研究者詳細 - 塚原　紘平

論文 - 塚原　紘平

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一酸化炭素中毒に対し高気圧酸素療法を行った妊婦の一例

小崎吉訓, 小出恭大, 野島剛, 藤崎宣友, 青景聡之, 塚原紘平, 山田太平, 尾迫貴章, 内藤宏道, 中尾篤典

中毒研究 33 ( 2 ) 162 - 162 2020年9月

Comparison of Two Different Intensive Care Unit Systems for Severely Ill Children in Japan: Data from the JaRPAC Registry.

Kohei Tsukahara, Hiromichi Naitou, Takashi Yorifuji, Nobuyuki Nosaka, Hirotsugu Yamamoto, Takaaki Osako, Atsunori Nakao

Acta medica Okayama 74 ( 4 ) 285 - 291 2020年8月

担当区分：筆頭著者記述言語：英語掲載種別：研究論文（学術雑誌）

The importance of centralizing treatment services for severely ill children has been well established, but such entralization remains difficult in Japan. We aimed to compare the trauma and illness severity and mortality of children admitted to two common types of ICUs for children. According to the type of management and disposition of the medical provider, we classified ICUs as pediatric ICUs [PICUs] or general ICUs, and analyzed differences in endogenous and exogenous illness settings between them. Overall, 1,333 pediatric patients were included, with 1,143 patients admitted to PICUs and 190 patients to general ICUs. The Pediatric Cerebral Performance Category score (PCPC) at discharge was significantly lower in the PICU group (adjusted OR: 0.45; 95%CI: 0.23-0.88). Death and unfavorable neurological outcomes occurred less often in the PICU group (adjusted OR: 0.29; 95%CI: 0.14-0.60). However, when limited to exogenous illness, PCPC scores (adjusted OR: 0.38; 95%CI: 0.07-1.99) or death/unfavorable outcomes (adjusted OR: 0.72; 95%CI: 0.08-6.34) did not differ between the groups. PCPC deterioration and overall sequelae/death rates were lower in PICUs for children with endogenous illnesses, although the outcomes of exogenous illness were similar between the 2 unit types. Further studies on the necessity of centralization are warranted.

DOI： 10.18926/AMO/60365

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救急隊活動における小児傷病者対応のポイント(第3回) 小児傷病者への対応(1)

塚原紘平, 問田千晶, 六車崇, 日本臨床救急医学会小児救急委員会

プレホスピタル・ケア 33 ( 2 ) 44 - 47 2020年4月

Pediatric airway compromise due to thyroid storm associated with influenza A infection: A case report. 国際誌

Taiki Higaki, Kohei Tsukahara, Takafumi Obara, Tsuyoshi Nojima, Hirotsugu Yamamoto, Takaaki Osako, Hiromichi Naito, Atsunori Nakao

Respiratory medicine case reports 31 101182 - 101182 2020年

記述言語：英語

Thyroid storm is a potentially fatal intensification of thyrotoxicosis normally marked by tachycardia, hyperthermia, impaired mental status, and severe agitation. It can be initiated by numerous causes. Failure to promptly diagnose the condition may lead to high mortality. Early diagnosis and treatment of thyroid storm are essential to prevent further life-threatening complications. A 10-year-old girl was admitted to our emergency center for intensive care. The patient presented tachypnea with stridor, paradoxical abdominal breathing, and "barking" cough. The patient was diagnosed as upper airway obstruction complicated by thyroid storm associated with influenza infection. Following immediate airway management, the patient was administered a short-acting beta-blocker, hydrocortisone, thiamazole, and saturated solution of potassium iodide was initiated. The patient was extubated on day 8 and transferred to a local hospital on day 11 without adverse complications. When examining patients with influenza infection, emergency doctors should be more attentive not to miss other critical diagnoses. The present case was initially diagnosed as croup due to influenza infection. Sharing our experience may help emergency physicians treat similar cases of pediatric airway compromise due to thyroid storm.

DOI： 10.1016/j.rmcr.2020.101182

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Extracorporeal membrane oxygenation in Stenotrophomonas maltophilia pneumonia during acute myeloid leukemia: A case report. 国際誌

Kenki Saito, Toshiyuki Aokage, Takayuki Sato, Kohei Tsukahara, Fumiaki Tokioka, Takanao Otake, Hiromasa Irie, Yasunori Ueda

Respiratory medicine case reports 31 101224 - 101224 2020年

記述言語：英語

Stenotrophomonas maltophilia (S. maltophilia) is a Gram-negative, multidrug-resistant organism that both opportunistically infects the bloodstream and leads to pneumonia in immunosuppressed patients, including those with hematologic malignancies. In patients with severe respiratory failure, venovenous extracorporeal membrane oxygenation (VV ECMO) can stabilize the respiratory status. However, whether ECMO in patients with hematologic malignancies improves the clinical outcomes is still controversial because ECMO increases the risk of the exacerbation of sepsis and bleeding. We report a case of a 46-year-old man with Stenotrophomonas maltophilia hemorrhagic pneumonia acquired during consolidation chemotherapy for acute myeloid leukemia in whom VV ECMO lead to a good clinical outcome. The stabilization of his respiratory status achieved with VV ECMO allowed time for trimethoprim-sulfamethoxazole antibiotic therapy to improve the pneumonia. We suggest the background of patients, including comorbidities and general conditions, should be taken into account when considering the clinical indications of ECMO.

DOI： 10.1016/j.rmcr.2020.101224

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Therapeutic strategies for ischemia reperfusion injury in emergency medicine. 国際誌

Hiromichi Naito, Tsuyoshi Nojima, Noritomo Fujisaki, Kohei Tsukahara, Hirotsugu Yamamoto, Taihei Yamada, Toshiyuki Aokage, Tetsuya Yumoto, Takaaki Osako, Atsunori Nakao

Acute medicine & surgery 7 ( 1 ) e501 2020年

記述言語：英語掲載種別：研究論文（学術雑誌）

Ischemia reperfusion (IR) injury occurs when blood supply, perfusion, and concomitant reoxygenation is restored to an organ or area following an initial poor blood supply after a critical time period. Ischemia reperfusion injury contributes to mortality and morbidity in many pathological conditions in emergency medicine clinical practice, including trauma, ischemic stroke, myocardial infarction, and post-cardiac arrest syndrome. The process of IR is multifactorial, and its pathogenesis involves several mechanisms. Reactive oxygen species are considered key molecules in reperfusion injury due to their potent oxidizing and reducing effects that directly damage cellular membranes by lipid peroxidation. In general, IR injury to an individual organ causes various pro-inflammatory mediators to be released, which could then induce inflammation in remote organs, thereby possibly advancing the dysfunction of multiple organs. In this review, we summarize IR injury in emergency medicine. Potential therapies include pharmacological treatment, ischemic preconditioning, and the use of medical gases or vitamin therapy, which could significantly help experts develop strategies to inhibit IR injury.

DOI： 10.1002/ams2.501

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大規模地震時医療活動訓練における医療資機材の空輸航空会社との連携と今後の課題

三木真彩菜, 三橋乙矢, 加藤湖月, 平山隆浩, 野島剛, 山田太平, 塚原紘平, 尾迫貴章, 中尾篤典

Japanese Journal of Disaster Medicine 24 ( 3 ) 338 - 338 2019年12月