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論文 |
論文
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Tsubo, Toshihito ; Fujita, Ayaka ; Hashiba, Eiji ; Ishihara, Hironori ; Hirota, Kazuyoshi
概要:
To investigated the eff ect of high volume continuous hemofi ltration（ HVHF） on the lung lesion observedwith transesopha
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geal echocardiography （TEE） in endotoxin-induced acute lung injury in piglets. Piglets weighing20-30kg. Interventions: After endotoxin of 20 μg/kg intravenous administration, animals were randomly assigned tocontrol group（ n=7） and HVHF group（ n=7）. In both group, fi ltration was performed for fi ve hours and zero balanced.Filtration fl ow was 150 ml/hr in HVHF group and 0ml/hr in control group. The area of the lesion, resistive indexand maximal blood velocity in regional pulmonary artery were estimated using TEE. High mobility group B1 protein（HMGB1）, cortisol and catecholamine concentrations were measured in plasma at endotoxin 5 hours. Measurements ofblood gas, hemodynamics and TEE images were obtained every hour. The value of PaO2, density area and resistiveindex were 70.0±8.8 mmHg, 10.7±4.5 cm2 and 0.61±0.23 in control group and 120.4±20.3 mmHg, 3.3±2.0 cm2 and 0.88±0.22 in HVHF group at endotoxin 5 hours respectively（ mean±SD）. PaO2 and resistive index increased, and densityarea decreased in HVHF group than those of control group signifi cantly（ p<0.05, respectively）. There was signifi cantrelationship between PaO2 and density area （r=0.76, p<0.01）. There was no signifi cant diff erence in hemodynamics,HMGB1, cortisol and catecholamines concentration in plasma and morphometry between control group and HVHFgroup. In conclusion, these results suggest that non-specifi c blood purifi cation with HVHF improves arterial oxygenationand lung image observed with TEE in endotoxin-induced acute lung injury in piglets.
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| 2.
論文 |
論文
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Kawaguchi, Yoko ; Hashiba, Eiji ; Kitayama, Masatou ; Hirota, Kazuyoshi
概要:
A 30-year-old woman underwent an emergency cesarean section because of fetal distress involveduterine rupture. As the pl
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acenta was firmly adhered to the uterine wall, following safe delivery, it took over one hour and more than 10000 ml blood loss until the placenta was removed. Additional blood was ordered, but there was delay in delivery. Bleeding was extremely beyond our estimation, and hardly controlled despite of transfusing1400 ml of prepared blood. With stopping operation and continuing hyperoxic ventilation, we decided to start intraoperative blood salvage. Though hemoglobin, platelet, and base excess decreased to 2.7 g/dl, 1000/μl, and -11.2,hemodynamics could be maintained with use of a blood salvage system. Salvaged blood was very helpful to manage critical hemodilution until additional blood was reached. Overall estimated blood loss was 20190 ml and massive blood transfusion was needed. The patient emerged from anesthesia with no neurological complication. Rarely but actually cesarean section resulted in life-threatening hemorrhage. Blood salvage systems is safe and useful during cesareansection. Blood salvage should be usually considered one of the suitable choices in cesarean section patients when supply of homologous blood is limited.
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| 3.
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論文
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Saito, Junichi ; Hashiba, Eiji ; Okawa, Hirobumi ; Tsubo, Toshihito ; Ishihara, Hironori ; Hirota, Kazuyoshi
概要:
Thrombotic thrombocytopenic purpura （TTP） is a life-threatening illness associated with cardiovascularsurgery, infection
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and medications. We report a case of a 77-year-old female patient with acute myocardial infarction（AMI） treated with percutaneous coronary intervention and suffered TTP immediately afterwards. This wassuccessfully treated with plasma exchanges. Differential diagnosis of the thrombocytopenia was important and assaysfor the activities of von Willebrand Factor-cleaving protease, its inhibitor and heparin-induced thrombocytopenia（ HIT）antibody were helpful to differentiate TTP from other conditions, including HIT and disseminated intravascularcoagulation. Intensivists should be aware of an atypical presentation of TTP associated with AMI.
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| 4.
学位論文 |
学位
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Saito, Junichi ; Ishihara, Hironori ; Hashiba, Eiji ; Okawa, Hirobumi ; Kudo, Tomoyuki ; Sawada, Masahiro ; Tsubo, Toshihito ; Hirota, Kazuyoshi
概要:
雑誌掲載本文：http://link.springer.com/article/10.1007/s00540-013-1558-z
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| 5.
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論文
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Suganuma, Takuya ; Hashiba, Eiji ; Akaishi, Masahiro ; Saito, Junichi ; Hirota, Kazuyoshi
概要:
Initial distribution volume of glucose （IDVG） has been demonstrated to reflect central extracellular fluid （ECF）volume a
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nd can be used as an indicator of cardiac preload. However, it is unknown whether IDVG reflects the cardiacpreload in septic patients. This study aimed to investigate the changes in IDVG in endotoxin（ ET）-induced septic pigmodels.METHODS: We anesthetized 13pigs and sepsis was induced with intravenous ET. Five pigs were used to investigatechanges in IDVG, 3pigs were used as controls and 5pigs underwent fluid resuscitation with Ringer’s lactate solutionsafter ET. IDVG was measured with 2g glucose and calculated with one compartment model. IDVG, CO, intrathoracicblood volume （ITBV）, and other parameters were measured after ET. The statistical analysis was performed withRM-ANOVA, followed by Dunnett’s test or the Newman-Keuls test. P<0.05 was considered significant.RESULTS: CO and systolic BP significantly decreased and lactate levels significantly increased 4h after ET. IDVGand ITBV significantly decreased but central venous pressure did not change 4h after ET. IDVG and CO weresignificantly increased with volume loading, but the effects disappeared after 1h.CONCLUSIONS: IDVG reflected the changes in the central ECF volumes and can be an indicator of cardiac preloadin septic states.
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