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		<h1 class="catchCopy">当直で，病棟で，「いま何をすべきか」がわかる！エビデンスに基づく内科研修医の必読書</h1>
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		<h1 class="title">内科レジデント実践マニュアル<span class="version">第12版</span></h1>
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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><h3 class="review">書評</h3></div><section class="current content">多くのレジデントに支持され続ける内科研修の定番マニュアル．三井記念病院の経験豊富な医師が，最新エビデンスと実践知を結集し，第12版として刷新した．救急外来での初期対応，病棟対応で「いま何をすべきか」．フローチャートを多数追加，レジデントにとって必要な検査・治療内容を強調し，さらにわかりやすく実践的に全面改訂．新設のQ&Aではレジデントの抱える臨床での疑問を解決した．迷ったときに頼れる，確かな知識がここにあります．</section><section class="preface">第12版発行に際して<br><br>　1989年に『内科レジデント実践マニュアル』第1版を出版してから約35年が経過しました．現在臨床の場でご活躍され指導的立場になられた多くの先生方から，「研修医の頃ポケットに入れて大変役に立ちました」とお褒めの言葉をいただくなど，幸いにも読者の皆様のご支持を得て，このたび第12版を発行することができました．<br>　本書は，主として卒後5年目までの，病棟診療を中心とする若手医師を対象としています．5年前に刊行した前版以降の医療の進歩を反映し，エビデンスを尊重しながらも実用的なマニュアルになるように心がけました．経験の少ない研修医や専攻医が，日常診療に円滑に対応し，当直や救急診療を乗り切ることができるように，「いま何をすればよいのか」がわかるマニュアルを目指しました．<br>　具体的には，①章の構成を見直し，フローチャートを使用するとともに，レジデントにとって必要な検査項目・治療内容を強調し，わかりやすい構成にすること，②Q and Aパートを通じて臨床問題解決により踏み込んだ内容にすることなどの改訂を行っています．記載内容については，三井記念病院の各領域の専門家がチェックし，必要な修正を行いました．<br>　研修期間中は，診療技術や知識だけでなく，スタッフや患者・家族とのコミュニケーションなど，多くの技能を習得する必要があります．本マニュアルが皆様の多忙な日常診療のなかでお役に立てば，大変嬉しく思います．<br><br>　2025年2月<br>　三瀬直文 三井記念病院 副院長<br>　戸田信夫 三井記念病院 内科部長</section><section class="indexes">第12版発行に際して<br><br>1　心肺蘇生法	<br>2　ショック	<br>3　アレルギー	<br>4　発　熱	<br>5　感染症	<br>　Ⅰ．咽頭炎<br>　Ⅱ．インフルエンザ<br>　Ⅲ．急性副鼻腔炎<br>　Ⅳ．伝染性単核球症<br>　Ⅴ．急性腎盂腎炎<br>　Ⅵ．急性腸炎<br>　Ⅶ．蜂窩織炎<br>　Ⅷ．壊死性筋膜炎<br>　Ⅸ．骨盤内炎症性疾患（PID）<br>　Ⅹ．COVID-19<br>6　敗血症	<br>7　意識障害	<br>8　精神科・脳神経内科レスキュー（悪性症候群）	<br>9　頭　痛	<br>10　めまい	<br>11　失　神	<br>12　けいれん，てんかん	<br>　Ⅰ．けいれん<br>　Ⅱ．てんかん<br>13  脳血管障害	<br>　Ⅰ．一過性脳虚血発作（TIA）<br>　Ⅱ．脳梗塞<br>　Ⅲ．脳出血<br>　Ⅳ．くも膜下出血<br>14　髄膜炎	<br>15　胸痛，呼吸困難	<br>　Ⅰ．胸　痛<br>　Ⅱ．呼吸困難<br>16　急性冠症候群	<br>17　心不全	<br>18　不整脈	<br>19　急性大動脈解離	<br>20　急性肺血栓塞栓症	<br>21　高血圧緊急症	<br>22　感染性心内膜炎	<br>23　呼吸不全	<br>24　気　胸	<br>25　気管支喘息，COPD	<br>　Ⅰ．気管支喘息<br>　Ⅱ．COPD<br>26　肺　炎	<br>27　腹　痛	<br>28　消化管疾患	<br>　Ⅰ．消化管出血<br>　Ⅱ．緊急処置を要する消化管疾患<br>29　肝疾患（肝不全）	<br>　Ⅰ．急性肝不全<br>　Ⅱ．肝硬変の合併症<br>30　胆・膵疾患	<br>　Ⅰ．急性胆管炎<br>　Ⅱ．急性胆囊炎<br>　Ⅲ．急性膵炎<br>31　糖尿病	<br>　Ⅰ．初期の血糖コントロール<br>　Ⅱ．糖尿病性昏睡（低血糖を除く）<br>　Ⅲ．低血糖性昏睡<br>32　内分泌疾患	<br>　Ⅰ．副腎クリーゼ（急性副腎不全）<br>　Ⅱ．甲状腺クリーゼ<br>　Ⅲ．粘液水腫性昏睡<br>33　膠原病，リウマチ性疾患	<br>　Ⅰ．膠原病領域における緊急症<br>　Ⅱ．関節炎のチェックリスト<br>　Ⅲ．関節炎の鑑別診断<br>　Ⅳ．膠原病・リウマチ患者の緊急入院時の注意点<br>34　ステロイドの使い方	<br>35　急性腎障害	<br>36　電解質・酸塩基平衡異常	<br>　Ⅰ．電解質異常の患者を診たら<br>　Ⅱ．カリウム（K）代謝の異常<br>　Ⅲ．ナトリウム（Na）代謝の異常<br>　Ⅳ．カルシウム（Ca）代謝の異常<br>　Ⅴ．マグネシウム（Mg）代謝の異常<br>　Ⅵ．各電解質異常をきたす代表的な薬剤<br>　Ⅶ．酸塩基平衡異常の患者を診たら<br>　Ⅷ．アシドーシスの診断と治療<br>　Ⅸ．アルカローシスの診断と治療<br>37　輸液療法	<br>　Ⅰ．輸液療法の概要<br>　Ⅱ．中心静脈栄養<br>　Ⅲ．透析患者の輸液療法<br>　Ⅳ．経腸栄養<br>38　貧血，出血傾向，DIC，輸血	<br>　Ⅰ．貧　血<br>　Ⅱ．出血傾向<br>　Ⅲ．DIC<br>　Ⅳ．輸　血<br>39　Oncologic emergency  	<br>　Ⅰ．Oncologic emergency<br>　Ⅱ．上大静脈（SVC）症候群<br>　Ⅲ．脊髄圧迫症候群（MSCC）<br>　Ⅳ．腫瘍崩壊症候群（TLS）<br>　Ⅴ．発熱性好中球減少症（FN）<br>　Ⅵ．抗がん剤の血管外漏出（EV）<br>　Ⅶ．薬剤性肺障害（ILD）<br>40　疼痛管理，緩和ケア	<br>41　せん妄，不眠	<br>　Ⅰ．せん妄<br>　Ⅱ．不　眠<br>42　下剤の使い方	<br>43　術前の循環器評価	<br><br>NOTE	<br>　1　アルコール多飲者が入院した場合の注意点<br>　2　B型肝炎再燃のリスク評価<br>　3　免疫関連有害事象（irAE）<br>　4　経腸栄養<br>　5　肺塞栓症の予防<br><br>●付　録	<br>　主な血液検査項目一覧<br>　緊急時によく使われる血液検査<br>　緊急時の代表的な昇圧・鎮痛・鎮静組成<br>　主な抗菌薬の略語一覧<br><br>●索　引	</section><section class="review">評者：伊苅裕二（東海大学医学部付属病院循環器内科学教授）<br><br>内科レジデント実践マニュアル第12版の刊行に寄せて<br><br>　三井記念病院は内科レジデントの聖地である．<br>　2004年の新医師臨床研修制度の施行以後は，マッチングにより研修先を選択し，初期研修2年間は外の病院で行うのが当たり前の時代となった．ところが，それ以前は全く異なっていた．多くの初期研修は大学もしくはその関連施設で行われ，それ以外で研修を行うのは，あるまじき行為とみなされたものである．その時代，いくつかの病院では外部からレジデントを募集しさまざまなメンバーが内科レジデントを行った．そのうちの一つが三井記念病院である．異種文化交流であるレジデント生活は学術的にも刺激が多く，またそれを受け入れる圧倒的パワーがあり，その中から稲妻のような輝きで作成されたのが三井記念病院版の「内科レジデント実践マニュアル」である．私は初版の副編集長という立場で，見本原稿の作成や序文の執筆などさまざまな作業を行い，卒後2年目の初期研修医の分際で出版を成し遂げたのであった．今みると初版は，勢いで作ってしまった感があり，包括性には欠けるものであったが意外と売れ行きがよく，その後も改訂を重ねていく礎になったと思われる．<br>　今回は，伝統のある三井記念病院版の内科レジデント実践マニュアルの第12版の刊行となり，内容が刷新され，ますます充実した使いやすいものになっている．ポケットにいれて，まず見る本として実践的なスタイルは貫かれていると思われる．ポケットに一冊いれて初期研修生活を送ることをお勧めしたい．<br>　研修医時代に学ぶべきことは多い．しかし，研修医時代に学んだことは一生の財産となる．大学教授という立場になったが，いまだに研修医時代に仲間と突き詰めて，近所の居酒屋で議論した内容などが役にたつこともある．この本を片手に充実した研修生活を送っていただくことを切に祈念する．<br><br>（「Medical Practice」2025年4月号（42巻4号）掲載）<br></section></article>
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