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| 1.
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Takei, Yutaka ; Inaba, Hideo ; Yachida, Takahiro ; Enami, Miki ; Goto, Yoshikazu ; Ohta, Keisuke
概要:
Review: The interval between collapse and emergency call influences the prognosis of out-of-hospital cardiac arrest (OHC
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A). To reduce the interval, it is essential to identify the causes of delay. Methods: Basal data were collected prospectively by fire departments from 3746 OHCAs witnessed or recognised by citizens and in which resuscitation was attempted by emergency medical technicians (EMTs) between 1 April 2003 and 31 March 2008. EMTs identified the reasons for call delay by interview. Results: The delay, defined as an interval exceeding 2 min (median value), was less frequent in the urban region, public places and for witnessed OHCAs. Delay was more frequent in care facilities and for elderly patients and OHCAs with longer response times. Multiple logistic regression analysis indicated that urban regions, care facilities and arrest witnesses are independent factors associated with delay. The ratio of correctable causes (human factors) was high at care facilities and at home, compared with other places. Calling others was a major reason for delay in all places. Performing cardiopulmonary resuscitation (CPR) and other treatments was another major reason at care facilities. Large delay, defined as an interval exceeding 5 min (upper-quartile value), was an independent factor associated with a low 1-year survival rate. Conclusion: The incidence of correctable causes of delay is high in the community. Correction of emergency call manuals in care facilities and public relation efforts to facilitate an early emergency call may be necessary. Basic life support (BLS) education should be modified to minimise delays related to making an emergency call. © 2010 Elsevier Ireland Ltd.
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| 2.
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Takei, Yutaka ; Enami, Miki ; Yachida, Takahiro ; Ohta, Keisuke ; Inaba, Hideo
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PURPOSE: It is not clear whether advanced airway management (AAM) with an endotracheal tube (ET) by paramedics may improve the outcome of out-of-hospital cardiac arrest (OHCA) compared with the use of a bag-valve-mask device (BVMD)
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and other AAM devices. METHODS: We analyzed 2,586 adult cases of OHCA without administration of adrenaline, witnessed or recognized by citizens in subjects transported to hospital by paramedics between 1 July 2004 and 31 March 2008 in Ishikawa, Japan, to determine whether AAM with an ET used under limited indication criteria may improve the outcome of OHCA. RESULTS: The airway was managed with an ET in 263 cases, other AAM devices in 660 cases, and a BVMD in 1,539 cases. The AAM failed or was discontinued in 124 cases, which were excluded from the analysis. The incidence of sustained return of spontaneous circulation (ROSC) was significantly higher in cases of AAM with an ET (30%) than in AAM with other devices (20.2%) and in the standard procedure with a BVMD (21.3%). The AAM with an ET did not significantly affect 1-year survival. Multiple regression analysis indicated that tracheal intubation (odds ratio = 1.503, 95% confidence interval 1.081-2078), but not patient management by paramedics qualified for ET use, was an independent factor associated with sustained ROSC. CONCLUSION: When subjects with difficult airway are excluded, tracheal intubation according to the limited indication criteria and well-organized protocol in Japan may improve the short-term outcome of OHCA of noncardiac origin. A large prospective study is needed to determine the general effects of tracheal intubation on the long-term outcome of OHCA with disturbed ventilation.
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3. Differential effects of ageing and BLS training experience on attitude towards basic life support
Enami, Miki ; Takei, Yutaka ; Inaba, Hideo ; Yachida, Takahiro ; Ohta, Keisuke ; Maeda, Testuo ; Goto, Yoshikazu
概要:
Purpose of study: To determine the effects of ageing and training experience on attitude towards performing basic life s
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upport (BLS). Methods: We gave a questionnaire to attendants of the courses for BLS or safe driving in authorised driving schools. The questionnaire included questions about participants' backgrounds. The questionnaire explored the participant's willingness to perform BLS in four hypothetical scenarios related to early emergency call, cardiopulmonary resuscitation (CPR) under their own initiative, telephone-assisted compression-only CPR and use of an automated external defibrillator (AED), respectively. Results: There were significant differences in gender, occupation, residential area, experience of BLS training, and knowledge of AED use among the young (17-29. y, N=6122), middle-aged (30-59. y, N=827) and elderly (>59. y, N=15,743) groups. In all four scenarios, the proportion of respondents willing to perform BLS was lowest in the elderly group. More respondents in the elderly group were willing to follow the telephone-assisted instruction rather than performing CPR under their own initiative. Multiple logistic regression analysis confirmed ageing as an independent factor related to negative attitude in all scenarios. Gender, occupation, resident area, experience with BLS training and knowledge about AED use were other independent factors. Prior BLS training did not increase willingness to make an emergency call. Conclusion: The aged population has a more negative attitude towards performing BLS. BLS training should be modified to help the elderly gain confidence with the essential elements of BLS, including making early emergency calls. © 2011 Elsevier Ireland Ltd.
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Enami, Miki ; Takei, Yutaka ; Goto, Yoshikazu ; Ohta, Keisuke ; Inaba, Hideo
概要:
Background: There is no study regarding the influence of cardiopulmonary resuscitation (CPR) guideline renewal on citize
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n's attitude towards all basic life support (BLS) actions. Methods and results: We conducted a questionnaire survey to new driver licence applicants who participated in the BLS course at driving schools either before (January 2007 to April 2007) or after (October 2007 to April 2008) the revision of the textbook. Upon completion of the course, participants were given a questionnaire concerning willingness to participate in CPR, early emergency call, telephone-assisted chest compression and use of an automated external defibrillator (AED). After the revision, the proportions of positive respondents to use of AED as well as to all the four scenarios significantly increased from 2331/3564 to 3693/5156 (odds ratio (OR)=1.34) and from 1889/3443 to 3028/5126 (OR=1.18), respectively. However, the new guideline slightly but significantly augmented the unwillingness to make an early call (236/3568 vs. 416/5283, OR = 0.83). Approximately 95% of respondents were willing to follow the telephone-assisted instruction of chest compression, while approximately 85% were eager to perform CPR on their own initiative. Multiple logistic regression analysis confirmed the results of mono-variate analysis, and identified previous CPR training, sex, rural area and student as other significant factors relating to attitude. Conclusions: Future guidelines should emphasise the significance and benefit of early call in relation to telephone-assisted instruction of CPR or chest compression. The course instructors should be aware of the backgrounds of participants as to how this may relate to their willingness to participate. © 2010 Elsevier Ireland Ltd.
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| 5.
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Nishi, Taiki ; Maeda, Tetsuo ; Takase, Keiko ; Kamikura, Takahiro ; Tanaka, Yoshio ; Inaba, Hideo
概要:
Review: An increased number of rescuers may improve the survival rate from out-of-hospital cardiac arrests (OHCAs). The
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majority of OHCAs occur at home and are handled by family members. Materials and methods: Data from 5078 OHCAs that were witnessed by citizens and unwitnessed by citizens or emergency medical technicians from January 2004 to March 2010 were prospectively collected. The number of rescuers was identified in 4338 OHCAs and was classified into two (single rescuer (N = 2468) and multiple rescuers (N = 1870)) or three (single rescuer, two rescuers (N = 887) and three or more rescuers (N = 983)) groups. The backgrounds, characteristics and outcomes of OHCAs were compared between the two groups and among the three groups. Results: When all OHCAs were collectively analysed, an increased number of rescuers was associated with better outcomes (one-year survival and one-year survival with favourable neurological outcomes were 3.1% and 1.9% for single rescuers, 4.1% and 2.0% for two rescuers, and 6.0% and 4.6% for three or more rescuers, respectively (p = 0.0006 and p < 0.0001)). A multiple logistic regression analysis showed that the presence of multiple rescuers is an independent factor that is associated with one-year survival (odds ratio (95% confidence interval): 1.539 (1.088-2.183)). When only OHCAs that occurred at home were analysed (N = 2902), the OHCAs that were handled by multiple rescuers were associated with higher incidences of bystander CPR but were not associated with better outcomes. Conclusions: In summary, an increased number of rescuers improves the outcomes of OHCAs. However, this beneficial effect is absent in OHCAs that occur at home. © 2012 Elsevier Ireland Ltd. All rights reserved.
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Shiraishi, Yosuke ; Okajima, Masaki ; Sai, Yoshimichi ; Miyamoto, Kenichi ; Inaba, Hideo
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Pharmaceutical agents directed against methicillin-resistant Staphylococcus aureus can be eliminated during haemodiafilt
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ration, not only by diffusion and ultrafiltration, but also by adsorption onto haemofilters. The latter may be affected by the binding of agents to serum albumin. The present study therefore investigated the affinity of anti-methicillin-resistant Staphylococcus aureus agents (teicoplanin, linezolid, vancomycin) for haemofilters and the pharmacokinetic properties of teicoplanin during haemodiafiltration. Linezolid, teicoplanin and vancomycin were first screened for their in vitro affinity for three different kinds of filter membranes: polysulfone, polyacrylonitrile and polymethylmethacrylate. Only teicoplanin showed significant filter-binding activity. An in vitro haemodiafiltration circulation model was then developed that incorporated a one-litre beaker containing Krebs-Ringer's bicarbonate solution with/without human albumin (0 or 3 g/dl) as an artificial plasma. Teicoplanin (initial concentration 50 μg/ml, representing the maximum plasma concentration (Cmax) resulting from a typical clinical dosage) was circulated throughout the beaker. Teicoplanin concentrations in the 'plasma' and ultrafiltrate were determined by high performance liquid chromatography. In the screening experiment, teicoplanin was predominantly adsorbed onto polysulfone and polymethylmethacrylate membranes. Furthermore, teicoplanin was primarily eliminated by adsorption onto these filters during in vitro haemodiafiltration. Albumin significantly reduced both haemodiafiltration clearance and the adsorption-dependent elimination, although there were complex but significant interactions between albumin and the filter membrane. Elimination of teicoplanin in an in vitro haemodiafiltration model was largely due to adsorption onto polysulfone and polymethylmethacrylate haemofilters. Future clinical studies should likely be designed to evaluate present recommendations of teicoplanin dosages in patients on haemodiafiltration.
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| 7.
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Tanaka, Yoshio ; Taniguchi, Junro ; Wato, Yukihiro ; Yoshida, Yutaka ; Inaba, Hideo
概要:
Review: In 2007, the Ishikawa Medical Control Council initiated the continuous quality improvement (CQI) project for tel
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ephone-assisted cardiopulmonary resuscitation (telephone-CPR), which included instruction on chest-compression-only CPR, education on how to recognise out-of-hospital cardiac arrests (OHCAs) with agonal breathing, emesis and convulsion, recommendations for on-line or redialling instructions and feedback from emergency physicians. This study aimed to investigate the effect of this project on the incidence of bystander CPR and the outcomes of OHCAs. Materials and methods: The baseline data were prospectively collected on 4995 resuscitation-attempted OHCAs, which were recognised or witnessed by citizens rather than emergency medical technicians during the period of February 2004 to March 2010. The incidence of telephone-CPR and bystander CPR, as well as the outcomes of the OHCAs, was compared before and after the project. Results: The incidence of telephone-CPR and bystander CPR significantly increased after the project (from 42% to 62% and from 41% to 56%, respectively). The incidence of failed telephone-CPR due to human factors significantly decreased from 30% to 16%. The outcomes of OHCAs significantly improved after the projects. A multiple logistic regression analysis revealed that the CQI project is one of the independent factors associated with one-year (1-Y) survival with favourable neurological outcomes (odds ratio = 1.81, 95% confidence interval = 1.20-2.76). Conclusions: The CQI project for telephone-CPR increased the incidence of bystander CPR and improved the outcome of OHCAs. A CQI project appeared to be essential to augment the effects of telephone-CPR. © 2012 Elsevier Ireland Ltd. All rights reserved.
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| 8.
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Tanaka, Yoshio ; Yamada, Hiroshi ; Tamasaku, Shuji ; Inaba, Hideo
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Purposes: Ambulance response time is a major factor associated with survival in out-of-hospital cardiac arrests (OHCAs);
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the fast emergency vehicle pre-emption system (FAST™) aids response time by controlling traffic signals. This eight-year observational study investigated whether FAST™ implementation reduced response times and improved OHCA outcomes. Methods: Data was prospectively collected from 1161 OHCAs that were not witnessed by emergency medical technicians from April 1, 2003, to March 31, 2011. The study took place in Kanazawa city, where ambulances without FAST™ (non-FAST™-equipped) were being progressively replaced by new FAST™-equipped ambulances. OHCA data, including the response times recorded in seconds, were collected and compared between the FAST™-equipped and non-FAST™-equipped ambulances. OHCA outcomes were subsequently compared in the subgroup of OHCAs managed by emergency medical technicians without tracheal intubation or epinephrine administration. The primary end-point of this study was one-year (1-Y) survival. Results: The median response time significantly differed between the FAST™-equipped and non-FAST™-equipped groups at 327 and 381 s, respectively. The 1-Y survival rates were 7.0% in the FAST™-equipped group and 2.8% in the non-FAST™-equipped group. Logistic regression analysis revealed that the dispatch of a FAST™-equipped ambulance was an independent factor for 1-Y survival (adjusted odds ratio = 3.077, 95% confidence interval = 1.180-9.350). Conclusions: The FAST™ implementation significantly reduced ambulance response times and improved OHCA outcomes in Kanazawa city. © 2013 Elsevier Inc. All rights reserved.
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| 9.
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Takei, Yutaka ; Nishi, Taiki ; Matsubara, Hiroki ; Hashimoto, Masaaki ; Inaba, Hideo
概要:
Aims: To identify the factors associated with good-quality bystander cardiopulmonary resuscitation (BCPR). Methods: Data
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were prospectively collected from 553 out-of-hospital cardiac arrests (OHCAs) managed with BCPR in the absence of emergency medical technicians (EMT) during 2012. The quality of BCPR was evaluated by EMTs at the scene and was assessed according to the standard recommendations for chest compressions, including proper hand positions, rates and depths. Results: Good-quality BCPR was more frequently confirmed in OHCAs that occurred in the central/urban region (56.3% [251/446] vs. 39.3% [42/107], p= 0.0015), had multiple rescuers (31.8% [142/446] vs. 11.2% [12/107], p< 0.0001) and received bystander-initiated BCPR (22.0% [98/446] vs. 5.6% [6/107], p< 0.0001). Good-quality BCPR was less frequently performed by family members (46.9% [209/446] vs. 67.3% [72/107], p= 0.0001), elderly bystanders (13.5% [60/446] vs. 28.0% [30/107], p= 0.0005) and in at-home OHCAs (51.1% [228/446] vs. 72.9% [78/107], p< 0.0001). BCPR duration was significantly longer in the good-quality group (median, 8 vs. 6. min, p= 0.0015). Multiple logistic regression analysis indicated that multiple rescuers (odds ratio. = 2.8, 95% CI 1.5-5.6), bystander-initiated BCPR (2.7, 1.1-7.3), non-elderly bystanders (1.9, 1.1-3.2), occurrence in the central region (2.1, 1.3-3.3) and duration of BCPR (1.1, 1.0-1.1) were associated with good-quality BCPR. Moreover, good-quality BCPR was initiated earlier after recognition/witness of cardiac arrest compared with poor-quality BCPR (3 vs. 4. min, p= 0.0052). The rate of neurologically favourable survival at one year was 2.7 and 0% in the good-quality and poor-quality groups, respectively (p= 0.1357). Conclusions: The presence of multiple rescuers and bystander-initiated CPR are predominantly associated with good-quality BCPR. © 2013 Elsevier Ireland Ltd.
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| 10.
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Kamikura, Takahisa ; Iwasaki, Hose ; Myojo, Yasuhiro ; Sakagami, Satoru ; Takei, Yutaka ; Inaba, Hideo
概要:
Aim: To assess the benefit of immediate call or cardiopulmonary resuscitation (CPR) for survival from out-of-hospital ca
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rdiac arrests (OHCAs). Methods: Of 952,288 OHCAs in 2005-2012, 41,734 were bystander-witnessed cases without prehospital involvement of physicians but with bystander CPR (BCPR) on bystander's own initiative. From those OHCAs, we finally extracted the following three call/BCPR groups: immediate Call + CPR (N= 10,195, emergency call/BCPR initiated at 0 or 1 min after witness, absolute call-BCPR time interval = 0 or 1. min), immediate Call-First (N= 1820, emergency call placed at 0 or 1 min after witness, call-to-BCPR interval = 2-4. min), immediate CPR-First (N= 5446, BCPR initiated at 0 or 1. min after witness, BCPR-to-call interval = 2-4 min). One-month neurologically favourable survivals were compared among the groups. Critical comparisons between Call-First and CPR-First groups were made considering arrest aetiology, age, and bystander-patient relationship after confirming the interactions among variables. Results: The overall survival rates in immediate Call + CPR, Call-First, and CPR-First groups were 11.5, 12.4, and 11.5%, respectively without significant differences (p= 0.543). Subgroup analyses by multivariate logistic regression following univariate analysis disclosed that CPR-first group is more likely to survive in subgroups of noncardiac aetiology (adjusted odds ratio; 95% confidence interval, 2.01; 1.39-2.98) and of nonelderly OHCAs (1.38; 1.09-1.76). Conclusions: Immediate CPR-first action followed by an emergency call without a large delay may be recommended when a bystander with sufficient skills to perform CPR witnesses OHCAs in nonelderly people and of noncardiac aetiology. © 2015 Elsevier Ireland Ltd.<br />Embargo Period 12 months
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Nishi, Taiki ; Kamikura, Takahisa ; Funada, Akira ; Myojo, Yasuhiro ; Ishida, Tetsuya ; Inaba, Hideo
概要:
Aim: Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) impacts the rates of bystander CPR (BCPR) and survival a
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fter out-of-hospital cardiac arrests (OHCAs). This study aimed to elucidate whether regional variations in indexes for BCPR and emergency medical service (EMS) may be associated with OHCA outcomes. Methods: We conducted a population-based observational study involving 157,093 bystander-witnessed, resuscitation-attempted OHCAs without physician involvement between 2007 and 2011. For each index of BCPR and EMS, we classified the 47 prefectures into the following three groups: advanced, intermediate, and developing regions. Nominal logit analysis followed by multivariable logistic regression including OHCA backgrounds was employed to examine the association between neurologically favourable 1-month survival, and regional classifications based on BCPR- and EMS-related indexes. Results: Logit analysis including all regional classifications revealed that the number of BLS training course participants per population or bystander's own performance of BCPR without DA-CPR was not associated with the survival. Multivariable logistic regression including the OHCA backgrounds known to be associated with survival (BCPR provision, arrest aetiology, initial rhythm, patient age, time intervals of witness-to-call and call-to-arrival at patient), the following regional classifications based on DA-CPR but not on EMS were associated with survival: sensitivity of DA-CPR [adjusted odds ratio (95% confidence intervals) for advanced region; those for intermediate region, with developing region as reference, 1.277 (1.131-1.441); 1.162 (1.058-1.277)]; the proportion of bystanders to follow DA-CPR [1.749 (1.554-1.967); 1.280 (1.188-1.380)]. Conclusions: Good outcomes of bystander-witnessed OHCAs correlate with regions having higher sensitivity of DA-CPR and larger proportion of bystanders to follow DA-CPR. © 2015 Elsevier Ireland Ltd.<br />Embargo Period 12 months
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| 12.
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Maeda, Tetsuo ; Yamashita, Akira ; Myojo, Yasuhiro ; Wato, Yukihiro ; Inaba, Hideo
概要:
Purpose To investigate the impacts of emergency calls made using mobile phones on the quality of dispatcher-assisted car
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diopulmonary resuscitation (DA-CPR) and survival from out-of-hospital cardiac arrests (OHCAs) that were not witnessed by emergency medical service (EMS). Methods In this prospective study, we collected data for 2530 DA-CPR-attempted medical emergency cases (517 using mobile phones and 2013 using landline phones) and 2980 non-EMS-witnessed OHCAs (600 using mobile phones and 2380 using landline phones). Time factors and quality of DA-CPR, backgrounds of callers and outcomes of OHCAs were compared between mobile and landline phone groups. Results Emergency calls are much more frequently placed beside the arrest victim in mobile phone group (52.7% vs. 17.2%). The positive predictive value and acceptance rate of DA-CPR in mobile phone group (84.7% and 80.6%, respectively) were significantly higher than those in landline group (79.2% and 70.9%). The proportion of good-quality bystander CPR in mobile phone group was significantly higher than that in landline group (53.5% vs. 45.0%). When analysed for all non-EMS-witnessed OHCAs, rates of 1-month survival and 1-year neurologically favourable survival in mobile phone group (7.8% and 3.5%, respectively) were higher than those in landline phone group (4.6% and 1.9%; p < 0.05). Multiple logistic regression analysis, including other backgrounds, revealed that mobile phone calls were associated with increased 1-month survival in the subgroup of OHCAs receiving bystander CPR (adjusted odds ratio, 1.84; 95% CI, 1.15–2.92). Conclusion Emergency calls made using mobile phones are likely to augment the survival from OHCAs by improving DA-CPR. © 2016 Elsevier Ireland Ltd<br />Embargo Period 12 months
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Hirose, Keiko ; Enami, Miki ; Matsubara, Hiroki ; Kamikura, Takahisa ; Takei, Yutaka ; Inaba, Hideo
概要:
Background: The aim of this study was to investigate effects of basic life support (BLS) training on willingness of sing
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le rescuers to make emergency calls during out-of-hospital cardiac arrests (OHCAs) with no available help from others.Methods: A cross-over questionnaire survey was conducted with two questionnaires. Questionnaires were administered before and after two BLS courses in fire departments. One questionnaire included two scenarios which simulate OHCAs occurring in situations where help from other rescuers is available (Scenario-M) and not available (Scenario-S). The conventional BLS course was designed for multiple rescuers (Course-M), and the other was designed for single rescuers (Course-S).Results: Of 2,312 respondents, 2,218 (95.9%) answered all questions and were included in the analysis. Although both Course-M and Course-S significantly augmented willingness to make early emergency calls not only in Scenario-M but also in Scenario-S, the willingness for Scenario-M after training course was significantly higher in respondents of Course-S than in those of Course-M (odds ratio 1.706, 95% confidential interval 1.301-2.237). Multiple logistic regression analysis for Scenario-M disclosed that post training (adjusted odds ratio 11.6, 95% confidence interval 7.84-18.0), age (0.99, 0.98-0.99), male gender (1.77, 1.39-2.24), prior BLS experience of at least three times (1.46, 1.25-2.59), and time passed since most recent training during 3 years or less (1.80, 1.25-2.59) were independently associated with willingness to make early emergency calls and that type of BLS course was not independently associated with willingness. Therefore, both Course-M and Course-S similarly augmented willingness in Scenario-M. However, in multiple logistic regression analyses for Scenario-S, Course-S was independently associated with willingness to make early emergency calls in Scenario-S (1.26, 1.00-1.57), indicating that Course-S more efficiently augmented willingness. Moreover, post training (2.30, 1.86-2.83) and male gender (1.26, 1.02-1.57) were other independent factors associated with willingness in Scenario-S.Conclusions: BLS courses designed for single rescuers with no help available from others are likely to augment willingness to make early emergency calls more efficiently than conventional BLS courses designed for multiple rescuers. © 2014 Hirose et al.
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| 14.
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Tsuchida, Masayuki ; Kawashiri, Masa-aki ; Teramoto, Ryota ; Takata, Mutsuko ; Sakata, Kenji ; Omi, Wataru ; Okajima, Masaki ; Takamura, Masayuki ; Ino, Hidekazu ; Kita, Yoshihito ; Takegoshi, Tadayoshi ; Inaba, Hideo ; Yamagishi, Masakazu ; 川尻, 剛照 ; 寺本, 了太 ; 坂田, 憲治 ; 岡島, 正樹 ; 高村, 雅之 ; 井野, 秀一 ; 稲葉, 英夫 ; 山岸, 正和
概要:
Background: Although acute coronary syndrome (ACS) and stroke are known to increase after earthquake, few data exist reg
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arding the effect of earthquake on these cardiovascular events in rural areas. Methods and Results: The Noto Peninsula earthquake with a magnitude of 6.9 occurred at 9:45 a.m. on 25 March 2007. The first case of ACS occurred approximately 15 min later, whereas cerebral hemorrhage (CH) occurred 72 h after the onset of earthquake. During the 35 days after earthquake, among 49 patients who were attended by local ambulance, 5 patients with ACS (10.2%) and 8 with CH (16.3%) were documented and 4 died. The total number of both ACS and CH cases was greater than the averages for the same period of the past 3 years in this area (2.0 vs 5 and 2.3 vs 8, P<0.01). Interestingly, the most cases of ACS had occurred within 7 days after earthquake and for CH not until 35 days later. Conclusions: Even in rural areas a severe earthquake results in increased incidence of ACS and CH, which can occur at different times after the event, although the effects of other environmental factors should be further investigated. (Circ J 2009; 73: 1243-1247)<br />出版者照会後に全文公開
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| 15.
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稲葉, 英夫 ; Inaba, Hideo
概要:
本研究は、短時間のPEEP負荷の(1)腎虚血再灌流障害の制御に対する効果、(2)腎組織熱ショック蛋自の誘導条件、(3)流血中熱ショック蛋白に対する影響を検討し、(4)短時間のPEEP負荷が敗血症ショックモデルのサイトカイン産生や血行動態の制
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御効果を検討するととともに、効果をサイトカイン除去療法と比較し、(5)臨床症例における血中熱ショック蛋白濃度と疾患、高PEEP負荷の関係を明らかにすることを目的とした。[結果](1)PEEP前処置は腎虚血再灌流障害を有意に抑制した。この効果はPEEPによる循環変動(低血圧)のみでは説明できない。(2)PEEPの負荷は圧・時間依存性に腎組織HSP72陽性細胞数を増加させたが、血中HSP72を検出範囲に増加さなかった。(3)PEEPによるHO-1の誘導効果は明らかでない。(4)除去カラムによるサイトカイン除去療法は敗血症ショックモデルに対し容量依存性効果を示した。しかし、腎虚血に対し有効であったPEEP前処置は、敗血症ショックモデルに対し有意の影響を与えなかった。(5)HSP72濃度は高いPEEP負荷とは有意に関係せず、原疾患により影響された。(6)血中ストレス蛋白濃度は蘇生された心停止例の予後を反映する可能性がある。[結論]短時問のPEEP負荷は腎虚血に対し防御効果を発揮するが、敗血症に対しては有意な影響を与えなかった。<br />Pretreatment with PEEP significantly attenuated the renal ischemia-reperfusion injuries in rats. This effect of PEEP was not solely attributed to the hemodynamic effects of PEEP. The PEEP administration increased HSP72-expressed cells in the kidney in time-and level-dependent manners. It remains uncertain whether the PEEP administration may induce other heat shock proteins in the renal cells. Pretreatment with high PEEP did not significantly influence either the plasma TNF-alpha, 11-6 and 11-10 levels or hemodynamic variables after endotoxin administration. In contrast, removal of cytokines with CTR column significantly decreased the mortality and attenuated the changes in hemodynamics and plasma cytokine levels in rat septic models. In critically ill patients, plasma HSP72 levels were not correlated with the application of PEEP. Heat shock protein may be useful to evaluate the prognosis in patient resuscitated from cardiac arrests.<br />研究課題/領域番号:17591885, 研究期間(年度):2005-2006<br />出典：「PEEPの短時間負荷により誘導される熱ショック蛋白を利用した敗血症の制御」研究成果報告書 課題番号17591885 (KAKEN：科学研究費助成事業データベース（国立情報学研究所）) 本文データは著者版報告書より作成
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稲葉, 英夫 ; Inaba, Hideo
概要:
金沢大学大学院・医学系研究科<br />1)摘出肝還流法における各種揮発性麻酔剤の虚血/低酸素-再灌流障害に対する影響の検討ハロタン、イソフルラン、セボフルランは、虚血再灌流障害を抑制した。このことは、揮発性麻酔剤が肝において虚血耐性増強効
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果を有することを示唆している。2)ラット肝スライス培養法におけるイソフルランのischemic preconditioning効果の検討イソフルランを低酸素前投与した場合、免疫組織学的に肝障害、特に肝細胞のアポトーシスの抑制効果が認められ、この効果は類洞内皮細胞より肝細胞において顕著であった。すなわち、イソフルランの虚血耐性増強効果には構成細胞特異性があることが示唆された。3)膵β細胞のATP感受性カリウムチャンネルに対するイソフルランの影響の検討マウスの膵臓より抽出・培養して得られたβ細胞を材料に、イソフルランのATP-感受性K^+(K_<ATP>)channelに対する直接作用を、whole cellを用いたパッチクランプ法により検討した。イソフルラン2%および5%投与により濃度依存性にATP-感受性K^+(K_<ATP>)channelの抑制効果が認められた。イソフランの反復投与によりATP-感受性K^+(K_<ATP>)channelの抑制作用の増強も認められた。イソフランのischemic preconditioning効果には、イソフルランのATP-感受性K^+(K_<ATP>)channelに対する直接的抑制作用が関与していることが示唆された。<br />Halothane, isoflurane and sevoflurane attenuated ischemia-reperfusion injury in the perfused liver of fasted rats, suggesting a possible involvement of ischemic preconditioning.In the rat liver slice incubation, isoflurane attenuated apoptosis induced by hypoxic challenge. Suppression of apoptosis is predominant in the hepatocyte.Direct effect of isoflurane on K-ATP channel was studied in isolated pancreatic β cells using whole cell patch clamp method. Isoflurane suppressed K-ATP channel in a dose-dependent manner. Repeated treatment of isoflurane enhanced the suppression of K-ATP channel.<br />研究課題/領域番号:12470314, 研究期間(年度):2000 – 2002<br />出典：「揮発性麻酔剤前処置の肝・肺における虚血耐性誘導機構と誘導条件の解明―実質細胞・内皮細胞・免疫担当細胞の細胞特異性と相互作用を含めて」研究成果報告書 課題番号12470314（KAKEN：科学研究費助成事業データベース（国立情報学研究所））（https://kaken.nii.ac.jp/ja/report/KAKENHI-PROJECT-12470314/124703142002kenkyu_seika_hokoku_gaiyo/)を加工して作成
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