研究者詳細 - 森松　博史

MISC - 森松　博史

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集中治療における急性血液浄化法の標準化と問題点急性血液浄化法の標準とは BEST KIDNEY STUDY

中敏夫, 内野滋彦, Bellomo Rinaldo, 森松博史

ICUとCCU 2005年

ピエール・ロバン症候群患者の手術室外での麻酔経験

紙谷順子, 戸田雄一郎, 中塚秀輝, 佐藤健治, 森松博史, 多賀直行, 竹内護, 森田潔

麻酔 2005年

Septic MODSに対しての急性血液浄化法のプランニング septic MODSに対する血液浄化法の新しいアプローチ

中敏夫, Bellomo Rinaldo, 篠崎正博, 内野滋彦, 森松博史, Baldwin Ian

ICUとCCU 29 S101 - 103 2005年

ラット出血性ショックモデルにおける消化管障害に対するヘムオキシゲナーゼ－1の保護効果（日本Shock学会会長賞）.

井上一由, 高橋徹, 井戸佳奈, 川上朋子, 上原健司, 森松博史, 前島亨一郎, 横山正尚, 森田潔

日本Shock学会雑誌 2005年

Rapid development of severe interstitial pneumonia caused by epoprostenol in a patient with primary pulmonary hypertension

H Morimatsu, K Goto, T Matsusaki, H Katayama, H Matsubara, T Ohe, K Morita

ANESTHESIA AND ANALGESIA 99 ( 4 ) 1205 - 1207 2004年10月

記述言語：英語出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS

A young woman with primary pulmonary hypertension developed severe interstitial pneumonia (IP) 5 days after induction of epoprostenol infusion. Although the pathogen involved was not identified, her IP was initially responsive to steroids, and discontinuation of steroid therapy caused the redevelopment of IP. After intensive treatment, including steroid therapy and inhaled nitric oxide, epoprostenol was successfully switched to prostaglandin E-1 infusion and she recovered. Epoprostenol infusion can cause a rapid severe IP, even soon after the induction of therapy. Clinicians should keep this syndrome in mind, especially when treating a severe case of IP.

DOI： 10.1213/01.ANE.0000130615.28893.52

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Pierre Robin症候群患者の手術室外での麻酔経験

紙谷順子, 戸田雄一郎, 中塚秀輝, 森松博史, 多賀直行, 竹内護, 森田潔

日本臨床麻酔学会誌 24 ( 8 ) 1 - 191 2004年9月

先天性表皮水ほう症患者の麻酔経験

戸田雄一郎, 中塚秀輝, 森松博史, 多賀直行, 竹内護, 片山浩, 森田潔

日本小児麻酔学会誌 10 ( 1 ) 107 2004年9月

気管支喘息 (特集急性呼吸不全に対する呼吸管理ベストプラクティス) -- (救急患者にみられる急性呼吸不全の病態と治療)

森松博史, 片山浩

救急医学 28 ( 10 ) 1348 - 1354 2004年9月

Diuretics and mortality in acute renal failure

S Uchino, GS Doig, R Bellomo, H Morimatsu, S Morgera, M Schetz, Tan, I, C Bouman, E Macedo, N Gibney, A Tolwani, C Ronco, JA Kellum

CRITICAL CARE MEDICINE 32 ( 8 ) 1669 - 1677 2004年8月

記述言語：英語出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS

Objective: According to recent research, diuretics may increase mortality in acute renal failure patients. The administration of diuretics in such patients has been discouraged. Our objective was to determine the impact of diuretics on the mortality rate of critically ill patients with acute renal failure.
Design: Prospective, multiple-center, multinational epidemiologic study.
Setting, Intensive care units from 54 centers and 23 countries.
Patients, Patients were 1,743 consecutive patients who either were treated with renal replacement therapy or fulfilled predefined criteria for acute renal failure.
Interventions: Three distinct multivariate models were developed to assess the relationship between diuretic use and subsequent mortality: a) a propensity score adjusted multivariate model containing terms previously identified to be important predictors of outcome; b) a new propensity score adjusted multivariate model; and c) a multivariate model developed using standard methods, compensating for collinearity.
Measurements and Main Results: Approximately 70% of patients were treated with diuretics at study inclusion. Mean age was 68 and mean Simplified Acute Physiology Score II was 47. Severe sepsis/septic shock (43.8%), major surgery (39.1), low cardiac output (29.7), and hypovolemia (28.2%) were the most common conditions associated with the development of acute renal failure. Furosemide was the most common diuretic used (98.3%). Combination therapy was used in 98 patients only. In all three models, diuretic use was not associated with a significantly increased risk of mortality.
Conclusions: Diuretics are commonly prescribed in critically ill patients with acute renal failure, and their use is not associated with higher mortality. There is full equipoise for a randomized controlled trial of diuretics in critically ill patients with renal dysfunction.

DOI： 10.1097/01.CCM.0000132892.51063.2F

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Increased carbon monoxide concentration in exhaled air after surgery and anesthesia

M Hayashi, T Takahashi, H Morimatsu, H Fujii, N Taga, S Mizobuchi, M Matsumi, H Katayama, M Yokoyama, M Taniguchi, K Morita

ANESTHESIA AND ANALGESIA 99 ( 2 ) 444 - 448 2004年8月

記述言語：英語出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS

Heme oxygenase-1 (HO-1) is induced by oxidative stress and is thought to confer protection against oxidative tissue injuries. HO-1 catalyzes the conversion of the heme moiety of hemeproteins, such as hemoglobin, myoglobin, and cytochrome P450, to biliverdin, liberating carbon monoxide (CO) in the process. CO reacts with hemoglobin to form carboxyhemoglobin. In this study, to examine the effect of anesthesia and/or surgery on endogenous CO production, we measured the amount of exhaled CO and the arterial carboxyhemoglobin concentration of patients who underwent surgery under general or spinal anesthesia. Both CO and carboxyhemoglobin concentrations were significantly larger on the day after surgery than during the preoperative period (P < 0.05) and in the recovery room (P < 0.05), regardless of anesthesia. However, neither index differed between general and spinal anesthesia. These results suggest that oxidative stress caused by anesthesia and/or surgery may induce HO-1, which catalyzes heme to produce CO, leading to increased exhaled CO concentration.

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Early and exclusive use of norepinephrine in septic shock

H Morimatsu, K Singh, S Uchino, R Bellomo, G Hart

RESUSCITATION 62 ( 2 ) 249 - 254 2004年8月

記述言語：英語出版者・発行元：ELSEVIER SCI IRELAND LTD

Background: The timing and use of norepinephrine (noradrenaline) (NE) in septic shock remain a matter of controversy. Aim: To study the outcome of septic patients treated with early and exclusive NE. Setting: Tertiary Intensive Care Unit. Patients: 142 patients with septic shock. Intervention: Exclusive NE infusion within 24 hours of admission to ICU. Methods and main results: Retrospective analysis of data from a unit database identified 142 patients. Their median admission simplified acute physiology score (SAPS II) score was 46 [38, 56] with 98 (69%) receiving mechanical ventilation. Mean arterial pressure (MAP) at the start of NE infusion was 60 [58, 68] mmHg. NE infusion was started at a median of 1.3 [0.3, 5.0] h after ICU admission. Restoration and maintenance of target MAP was achieved initially in all patients and, in 61.3%, within 30 min. The median peak dose of NE was 0.28 [0.14, 0.61] mug/(kg min) and the duration of infusion was 88 [42, 175] h. SAPS II predicted mortality was 40.8%, however, only 34.5% (P = 0.27) died. Among the most severely ill patients (SAPS II score > 56) actual mortality was 50.0% versus 74.7% predicted (P = 0.07). Conclusions: Early and exclusive use of NE in hyperdynamic septic shock achieved a stable MAP > 75 mmHg in all patients. Survival compared favorably with that predicted by illness severity scores. (C) 2004 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.resuscitation.2004.03.016

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Increasing renal blood flow - Low-dose dopamine or medium-dose norepinephrine

D Di Giantomasso, H Morimatsu, CN May, R Bellomo

CHEST 125 ( 6 ) 2260 - 2267 2004年6月

記述言語：英語出版者・発行元：AMER COLL CHEST PHYSICIANS

Background and objectives: Many clinicians believe that low-dose dopamine (LDD) [2 mug/kg/min] increases renal blood flow (RBF) and medium-dose norepinephrine (MD-NE) [0.4 mug/kg/min] decreases RBF. They also believe that MD-NE might induce mesenteric and/or coronary ischemia. In fact, the effects of these drugs on renal and vital organ blood flow are poorly understood. The aim of this study was to compare the effects of 6 h of IV LDD and MD-NE infusion on mammalian renal, coronary, mesenteric, and sagittal blood flow.
Design: Randomized, controlled, experimental animal study.
Setting: Animal laboratory of tertiary physiology institute.
Subjects: Seven Merino cross sheep were studied.
Measurements and results: We performed a staged insertion of transit-time flow probes around ascending aorta, sagittal sinus and circumflex coronary, superior mesenteric, and left renal arteries. We then randomized these animal with long-term embedded flow probes to either 6 h of placebo (saline solution) or drugs (MD-NE at 0.4 mug/kg/min or LDD at 2 mug/kg/min), and performed continuous measurement of systemic pressures, cardiac output (CO), and flow to vital organs. We also sampled blood and urine for the measurement of lactate, creatinine, and creatinine clearances at preset intervals.
Results: Compared to placebo, LDD did not affect systemic hemodynamics. However, it increased mean RBF by 20% (267.3 +/- 87.6 mL/min vs 222.0 +/- 74.4 mL/min, p = 0.028) without a detectable effect on other vital regional circulations. MD-NE, however, increased mean arterial pressure (101.0 +/- 8.3 mL/min vs 84.2 +/- 5.2 mL/min, p = 0.018) [mean +/- SD] and CO (4.93 +/- 1.45 L/min vs 3.81 +/- 0.57 L/min, p = 0.028). It also increased coronary blood flow (36.0 +/- 15.7 mL/min vs 23.0 +/- 10.7 mL/min, p = 0.018) and RBF (286.5 +/- 79.0 mL/min vs 222.0 +/- 74.4 mL/min, p = 0.018). MD-NE had no detectable effect on mesenteric or sagittal sinus flow. LDD infusion increased urine output, but did not change creatinine clearance. MD-NE infusion increased urine output significantly more than LDD but not creatinine clearance.
Conclusions: Both LDD (2 mug/kg/min) and MD-NE (0.4 mug/kg/min) increased RBF and urine output. However, the effect of MD-NE was more pronounced. LDD did not affect other vital organ flows, but MD-NE increased coronary blood flow without any changes in mesenteric and sagittal sinus blood flow.

DOI： 10.1378/chest.125.6.2260

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重症心不全を合併した心室性不整脈に対する塩酸ニフェカラントの使用経験

杉本健太郎, 森松博史, 小林求, 藤井洋泉, 佐藤哲文, 中塚秀輝, 五藤恵次, 片山浩, 森田潔

日本集中治療医学会雑誌 11 ( Supplement ) 204 2004年1月

原発性肺高血圧症の治療中にプロスタサイクリンが原因と思われる間質性肺炎を合併した1症例

松崎孝, 森松博史, 清水一好, 小林求, 中塚秀輝, 五藤恵次, 片山浩, 森田潔

日本集中治療医学会雑誌 11 ( Supplement ) 176 2004年1月

Strong ions, weak acids and base excess: a simplified Fencl-Stewart approach to clinical acid-base disorders

DA Story, H Morimatsu, R Bellomo

BRITISH JOURNAL OF ANAESTHESIA 92 ( 1 ) 54 - 60 2004年1月

記述言語：英語出版者・発行元：OXFORD UNIV PRESS

Background. The Fencl-Stewart approach to acid-base disorders uses five equations of varying complexity to estimate the base excess effects of the important components: the strong ion difference (sodium and chloride), the total weak acid concentration (albumin) and unmeasured ions. Although this approach is straightforward, most people would need a calculator to use the equations. We proposed four simpler equations that require only mental arithmetic and tested the hypothesis that these simpler equations would have good agreement with more complex Fencl-Stewart equations.
Methods. We reduced two complex equations for the sodium-chloride effect on base excess to one simple equation: sodium-chloride effect (meq litre(-1))=[Na+]-[Cl-]-38. We simplified the equation of the albumin effect on base excess to an equation with two constants: albumin effect (meq litre(-1))=0.25x(42-[albumin]g litre(-1)). Using 300 blood samples from critically ill patients, we examined the agreement between the more complex Fencl-Stewart equations and our simplified versions with Bland-Altman analyses.
Results. The estimates of the sodium-chloride effect on base excess agreed well, with no bias and limits of agreement of -0.5 to 0.5 meq litre(-1). The albumin effect estimates required log transformation. The simplified estimate was, on average, 90% of the Fencl-Stewart estimate. The limits of agreement for this percentage were 82-98%.
Conclusions. The simplified equations agree well with the previous, more complex equations. Our findings suggest a useful, simple way to use the Fencl-Stewart approach to analyse acid-base disorders in clinical practice.

DOI： 10.1093/bja/aeh018

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Continuous Venovenous hemofiltration without anticoagulation

S Uchino, N Fealy, Baldwin, I, H Morimatsu, R Bellomo

ASAIO JOURNAL 50 ( 1 ) 76 - 80 2004年1月

記述言語：英語出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS

We conducted a prospective observational study to assess the efficacy of continuous venovenous hemofiltration (CVVH) with no anticoagulation. A standard anticoagulation protocol for CVVH, which prescribed no anticoagulation for patients at risk of bleeding, was applied to 48 critically ill patients treated with CVVH. Circuit life was prospectively observed, and the following data were obtained for each circuit: heparin use and dose, protamine use, daily prothrombin time-international normalized ratio, activated partial thromboplastin time, and platelet count. Out of 300 consecutive circuits 143 (47.6%) received no anticoagulation, 31 (10.3%) received regional anti coagulation, and 126 received low dose heparin. No patients experienced bleeding complications secondary to CVVH. Platelet count was significantly lower in the no anticoagulation group (73 X 10(3)/mul) compared with the low dose heparin group (19 X 10(3)/mul) and the protamine group (104 X 10(3)/mul) (p < 0.01 for both comparisons). There was no significant difference in mean circuit life among the three groups (heparin, 20.9 hours; no anti coagulation, 19.3 hours; protamine, 21.2 hours; not significant). In conclusion, for a group of patients deemed to be at risk of bleeding, CVVH without anticoagulation achieved an acceptable circuit life, which was similar to that obtained in other patients with low dose heparin atiticoagulation or regional anticoagulation with heparin/protamine.

DOI： 10.1097/01.MAT.0000104822.30759.A7

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急性血液浄化劇症肝炎における予後と意識改善に影響を与える因子.

森松博史, 片山浩, 清水一好, 賀来隆治, 藤井洋泉, 松三昌樹, 森田潔

ICUとCCU 2004年

喘息

森松博史, 片山浩

救急医学 28 (10)、1348-1354 2004年

直腸癌術後急性肺塞栓症の一例

篠浦先, 森松博史, 片山浩, 国富彩, 貞森裕, 八木孝仁, 河田政明, 金沢右, 岩垣博巳, 田中紀章

岡山医学会雑誌 2004年