研究者詳細 - 森松　博史

MISC - 森松　博史

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Perioperative Brain Natriuretic Peptide in Pediatric Cardiac Surgery Patients: Its Association With Postoperative Outcomes

Tomoyuki Kanazawa, Moritoki Egi, Yuichiro Toda, Kazuyoshi Shimizu, Kentaro Sugimoto, Tatsuo Iwasaki, Hiroshi Morimatsu

JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA 31 ( 2 ) 537 - 542 2017年4月

記述言語：英語出版者・発行元：W B SAUNDERS CO-ELSEVIER INC

Objectives: The aim of this study was to investigate the relationship between perioperative brain natriuretic peptide levels and the incidence of postoperative serious adverse events (SAEs) in pediatric cardiac patients.
Design: A prospective observational study.
Setting: A single-institution university hospital.
Participants: Children under 15 years old who underwent cardiac surgery that required cardiopulmonary bypass from December 21, 2012 to February 26, 2014. The Risk Adjustment for Congenital Heart Surgery 1 category less than 1 was excluded.
Interventions: Brain natriuretic peptide (BNP) levels were measured preoperatively (BNPpre) and on postoperative day 1 (BNPpoDi) and postoperative day 3 (BNPpoD3).
Methods and Results: Primary outcome was the incidence of postoperative SAEs; (1) death in the intensive care unit, (2) requirement of extracorporeal membrane oxygenation, (3) cardiac arrest, and (4) requirement of reoperation for hemodynamic instability. The authors included 71 patients in this study. There were 8 patients (11%) who had at least 1 SAE. Median preoperative BNP level in patients with. SAEs was significantly higher than in those without SAEs (1,541 pg/mL [IQR: 121-5,962] v 122 pg/mL [QR: 34-342], p = 0.01). From the receiver operating characteristic curve of BNPpre for the incidence of SAEs, an area under the curve was 0.77 (95%CI 0.55-0.91). The best cutoff BNPpre number was 1,000 pg/mL. From the multivariate logistic regression model, BNPpre > 1,000 pg/mL was associated independently with risk of SAEs (adjusted odds ratio = 8.5, 95% CI [1.3, 59.3], p = 0.02).
Conclusions: In conclusion, the authors' study showed that increased preoperative brain natriuretic peptide concentration, especially a concentration of more than 1,000 pg/mL, was associated with risk of SAEs in pediatric. cardiac surgery patients. (C) 2017 Elsevier Inc. All rights reserved.

DOI： 10.1053/j.jvca.2016.09.008

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【突然死をきたす不整脈(致死的不整脈)と治療】カテコラミン誘発多形性心室頻拍

塩路直弘, 金澤伴幸, 森松博史

臨床麻酔 41 ( 3 ) 457 - 463 2017年3月

記述言語：日本語出版者・発行元：真興交易(株)医書出版部

カテコラミン誘発多形性心室頻拍(Catecholaminergic polymorphic ventricular tachycardia:CPVT)は遺伝性不整脈疾患で突然死の原因となる。器質的心疾患がないこと、安静時心電図に異常がないこと、運動や情動による交感神経刺激で誘発される2方向性あるいは多形性の心室頻拍を特徴とする。β遮断薬が治療の中心になるが、治療中でも発作を起こす症例がある。本疾患は特異的な病態から急性期治療、周術期管理に特別の注意が必要で、病態生理を理解することが治療法の理解につながる。本稿ではCPVTの疾患の病態生理、分類、診断、慢性期治療について記述し、急性期治療、周術期管理について考察する。(著者抄録)

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Reverse Right Ventricular Remodeling After Lung Transplantation in Patients With Pulmonary Arterial Hypertension Under Combination Therapy of Targeted Medical Drugs

Toshihiro Sarashina, Kazufumi Nakamura, Satoshi Akagi, Takahiro Oto, Hiroki Oe, Kentaro Ejiri, Koji Nakagawa, Nobuhiro Nishii, Hiromi Matsubara, Motomu Kobayashi, Hiroshi Morimatsu, Shinichiro Miyoshi, Hiroshi Ito

CIRCULATION JOURNAL 81 ( 3 ) 383 - 390 2017年3月

記述言語：英語出版者・発行元：JAPANESE CIRCULATION SOC

Background: Patients with pulmonary arterial hypertension (PAH) are currently treated with combination therapy of PAH-targeted drugs. Reverse right ventricular (RV) remodeling after lung transplantation (LTx) in patients with end-stage PAH despite combination therapy of PAH-targeted drugs has not been fully elucidated.
Methods and Results: A total of 136 patients, including 32 with PAH, underwent LTx from 1998 to 2014. We enrolled 12 consecutive patients with PAH treated with combination therapy of PAH-targeted drugs who underwent LTx and retrospectively analyzed the temporal and serial changes in hemodynamics and echocardiography before LTx and at 3 and 12 months after LTx. Before LTx, the RV was markedly dilated with substantially reduced RV fractional area change (RVFAC). At 3 months after LTx, pulmonary artery pressure, pulmonary vascular resistance and RV stroke work index were significantly decreased, while left ventricular stroke work index was increased. RV size assessed by echocardiography also significantly decreased and RVFAC improved. At 12 months after LTx, RVFAC was further increased and RV wall thickness was decreased significantly.
Conclusions: Although severe RV dysfunction and dilation were observed in patients with end-stage PAH despite combination therapy of PAH-targeted drugs, RV function and morphology were improved after reduction of RV pressure load by LTx.

DOI： 10.1253/circj.CJ-16-0838

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NAVA : Neurally Adjusted Ventilatory Assist : 基礎と実践 (特集急性期呼吸管理の基礎と実践)

塩路直弘, 岡原修司, 金澤伴幸, 清水一好, 森松博史

ICUとCCU = Japanese journal of intensive care medicine : 集中治療医学 41 ( 1 ) 21 - 27 2017年1月

High Ionized Calcium Concentration Is Associated With Prolonged Length of Stay in the Intensive Care Unit for Postoperative Pediatric Cardiac Patients 国際誌

Satoshi Kimura, Tatsuo Iwasaki, Katsunori Oe, Kazuyoshi Shimizu, Tomohiko Suemori, Tomoyuki Kanazawa, Naohiro Shioji, Yasutoshi Kuroe, Yuto Matsuoka, Hiroshi Morimatsu

Journal of Cardiothoracic and Vascular Anesthesia, Journal of Cardiothoracic Anesthesia 32 ( 4 ) 371 - 377 2017年

急性期呼吸管理の基礎と実践 NAVA : Neurally Adjusted Ventilatory Assist:基礎と実践

塩路直弘, 岡原修司, 金澤伴幸, 清水一好, 森松博史

ICUとCCU 41 ( 1 ) 2017年

A Case of Refractory Systemic Capillary Leak Syndrome (Clarkson's Disease) during Pregnancy

Yukiko Hikasa, Masao Hayashi, Satoshi Suzuki, Hiroshi Morimatsu

ACTA MEDICA OKAYAMA 70 ( 6 ) 497 - 501 2016年12月

記述言語：英語出版者・発行元：OKAYAMA UNIV MED SCHOOL

A 32-year-old woman, pregnant with twins, presented with a chief complaint of general fatigue. Her general condition had rapidly deteriorated since her last visit to the primary obstetrician; the patient was then referred to our hospital because of suspected fetal death. She underwent emergency cesarean section because fetal death had indeed occurred, and she was then admitted to the intensive care unit (ICU). On ICI: admission, she was found to he in shock. Laboratory analysis revealed extreme hemoconcentration and a low albumin level, and initially, septic shock with obstetric complications was suspected. However, because she did not respond to conventional therapy but instead, rapidly developed severe generalized edema, systemic capillary leak syndrome (SCLS) was diagnosed. The patient remained in shock for several days until undergoing plasma exchange (PE), despite some earlier empirical treatments. She eventually recovered from profound shock status and was discharged from the ICU without sequelae. Among potentially effective treatments, PE seemed to be the most reasonable choice for the treatment of her SCLS.

DOI： 10.18926/AMO/54814

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INTRAOPERATIVE FLUID THERAPY IN VIDEO-ASSISTED THORACOSCOPIC ESOPHAGECTOMY: A RETROSPECTIVE STUDY

Yukiko Hikasa, Satoshi Suzuki, Tomoyuki Kanazawa, Masao Hayashi, Takashi Matsusaki, Kazuyoshi Shimizu, Hiroshi Morimatsu

CRITICAL CARE MEDICINE 44 ( 12 ) 2016年12月

Isoflurane Induces Transient Impairment of Retention of Spatial Working Memory in Rats

Masaaki Tanino, Motomu Kobayashi, Toshihiro Sasaki, Ken Takata, Yoshimasa Takeda, Satoshi Mizobuchi, Kiyoshi Morita, Taku Nagai, Hiroshi Morimatsu

ACTA MEDICA OKAYAMA 70 ( 6 ) 455 - 460 2016年12月

記述言語：英語出版者・発行元：OKAYAMA UNIV MED SCHOOL

Postoperative cognitive dysfunction (POCD) occurs in nearly one-third of patients after non-cardiac surgery. Many animal behavior studies have investigated the effect of general anesthesia on cognitive function. However, there have been no studies examining the effects on working memory specifically, with a focus on the retention of working memory. We demonstrate here that isoflurane anesthesia induces deficits in the retention of spatial working memory in rats, as revealed by an increase in isoflurane-induced across-phase errors in the delayed spatial win-shift (SWSh) task with a 30-min delay in an 8-arm radial arm maze on post-anesthesia days (PADs) 1,2,4, and 10. A post-hoc analysis revealed a significant increase in across-phase errors on PAD 1 and recovery on PAD 10 in the isoflurane group. In contrast, within-phase errors independent of the retention of working memory were unaffected by isoflurane. These results demonstrate that isoflurane anesthesia transiently impairs the retention of spatial working memory in rats.

DOI： 10.18926/AMO/54808

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THE STATE OF INTERVENTION BY BRAIN NATRIURETIC PEPTIDE VALUES IN PEDIATRIC CARDIAC SURGERY PATIENTS

Yasutoshi Kuroe, Tomoyuki Kanazawa, Naohiro Shioji, Kentaro Sugimoto, Tomohiko Suemori, Kazuyoshi Shimizu, Tatsuo Iwasaki, Hiroshi Morimatsu

CRITICAL CARE MEDICINE 44 ( 12 ) 2016年12月

Effect of Residual Cerebral Blood Flow During Ischemic Depolarization on Neuronal Cell Damage in Rats

Hirokazu Kawase, Yoshimasa Takeda, Ryoichi Mizoue, Sachiko Sato, Miki Fushimi, Hiroshi Morimatsu

CIRCULATION 134 2016年11月

新生児の麻酔ぜよ!! 総肺静脈還流異常症、大血管転位症の麻酔管理

末盛智彦, 塩路直弘, 野々村智子, 杉本健太郎, 金澤伴幸, 清水一好, 岩崎達雄, 森松博史

日本臨床麻酔学会誌 36 ( 6 ) S196 - S196 2016年10月

術前肝硬変重症度と術後オピオイド使用量の関係

廣井一正, 松崎孝, 賀来隆治, 森松博史

日本ペインクリニック学会誌 23 ( 4 ) 595 - 595 2016年10月

症例レボチロキシン内服中止により気管切開後気管狭窄が増悪した慢性甲状腺炎の1例

名原功, 清水一好, 片山明, 川出健嗣, 日笠友起子, 林真雄, 松岡義和, 森松博史

ICUとCCU = Japanese journal of intensive care medicine : 集中治療医学 40 ( 9 ) 653 - 657 2016年9月

Analysis of Prognostic Factors of Hematopoietic Stem Cell Transplantation Patients Admitted to ICU

Malcoto Nakamura, Nobuharu Fujii, Kazuyoshi Shimizu, Hisakazu Nishimori, Ken-ichi Matsuoka, Eisei Kondo, Yoshinobu Maeda, Hiroshi Morimatsu, Mitsune Tanimoto

BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION 22 ( 3 ) S293 - S293 2016年3月

Urinary Albumin Levels Predict Development of Acute Kidney Injury After Pediatric Cardiac Surgery: A Prospective Observational Study

Kentaro Sugimoto, Yuichiro Toda, Tatsuo Iwasaki, Kazuyoshi Shimizu, Tomoyuki Kanazawa, Noriko Muto, Hirokazu Kawase, Hiroshi Morimatsu, Kiyoshi Morita, Yohei Maeshima, Kiyoshi Mori, Shunji Sano

JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA 30 ( 1 ) 64 - 68 2016年2月

記述言語：英語出版者・発行元：W B SAUNDERS CO-ELSEVIER INC

Objective: Mortality and morbidity of acute kidney injury (AKI) after cardiac surgery still remain high. The authors undertook the present study to evaluate the utility of early postoperative urinary albumin (uAlb) as a diagnostic marker for predicting occurrence of AKI and its severity in pediatric patients undergoing cardiac surgery.
Design: A prospective observational study.
Setting: A single-institution university hospital.
Participants: All patients <18 years of age who underwent repair of congenital heart disease with cardiopulmonary bypass between July 2010 and July 2012 were included in the study. Neonates age <1 month were excluded from the study population.
Interventions: The association between uAlb and occurrence of AKI within 3 days after admission to the intensive care unit was investigated. Criteria from pediatric modified Risk Injury Failure Loss and End-stage kidney disease (pRIFLE) were used to determine the occurrence of AKI. The value of uAlb was measured at intensive care unit admission immediately after cardiac surgery in all participants from whom a 5-mL urine sample was obtained.
Measurements and Main Results: Of 376 patients, AKI assessed by pRIFLE was identified in 243 (64.6%): 172 for risk (R; 45.7%), 44 for injury (I; 11.7%), and 27 for failure (F; 7.2%). One hundred thirty-three patients (35.4%) were classified as being without AKI (normal [N]) by pRIFLE. The concentration of uAlb was significantly higher in AKI patients than in non-AKI patients (median [interquartile range]): uAlb (mu g/mL): 13.5 (6.4-39.6) v 6.0 (3.4-16), p < 0.001; uAlb/Cr (mg/gCr): 325 (138-760) v 121 (53-269), p < 0.001.
Conclusions: The utility of uAlb for prompt diagnosis of AKI was shown. Obtaining uAlb measurements early after pediatric cardiac surgery may be useful for predicting the occurrence and severity of AKI. (C) 2016 Elsevier Inc. All rights reserved.

DOI： 10.1053/j.jvca.2015.05.194

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肝移植医療を地域と大学が一体としてまとめ上げた実績とさらなる発展

八木孝仁, 篠浦先, 楳田祐三, 吉田龍一, 信岡大輔, 杭瀬崇, 渡辺信之, 高木弘誠, 須井健太, 藤原俊義, 高木章乃夫, 吉田真理, 保田裕子, 森松博史

肝胆膵 72 ( 3 ) 481 - 487 2016年

Perioperative Management Center (PERIO) for Neurosurgical Patients

Takao Yasuhara, Tomohito Hishikawa, Takashi Agari, Kazuhiko Kurozumi, Tomotsugu Ichikawa, Masahiro Kameda, Aiko Shinko, Joji Ishida, Masafumi Hiramatsu, Motomu Kobayashi, Yoshikazu Matsuoka, Toshihiro Sasaki, Yoshihiko Soga, Reiko Yamanaka, Takako Ashiwa, Akemi Arioka, Yasuko Hashimoto, Ayasa Misaki, Yuriko Ishihara, Machiko Sato, Hiroshi Morimatsu, Isao Date

NEUROLOGIA MEDICO-CHIRURGICA 56 ( 9 ) 574 - 579 2016年

記述言語：英語出版者・発行元：JAPAN NEUROSURGICAL SOC

Perioperative management is critical for positive neurosurgical outcomes. In order to maintain safe and authentic perioperative management, a perioperative management center (PERIO) was introduced to patients of our Neurosurgery Department beginning in June 2014. PERIO involves a multidisciplinary team consisting of anesthesiologists, dentists/dental hygienists/technicians, nurses, physical therapists, pharmacists, and nutritionists. After neurosurgeons decide on the course of surgery, a preoperative evaluation consisting of blood sampling, electrocardiogram, chest X-ray, and lung function test was performed. The patients then visited the PERIO clinic 7-14 days before surgery. One or two days before surgery, the patients without particular issues enter the hospital and receive a mouth cleaning one day before surgery. After surgery, postoperative support involving eating/swallowing evaluation, rehabilitation, and pain control is provided. The differences in duration from admission to surgery, cancellation of surgery, and postoperative complications between PERIO and non-PERIO groups were examined. Eighty-five patients were enrolled in the PERIO group and 131 patients in the non-PERIO group. The duration from admission to surgery was significantly decreased in the PERIO group (3.6 +/- 0.3 days), compared to that in the non-PERIO group (4.7 +/- 0.2 days). There was one cancelled surgery in the PERIO group and six in the non-PERIO group. Postoperative complications and the overall hospital stay did not differ between the two groups. The PERIO system decreased the duration from admission to surgery, and it is useful in providing high-quality medical service, although the system should be improved so as not to increase the burden on medical staff.

DOI： 10.2176/nmc.oa.2016-0085

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iPS細胞から2型肺胞上皮細胞への分化誘導

林真雄, 神崎浩孝, 松岡義和, 森松博史

日本集中治療医学会学術集会(Web) 43rd 2016年

術前ルーチン検査 : 海外のガイドライン,エビデンスから考える (特集周術期マネジメント)

松﨑孝, 森松博史

Hospitalist = ホスピタリスト 4 ( 2 ) 204 - 211 2016年

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