　　　 時　　 分"]
[]
["　　　ガーゼタンポナーデ(子宮体部・頚管)",null,null,"20　　  /        /              ","　","　　　 時　　 分"]
[]
["　　　その他","　",null,"20　　  /        /              ","　","　　　 時　　 分"]

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[]
["抗DIC・ショック療法",{"$nulls":7},"　"]
[]
["　　　なし"]
[null,"１日投与量",null,null,null,"投 与 期 間"]
["　　　アンチトロンビン製剤",null,"　","　",null,"20　  /     /              ","～","20　  /     /              "," "]
[]
["　　　ダナパロイドナトリウム",null,"　","　"," ","20　  /     /              ","～","20　  /     /              "," "]
[]
["　　　アプロチニン",null,"　","　"," ","20　  /     /              ","～","20　  /     /              "," "]
[]
["　　　未分画ヘパリン",null,"　","　"," ","20　  /     /              ","～","20　  /     /              "," "]
[]
["　　　低分子量ヘパリン",null,"　","　"," ","20　  /     /              ","～","20　  /     /              "," "]
[]
["　　　エフ・オー・ワイ",null,"　","　"," ","20　  /     /              ","～","20　  /     /              "," "]
[]
["　　　フサン",null,"　","　"," ","20　  /     /              ","～","20　  /     /              "," "]
[]
["　　　ウリナスタチン",null,"　","　"," ","20　  /     /              ","～","20　  /     /              "," "]
[]
["　　　ステロイド",null,"　","　"," ","20　  /     /              ","～","20　  /     /              "," "]
[]
["　　　塩酸ドパミン/塩酸ドブタミン",null,"　","　"," ","20　  /     /              ","～","20　  /     /              "," "]
[]
["　　　ラシックス",null,"　","　"," ","20　  /     /              ","～","20　  /     /              "," "]
[]
["　　　その他",null,"　","　"," ","20　  /     /              ","～","20　  /     /              "," "]
[]
[]
["ノボセブン投与",null,null,"　",null,null,null," "," "]
[]
["　投与回数：","回",null,"　",null,null,null," "," "]
[]
[null,"１回目",null,"2回目",null,"3回目",null,"４回目以上"]
[]
["　投与量：","mg",null,"mg",null,"mg",null,"mg"," "]
[]
["　投与日：","20   /  /",null,"20   /  /",null,"20   /  /",null,"20   /  /"," "]
[]
["　投与時刻："," 時　　分",null," 時　　分",null," 時　　分",null," 時　　分"," "]
[]
["　体温：","℃",null,"℃",null,"℃",null,"℃"," "]
[]
["　動脈血pH：","　",null,"　",null,"　",null,"　"," "]
[]
[]
["　投与場所：","1, 2, 3, 4, 5",null,"1, 2, 3, 4, 5",null,"1, 2, 3, 4, 5",null,"1, 2, 3, 4, 5"," "]
["1.分娩室, 2.手術室, 3.リカバリールーム, 4.ICU, 5.一般病棟","当てはまるものにマルを付けてください"]
["　","　"]
["　ノボセブンの効果：","1, 2, 3, 4",null,"1, 2, 3, 4",null,"1, 2, 3, 4",null,"1, 2, 3, 4"," "]
["1. 止血、2.出血減、3.不変、4.出血増","当てはまるものにマルを付けてください"]

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[]
["臨床検査値"]
[]
[null,null,"入院時",null,"初回投与前",null,"初回投与後",null,"2回目投与前",null,"2回目投与後",null,"最終投与後"]
[]
["　日付",null,"20   /  /",null,"20   /  /",null,"20   /  /",null,"20   /  /",null,"20   /  /",null,"20   /  /"]
[]
["　時刻",null," 時　　分",null," 時　　分",null," 時　　分",null," 時　　分",null," 時　　分",null," 時　　分"]
[]
["　収縮期血圧(mmHg)"]
[]
["　脈拍(/分)"]
[]
["　時間尿量(mL/kg/h)"]
[]
["　PT(秒)"]
[]
["　APTT(秒）"]
[]
["　血小板(万/mm3)"]
[]
["　Hb (g/dL)"]
[]
["　Ht (%)"]
[]
["  FDP(D-dimer)(μg/mL)"]
[]
["　AT活性(%)"]
[]
["　フィブリノゲン(mg/dL)"]
[]
[]
["輸血・輸液療法"]
[{"$nulls":13}," "]
[null,null,"搬送の場合入院まで",null,"入院から初回投与まで",null,"初回投与後24時間",null,"1回目-2回目投与間",null,"2回目投与後24時間",null,"最終投与後24時間"," "]
[{"$nulls":13}," "]
["　赤血球濃厚液（Ｕ）*",{"$nulls":12}," "]
[]
["　新鮮凍結血漿（mL）**",{"$nulls":12}," "]
[]
["　血小板濃厚液（Ｕ）*",{"$nulls":12}," "]
[]
["　自己血（mL）",{"$nulls":12}," "]
[]
["　膠質液(ヘスパンダー等）(mL)",{"$nulls":10}," ",null," "]
[]
["　アルブミン製剤(g)"]
[]
["　乳酸リンゲル/酢酸リンゲル輸液(mL)"]
[]
["　その他"]
[]
[]
["出血量 (mL)"]
[{"$nulls":13}," "]
[null,null,"搬送の場合入院まで",null,"入院から初回投与まで",null,"初回投与後24時間",null,"1回目-2回目投与間",null,"2回目投与後24時間",null,"最終投与後24時間"," "]
[{"$nulls":13}," "]
["　出血量(mL)",{"$nulls":12}," "]
[]
["*：1Ｕは血液200mL由来"]
[" **：新鮮凍結血漿は2007年8月より、製剤1単位が約80mLから約120mLへ変更"]

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[]
["有害事象/副作用（該当する項目に印を付け、詳細を記載してください）"]
[]
["　　投与後28日以内に有害事象や副作用なし"]
[null,null,null,"ﾉﾎﾞｾﾌﾞﾝ投与からの時間",{"$nulls":5},"ﾉﾎﾞｾﾌﾞﾝとの因果関係"]
[null,null,null,"1.直後",null,"5.1～2日",null,null,null,"1.なし",null,"3.否定できない"]
[null,null,null,"2. 6時間未満",null,"6.2～7日",null,null,null,"2.あり",null,"4.判断不能"]
[null,null,null,"3. 6～12時間",null,"7.8～28日"]
[null,null,null,"4.12～24時間",{"$nulls":7},"　"]
[{"$nulls":5},"上記より選んで記載",{"$nulls":5},"上記より選んで記載"]
["　　脳血管障害",null,null,"ﾉﾎﾞｾﾌﾞﾝ投与からの時間",{"$nulls":5},"ﾉﾎﾞｾﾌﾞﾝ投与との関連性"]
[]
["　　一過性脳虚血発作",null,null,"ﾉﾎﾞｾﾌﾞﾝ投与からの時間",{"$nulls":5},"ﾉﾎﾞｾﾌﾞﾝ投与との関連性"]
[]
["　　深部静脈血栓症",null,null,"ﾉﾎﾞｾﾌﾞﾝ投与からの時間",{"$nulls":5},"ﾉﾎﾞｾﾌﾞﾝ投与との関連性"]
[]
["　　肺塞栓症",null,null,"ﾉﾎﾞｾﾌﾞﾝ投与からの時間",{"$nulls":5},"ﾉﾎﾞｾﾌﾞﾝ投与との関連性"]
[]
["　　急性心筋梗塞",null,null,"ﾉﾎﾞｾﾌﾞﾝ投与からの時間",{"$nulls":5},"ﾉﾎﾞｾﾌﾞﾝ投与との関連性"]
[]
["　　動脈血栓症",null,null,"ﾉﾎﾞｾﾌﾞﾝ投与からの時間",{"$nulls":5},"ﾉﾎﾞｾﾌﾞﾝ投与との関連性"]
[]
["　　DIC",null,null,"ﾉﾎﾞｾﾌﾞﾝ投与からの時間",{"$nulls":5},"ﾉﾎﾞｾﾌﾞﾝ投与との関連性"]
[]
["　　多臓器不全",null,null,"ﾉﾎﾞｾﾌﾞﾝ投与からの時間",{"$nulls":5},"ﾉﾎﾞｾﾌﾞﾝ投与との関連性"]
[]
["　　急性呼吸窮迫症候群",null,null,"ﾉﾎﾞｾﾌﾞﾝ投与からの時間",{"$nulls":5},"ﾉﾎﾞｾﾌﾞﾝ投与との関連性"]
[]
["　　アレルギー",null,null,"ﾉﾎﾞｾﾌﾞﾝ投与からの時間",{"$nulls":5},"ﾉﾎﾞｾﾌﾞﾝ投与との関連性"]
[]
["　　その他",null,null,"ﾉﾎﾞｾﾌﾞﾝ投与からの時間",{"$nulls":5},"ﾉﾎﾞｾﾌﾞﾝ投与との関連性"]
{"$rows_empty":11}
["転帰(退院又は少なくとも28日後までの患者の経過を記載）"]
["下記より該当するものを１つ選んでください。"]
[]
["　　　入院中","  /　　　 /",null,null,null,"現在"]
[]
[]
["　　　退院","退院日",null,"  /　　　 /"]
[]
[null,"退院先",null,null,null,"家庭"]
[]
[{"$nulls":5},"他院"]
[]
[{"$nulls":5},"その他"]
[]
["　　　死亡","死亡日",null,"  /　　　 /"]
[]
[null,"死亡原因"]