論文 - 山元　良

尿酸クリアランスと院外心停止後の予後の関連 SOS-KANTO 2017 Study

多村 知剛, 山元 良, 本間 康一郎, 北村 伸哉, 野村 智久, 田上 隆, 康永 秀生, 麻生 将太郎, 武田 宗和, 佐々木 淳一

日本救急医学会関東地方会雑誌 （日本救急医学会-関東地方会）  45 （ 1 ） 80 - 80 2024年02月

ISSN  0287-301X

日本版敗血症診療ガイドライン2024

志馬 伸朗, 中田 孝明, 矢田部 智昭, 山川 一馬, 青木 善孝, 井上 茂亮, 射場 敏明, 小倉 裕司, 河合 佑亮, 川口 敦, 川崎 達也, 近藤 豊, 櫻谷 正明, 對東 俊介, 土井 研人, 橋本 英樹, 原 嘉孝, 福田 龍将, 松嶋 麻子, 江木 盛時, 久志本 成樹, 大網 毅彦, 菊谷 知也, 相川 玄, 青木 誠, 赤塚 正幸, 淺井 英樹, 阿部 智一, 雨宮 優, 石澤 嶺, 石原 唯史, 石丸 忠賢, 糸洲 佑介, 井上 拓保, 今長谷 尚史, 井村 春樹, 岩崎 直也, 生塩 典敬, 内田 雅俊, 内 倫子, 梅垣 岳志, 梅村 穣, 遠藤 彰, 大井 真里奈, 大内 玲, 大沢 樹輝, 大島 良康, 太田 浩平, 大野 孝則, 岡田 遥平, 岡野 弘, 小川 新史, 柏浦 正広, 春日井 大介, 狩野 謙一, 上谷 遼, 河内 章, 川上 定俊, 川上 大裕, 川村 雄介, 神鳥 研二, 岸原 悠貴, 木村 翔, 久保 健児, 栗原 知己, 小網 博之, 小谷 祐樹, 木庭 茂, 佐藤 威仁, 佐藤 蓮, 澤田 悠輔, 志田 瑶, 島田 忠長, 志水 元洋, 清水 一茂, 白石 拓人, 新貝 達, 丹保 亜希仁, 杉浦 岳, 杉本 健輔, 杉本 裕史, 壽原 朋宏, 関野 元裕, 其田 健司, 對東 真帆子, 高橋 希, 竹下 淳, 武田 親宗, 立野 淳子, 田中 愛子, 谷 昌憲, 谷河 篤, 陳 昊, 土田 拓見, 堤 悠介, 恒光 健史, 出口 亮, 鉄原 健一, 寺山 毅郎, 戸上 由貴, 十時 崇彰, 友田 吉則, 中尾 俊一郎, 長澤 宏樹, 中谷 安寿, 中西 信人, 西岡 典宏, 錦見 満暁, 野口 智子, 野浪 豪, 野村 理, 橋本 克彦, 畠山 淳司, 濵井 康貴, 彦根 麻由, 久宗 遼, 廣瀬 智也, 福家 良太, 藤井 遼, 藤江 直輝, 藤永 潤, 藤浪 好寿, 藤原 翔, 舩越 拓, 本間 康一郎, 牧野 佑斗, 松浦 裕司, 松岡 綾華, 松岡 義, 松村 洋輔, 水野 彰人, 宮本 颯真, 三好 ゆかり, 村田 慧, 村田 哲平, 薬師寺 泰匡, 安尾 俊祐, 山田 浩平, 山田 博之, 山元 良, 山本 良平, 湯本 哲也, 吉田 裕治, 吉廣 尚大, 吉村 聡志, 吉村 旬平, 米倉 寛, 若林 侑起, 和田 剛志, 渡辺 伸一, 井尻 篤宏, 宇賀田 圭, 宇田 周司, 小野寺 隆太, 高橋 正樹, 中島 聡志, 本多 純太, 松本 承大, 日本版敗血症診療ガイドライン2024特別委員会

日本集中治療医学会雑誌 （一般社団法人 日本集中治療医学会）  advpub （ 0 ）  2024年

ISSN  13407988

　概要を見る

<p>日本集中治療医学会と日本救急医学会は合同で特別委員会を結成し、日本版敗血症診療ガイドライン2024年版（J-SSCG2024）として公表する。今回の改訂により、2012年の初版から数えて3回目の改訂となる。本ガイドラインの目的は、敗血症および敗血症性ショックの診療において、医療従事者が適切な判断を下し、患者の転帰改善につなげるための支援を行うことである。敗血症を認識し初期対応する医師、引き継いで専門家として診療する医師、そして看護師、理学療法士、臨床工学技士、薬剤師など、多職種の医療従事者にとって理解しやすく、使いやすいものを目指した。 J-SSCG2024は、敗血症の診断と感染源のコントロール、抗菌薬治療、初期蘇生・循環作動薬、急性血液浄化、DIC 診断と治療、その他の補助療法、PICS 対策、家族ケア、小児の9領域をカバーし、合計78 個の重要臨床課題を設定した。ガイドラインパネルには両学会から委員21名を任用し、ワーキンググループメンバー107名（医師、看護師、理学療法士、臨床工学技士、薬剤師）のサポートのもとに作成した。将来への発展性を見据えて、多くの若手医療従事者や研究者を含めた。また前回と同様に、中立的立場で領域を横断的に俯瞰するアカデミックガイドライン推進班を構成し、質の担保と作業過程の透明化を目的にパブリックコメントを募集した。作成手法にはGRADE（The Grading of Recommendations Assessment, Development and Evaluation）システムを採用し、質の高いガイドラインを目指した。7個のGood practice statement（GPS）と42個のGRADE に基づく推奨を提示した。その他に、Background question（BQ）22個、future research question（FRQ）12個の解説文を付記した。さらにガイドラインの幅広い普及と教育効果の向上を目指し、スマートフォンアプリを開発した。 本ガイドラインは日本集中治療医学会と日本救急医学会の両機関誌のガイドライン増刊号として同時掲載される。日本集中治療医学会と日本救急医学会の精鋭の英知が詰まった本ガイドラインが、より多くの関係者に利用され、評価され、1人でも多くの敗血症患者の転帰改善に繫がることを願っている。</p>

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Urine Output and Development of Acute Kidney Injury in Sepsis: A Multicenter Observational Study

Yamamoto R., Yamakawa K., Yoshizawa J., Kaito D., Umemura Y., Homma K., Sasaki J.

Journal of Intensive Care Medicine    8850666241268390 2024年

ISSN  08850666

　概要を見る

Background: Acute kidney injury (AKI) is common in sepsis and a urine output <0.5 mL/kg/h associated with increased mortality is incorporated into AKI diagnosis. We aimed to identify the urine-output threshold associated with increased AKI incidence and hypothesized that a higher urine output than a specified threshold, which differs from the predominantly used 0.5 mL/kg/h threshold, would be associated with an increased AKI incidence. Methods: This was a post-hoc analysis of a nationwide prospective observational study. This study included adult patients newly diagnosed with sepsis and requiring intensive care. Urine output on the day of sepsis diagnosis was categorized as low, moderate, or high (<0.5, 0.5-1.0, and >1.0 mL/kg/h, respectively), and we compared AKI incidence, renal replacement therapy (RRT) requirement, and 28-day survival by category. Estimated probabilities for these outcomes were also compared after adjusting for patient background and hourly fluid administration. Results: Among 172 eligible patients, AKI occurred in 46.3%, 48.3%, and 53.1% of those with high, moderate, and low urine output, respectively. The probability of AKI was lower in patients with high urine output than in those with low output (43.6% vs 56.5%; P =.028), whereas RRT requirement was lower in patients with high and moderate urine output (11.7% and 12.8% vs 49.1%; P <.001). Patients with low urine output demonstrated significantly lower survival (87.7% vs 82.8% and 67.8%; P =.018). Cubic spline curves for AKI, RRT, and survival prediction indicated different urine-output thresholds, including <1.2 to 1.3 mL/kg/h for AKI and <0.6 to 0.8 mL/kg/h for RRT and mortality risk. Conclusions: Urine output >1.0 mL/kg/h on the day of sepsis diagnosis was associated with lower AKI incidence. The urine-output threshold was higher for developing AKI than for RRT requirement or mortality.

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Follow-up computed tomography and unexpected hemostasis in non-operative management of pediatric blunt liver and spleen injury

Yamamoto R., Sato Y., Cestero R.F., Eastridge B.J., Maeshima K., Katsura M., Kondo Y., Yasuda H., Kushimoto S., Sasaki J.

European Journal of Trauma and Emergency Surgery 2024年

ISSN  18639933

　概要を見る

Purpose: While follow-up CT and prophylactic embolization with angiography are often conducted during non-operative management (NOM) for BLSI, particularly in a high-grade injury, the utility of early repeated CT for preventing unexpected hemorrhage remains unclear. This study aimed to elucidate whether early follow-up computerized tomography (CT) within 7 days after admission would decrease unexpected hemostatic procedures on pediatric blunt liver and spleen injury (BLSI). Methods: A post-hoc analysis of a multicenter observational cohort study on pediatric patients with BLSI (2008–2019) was conducted on those who underwent NOM, in whom the timing of follow-up CT were decided by treating physicians. The incidence of unexpected hemostatic procedure (laparotomy and/or emergency angiography for ruptured pseudoaneurysm) and complications related to BLSI were compared between patients with and without early follow-up CT within 7 days. Inverse probability weighting with propensity scores adjusted patient demographics, comorbidities, mechanism and severity of injury, initial resuscitation, and institutional characteristics. Results: Among 1320 included patients, 552 underwent early follow-up CT. Approximately 25% of patients underwent angiography on the day of admission. The incidence of unexpected hemostasis was similar between patients with and without early repeat CT (8 [1.4%] vs. 6 [0.8%]; adjusted OR, 1.44 [0.62–3.34]; p = 0.40). Patients with repeat CT scans more frequently underwent multiple angiographies (OR, 2.79 [1.32–5.88]) and had more complications related to BLSI, particularly bile leak (OR, 1.73 [1.04–2.87]). Conclusion: Follow-up CT scans within 7 days was not associated with reduced unexpected hemostasis in NOM for pediatric BLSI.

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人工真皮サンドウィッチ法の有用性：多施設共同前向き観察研究の立案および現状

山元 良, 佐藤 幸男, 松村 一, 池田 弘人, 今井 啓道, 上田 敬博, 福田 憲翁, 佐々木 淳一

熱傷 （一般社団法人 日本熱傷学会）  49 （ 5 ） 263 - 267 2023年12月

ISSN  0285113X

　概要を見る

<p> 本報告では, 皮膚移植に関する臨床研究の立案過程を解説する. さまざまな皮膚移植法が存在するなか, 人工真皮を用いた移植によって創の機能や整容を向上させる可能性が示唆されている. 従来, 人工真皮を用いた治療戦略では, 人工真皮の移植・生着確認ののちに自家分層植皮を行うという二期的手術が一般的であったが, 近年では自家網状分層植皮の表層に人工真皮の植皮を一期的に行うという手法, 人工真皮サンドウィッチ法が提案され, 臨床実用されている. しかし, その効果は証明されておらず, われわれはその有用性を評価するため多施設共同前向き観察研究を実施するにいたった. そこで, 本研究の立案・開始までの過程を紹介する. 研究立案期において, 人工真皮サンドウィッチ法の対象創と対照術式の設定に苦慮した. 最終的に, 期待される効果を総治療期間の短縮効果および採皮面積の縮小効果の2つに整理し検討した. 総治療期間の短縮効果を評価するために, 深部まで及ぶ皮膚欠損創を対象創とし, 人工真皮を用いる従来の二期的手術を対照術式とした. また, 採皮面積の減少効果を評価するために, 広範囲皮膚欠損創を対象とし, 低倍率網状分層植皮を対照術式とした. また, 術式選択に関して多くの交絡因子が存在することが考えられ, 皮膚移植対象創に関する過不足ない情報が何かを検討し, アウトカムの評価方法について深く議論したことが, 研究計画設定において非常に重要であったと考えられる. 本研究結果がつぎのランダム化比較試験へ繋がることを期待している. </p>

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Hyperoxia for sepsis and development of acute lung injury with increased mortality

Yamamoto R., Fujishima S., Yamakawa K., Abe T., Ogura H., Saitoh D., Gando S., Sasaki J.

BMJ Open Respiratory Research 10 （ 1 ）  2023年12月

　概要を見る

Background Supraphysiological oxygen administration causes unfavourable clinical outcomes in various diseases. This study aimed to determine whether hyperoxia would be associated with increased mortality in patients with severe infection. Methods A post-hoc analysis of a nationwide multicentre prospective observational study on sepsis (SPICE Study) was conducted, including adult patients admitted to the intensive care unit with available arterial partial pressure of oxygen (PaO2) at the treatment initiation for severe infection. Hyperoxia was defined as a PaO2 level of ≥300 mm Hg and in-hospital mortality was compared between patients with and without hyperoxia. Results Of the 563 patients eligible for the study, 49 had hyperoxia at treatment initiation for severe infection. The in-hospital all-cause mortality rates of patients with and without hyperoxia were 14 (29.2%) and 90 (17.6%), respectively. Inverse probability weighting analyses with propensity scores revealed the association between hyperoxia and increased in-hospital mortality rate (28.8% vs 18.8%; adjusted OR 1.75 (1.03 to 2.97); p=0.038), adjusting for patient demographics, comorbidities, site of infection, severity of infection, haemodynamic and respiratory status, laboratory data and location of patient at infection development. Acute lung injury developed more frequently in patients with hyperoxia on the following days after infection treatment, whereas sepsis-related mortality was comparable regardless of hyperoxia exposure. Conclusion Hyperoxia with PaO2 ≥300 mm Hg at treatment initiation of severe infection was associated with an increased in-hospital mortality rate in patients requiring intensive care. The amount of oxygen to administer to patients with severe infection should be carefully determined.

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Optimal tentative abdominal closure for open abdomen: a multicenter retrospective observational study (OPTITAC study)

Yamamoto R., Kuramoto S., Shimizu M., Shinozaki H., Miyake T., Sadakari Y., Sekine K., Kaneko Y., Kurosaki R., Koizumi K., Shibusawa T., Sakurai Y., Wakahara S., Sasaki J.

International journal of surgery (London, England) 109 （ 12 ） 4049 - 4056 2023年12月

ISSN  1743-9191

　概要を見る

BACKGROUND: Primary fascia closure is often difficult following an open abdomen (OA). While negative-pressure wound therapy (NPWT) is recommended to enhance successful primary fascia closure, the optimal methods and degree of negative pressure remain unclear. This study aimed to elucidate optimal methods of NPWT as a tentative abdominal closure for OA to achieve primary abdominal fascia closure. MATERIALS AND METHODS: A multicenter, retrospective, cohort study of adults who survived OA greater than 48 h was conducted in 12 institutions between 2010 and 2022. The achievement of primary fascia closure and incidence of enteroatmospheric fistula were examined based on methods (homemade, superficial NPWT kit, or open-abdomen kit) or degrees of negative pressure (<50, 50-100, or >100 mmHg). A generalized estimating equation was used to adjust for age, BMI, comorbidities, etiology for laparotomy requiring OA, vital signs, transfusion, severity of critical illness, and institutional characteristics. RESULTS: Of the 279 included patients, 252 achieved primary fascia closure. A higher degree of negative pressure (>100 mmHg) was associated with fewer primary fascia closures than less than 50 mmHg [OR, 0.18 (95% CI: 0.50-0.69), P =0.012] and with more frequent enteroatmospheric fistula [OR, 13.83 (95% CI: 2.30-82.93)]. The methods of NPWT were not associated with successful primary fascia closure. However, the use of the open-abdomen kit was related to a lower incidence of enteroatmospheric fistula [OR, 0.02 (95% CI: 0.00-0.50)]. CONCLUSION: High negative pressure (>100 mmHg) should be avoided in NPWT during tentative abdominal closure for OA.

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Hyperoxia for accidental hypothermia and increased mortality: a post-hoc analysis of a multicenter prospective observational study

Yamamoto R., Yoshizawa J., Takauji S., Hayakawa M., Sasaki J.

Critical Care （Critical Care）  27 （ 1 ） 131 2023年12月

ISSN  13648535

　概要を見る

Background: Supraphysiologic oxygen administration causes unfavorable clinical outcomes in various diseases, including traumatic brain injury, post–cardiac arrest syndrome, and acute lung injury. Accidental hypothermia is a critical illness that reduces oxygen demands, and excessive oxygen is likely to emerge. This study aimed to determine whether hyperoxia would be associated with increased mortality in patients with accidental hypothermia. Methods: A post-hoc analysis of a nationwide multicenter prospective observational study (ICE-CRASH study) on patients with accidental hypothermia admitted in 2019–2022 was conducted. Adult patients without cardiac arrest whose core body temperature was < 32 °C and whose arterial partial pressure of oxygen (PaO2) was measured at the emergency department were included. Hyperoxia was defined as a PaO2 level of 300 mmHg or higher, and 28-day mortality was compared between patients with and without hyperoxia before rewarming. Inverse probability weighting (IPW) analyses with propensity scores were performed to adjust patient demographics, comorbidities, etiology and severity of hypothermia, hemodynamic status and laboratories on arrival, and institution characteristics. Subgroup analyses were conducted according to age, chronic cardiopulmonary diseases, hemodynamic instability, and severity of hypothermia. Results: Of the 338 patients who were eligible for the study, 65 had hyperoxia before rewarming. Patients with hyperoxia had a higher 28-day mortality rate than those without (25 (39.1%) vs. 51 (19.5%); odds ratio (OR) 2.65 (95% confidence interval 1.47–4.78); p < 0.001). IPW analyses with propensity scores revealed similar results (adjusted OR 1.65 (1.14–2.38); p = 0.008). Subgroup analyses showed that hyperoxia was harmful in the elderly and those with cardiopulmonary diseases and severe hypothermia below 28 °C, whereas hyperoxia exposure had no effect on mortality in patients with hemodynamic instability on hospital arrival. Conclusions: Hyperoxia with PaO2 levels of 300 mmHg or higher before initiating rewarming was associated with increased 28-day mortality in patients with accidental hypothermia. The amount of oxygen to administer to patients with accidental hypothermia should be carefully determined. Trial Registration: The ICE-CRASH study was registered at the University Hospital Medical Information Network Clinical Trial Registry on April 1, 2019 (UMIN-CTR ID, UMIN000036132).

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Early symptoms preceding post-infectious irritable bowel syndrome following COVID-19: a retrospective observational study incorporating daily gastrointestinal symptoms

Yamamoto R., Yamamoto A., Masaoka T., Homma K., Matsuoka T., Takemura R., Wada M., Sasaki J., Kanai T., Amagai M., Saya H., Nishihara H.

BMC Gastroenterology （BMC Gastroenterology）  23 （ 1 ） 108 - 108 2023年12月

　概要を見る

Background: Intestinal microinflammation with immune dysfunction due to severe acute respiratory syndrome coronavirus 2 reportedly precipitates post-infectious irritable bowel syndrome. This study aimed to elucidate potential risk factors for subsequent development of irritable bowel syndrome, hypothesizing that it is associated with specific symptoms or patient backgrounds. Methods: This single-center retrospective observational study (2020–2021) included adults with confirmed coronavirus disease requiring hospital admission and was conducted using real-world data retrieved from a hospital information system. Patient characteristics and detailed gastrointestinal symptoms were obtained and compared between patients with and without coronavirus disease-induced irritable bowel syndrome. Multivariate logistic models were used to validate the risk of developing irritable bowel syndrome. Moreover, daily gastrointestinal symptoms during hospitalization were examined in patients with irritable bowel syndrome. Results: Among the 571 eligible patients, 12 (2.1%) were diagnosed with irritable bowel syndrome following coronavirus disease. While nausea and diarrhea during hospitalization, elevated white blood cell count on admission, and intensive care unit admission were associated with the development of irritable bowel syndrome, nausea and diarrhea were identified as risk factors for its development following coronavirus disease, as revealed by the adjusted analyses (odds ratio, 4.00 [1.01–15.84] and 5.64 [1.21–26.31], respectively). Half of the patients with irritable bowel syndrome had both diarrhea and constipation until discharge, and constipation was frequently followed by diarrhea. Conclusions: While irritable bowel syndrome was rarely diagnosed following coronavirus disease, nausea and diarrhea during hospitalization precede the early signs of irritable bowel syndrome following coronavirus disease.

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Potential harms of emergency department thoracotomy in patients with persistent cardiac arrest following trauma: a nationwide observational study

Yamamoto R., Suzuki M., Sasaki J.

Scientific Reports 13 （ 1 ） 16042 - 16042 2023年12月

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Emergency department thoracotomy (EDT) was incorporated into traumatic out-of-hospital cardiac arrest (t-OHCA) resuscitation. Although current guidelines recommend EDT with survival predictors, futility following EDT has been demonstrated and the potential risks have not been thoroughly investigated. This study aimed to elucidate the benefits and harms of EDT for persistent cardiac arrest following injury until hospital arrival. This retrospective cohort study used a nationwide trauma registry (2019–2021) and included adult patients with t-OHCA both at the scene and on hospital arrival. Survival to discharge, hemostatic procedure frequency, and transfusion amount were compared between patients treated with and without EDT. Inverse probability weighting using a propensity score was conducted to adjust age, sex, comorbidities, mechanism of injury, prehospital resuscitative procedure, prehospital physician presence, presence of signs of life, degree of thoracic injury, transportation time, and institutional characteristics. Among 1289 patients, 374 underwent EDT. The longest transportation time for survivors was 8 and 23 min in patients with and without EDT, respectively. EDT was associated with lower survival to discharge (4/374 [1.1%] vs. 22/915 [2.4%]; adjusted odds ratio [OR], 0.43 [95% CI 0.22–0.84]; p = 0.011), although patients with EDT underwent more frequent hemostatic surgeries (46.0% vs. 5.0%; adjusted OR, 16.39 [95% CI 12.50–21.74]) and received a higher amount of transfusion. Subgroup analyses revealed no association between EDT and lower survival in patients with severe chest injuries (1.0% vs. 1.4%; adjusted OR, 0.72 [95% CI 0.28–1.84]). EDT was associated with lower survival till discharge in trauma patients with persistent cardiac arrests after adjusting for various patient backgrounds, including known indications for EDT. The idea that EDT is the last resort for t-OHCA should be reconsidered and EDT indications need to be deliberately determined. Trial registration This study is retrospectively registered at University Hospital Medical Information Network (UMIN ID: UMIN000050840).

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院外心停止患者における自己心拍再開直後の高酸素血症と神経学的予後の関連

山中 隆広, 山元 良, 小笠原 智子, 北村 伸哉, 田上 隆, 康永 秀生, 麻生 将太郎, 武田 宗和, 多村 知剛, 本間 康一郎, 佐々木 淳一

日本救急医学会雑誌 （(一社)日本救急医学会）  34 （ 12 ） 702 - 702 2023年12月

ISSN  0915-924X

院外心停止患者における自己心拍再開直後の高酸素血症と神経学的予後の関連

山中 隆広, 山元 良, 小笠原 智子, 北村 伸哉, 田上 隆, 康永 秀生, 麻生 将太郎, 武田 宗和, 多村 知剛, 本間 康一郎, 佐々木 淳一

日本救急医学会雑誌 （(一社)日本救急医学会）  34 （ 12 ） 702 - 702 2023年12月

ISSN  0915-924X

老健施設内の心停止患者における神経予後の検討

大野 聡一郎, 山元 良, 多村 知剛, 本間 康一郎, 佐々木 淳一, 杉山 和宏, 北村 伸哉, 田上 隆, 康永 秀生, 麻生 将太郎, 武田 宗和

日本救急医学会雑誌 （(一社)日本救急医学会）  34 （ 12 ） 702 - 702 2023年12月

ISSN  0915-924X

老健施設内の心停止患者における神経予後の検討

大野 聡一郎, 山元 良, 多村 知剛, 本間 康一郎, 佐々木 淳一, 杉山 和宏, 北村 伸哉, 田上 隆, 康永 秀生, 麻生 将太郎, 武田 宗和

日本救急医学会雑誌 （(一社)日本救急医学会）  34 （ 12 ） 702 - 702 2023年12月

ISSN  0915-924X

病院前でのshockable rhythmは心原性心停止を示唆し転帰と関連するか

小川 広晃, 多村 知剛, 立石 順久, 北村 伸哉, 田上 隆, 康永 秀生, 麻生 将太郎, 武田 宗和, 山元 良, 本間 康一郎, 佐々木 淳一

日本救急医学会雑誌 （(一社)日本救急医学会）  34 （ 12 ） 751 - 751 2023年12月

ISSN  0915-924X

病院前でのshockable rhythmは心原性心停止を示唆し転帰と関連するか

小川 広晃, 多村 知剛, 立石 順久, 北村 伸哉, 田上 隆, 康永 秀生, 麻生 将太郎, 武田 宗和, 山元 良, 本間 康一郎, 佐々木 淳一

日本救急医学会雑誌 （(一社)日本救急医学会）  34 （ 12 ） 751 - 751 2023年12月

ISSN  0915-924X

早期緊急通報の転帰に及ぼす影響

笠茂 修平, 山元 良, 舩越 拓, 北村 伸哉, 田上 隆, 康永 秀生, 麻生 将太郎, 武田 宗和, 山下 幾太郎, 多村 知剛, 本間 康一郎, 佐々木 淳一

日本救急医学会雑誌 （(一社)日本救急医学会）  34 （ 12 ） 703 - 703 2023年12月

ISSN  0915-924X

早期緊急通報の転帰に及ぼす影響

笠茂 修平, 山元 良, 舩越 拓, 北村 伸哉, 田上 隆, 康永 秀生, 麻生 将太郎, 武田 宗和, 山下 幾太郎, 多村 知剛, 本間 康一郎, 佐々木 淳一

日本救急医学会雑誌 （(一社)日本救急医学会）  34 （ 12 ） 703 - 703 2023年12月

ISSN  0915-924X

新型コロナウイルス感染症の真菌感染合併リスクの検討

前島 克哉, 山元 良, 松村 一希, 遠藤 彰, 田上 隆, 山川 一馬, 早川 峰司, 小倉 崇以, 平山 敦士, 康永 秀生, 佐々木 淳一

日本救急医学会雑誌 （(一社)日本救急医学会）  34 （ 12 ） 725 - 725 2023年12月

ISSN  0915-924X

新型コロナウイルス感染症の真菌感染合併リスクの検討

前島 克哉, 山元 良, 松村 一希, 遠藤 彰, 田上 隆, 山川 一馬, 早川 峰司, 小倉 崇以, 平山 敦士, 康永 秀生, 佐々木 淳一

日本救急医学会雑誌 （(一社)日本救急医学会）  34 （ 12 ） 725 - 725 2023年12月

ISSN  0915-924X