研究者詳細 - 山元　良

論文 - 山元　良

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Hydrocortisone with fludrocortisone for septic shock: a systematic review and meta-analysis.

Yamamoto R, Nahara I, Toyosaki M, Fukuda T, Masuda Y, Fujishima S

Acute medicine & surgery （Wiley） 7 （ 1 ） e563 2020年01月

研究論文（学術雑誌）, 共著, ISSN 2052-8817

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Length of hospital stay and mortality associated with burns from assault: a retrospective study with inverse probability weighting analysis.

Yamamoto R, Toyosaki M, Kurihara T, Sasaki J

Burns & trauma 8 tkaa001 2020年

研究論文（学術雑誌）, 共著, 査読有り, ISSN 2321-3868

Background: Burns resulting from assaults account for considerable morbidity and mortality among patients with burn injuries around the world. However, it is still unclear whether unfavorable clinical outcomes are associated primarily with the severity of the injuries. To elucidate the direct relationship between burns resulting from assaults and mortality and/or length of hospital stays, we performed this study with the hypothesis that burns from assault would be independently associated with fewer hospital-free days than would burns from other causes, regardless of the severity of burn injuries. Methods: We conducted a retrospective cohort study, using a city-wide burn registry (1996-2017) accounting for 14 burn centers in Tokyo, Japan. Patients who arrived within 24 hours after injury were included, and those with self-inflicted burn injuries were excluded. Patients were divided into two groups according to mechanism of burns (assault vs. accident), and the number of hospital-free days until day 30 after injury (a composite of in-hospital death and hospital length of stay) was compared between the groups. To estimate the probability that an injury would be classified as an assault, we calculated propensity scores, using multivariate logistic regression analyses adjusted for known outcome predictors. We also performed an inverse probability weighting (IPW) analysis to compare adjusted numbers of hospital-free days. Results: Of 7419 patients in the registry with burn injuries during the study period, 5119 patients were included in this study. Of these, 113 (2.2%) were injured as a result of assault; they had significantly fewer hospital-free days than did those with burns caused by accident (18 [27] vs. 24 [20] days; coefficient = [Formula: see text]3.4 [[Formula: see text]5.5 to [Formula: see text]1.3] days; p = 0.001). IPW analyses similarly revealed the independent association between assault burn injury and fewer hospital-free days (adjusted coefficient = [Formula: see text]0.6 [[Formula: see text]1.0 to [Formula: see text]0.1] days; p = 0.009). Conclusions: Burn from assault was independently associated with fewer hospital-free days, regardless of the severity of burn injuries. The pathophysiological mechanism underlying the relationship should be further studied in a prospective observational study.

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A novel scale for predicting delayed intubation in patients with inhalation injury

Matsumura K., Yamamoto R., Kamagata T., Kurihara T., Sekine K., Takuma K., Kase K., Sasaki J.

Burns （Burns） 46 （ 5 ） 1201 - 1207 2020年

研究論文（学術雑誌）, 共著, 査読有り, ISSN 03054179

© 2020 Elsevier Ltd and ISBI Background: Strategies to predict delayed airway obstruction in patients with inhalation injury have not been extensively studied. This study aimed to develop a novel scale, predicting the need for Delayed Intubation after inhalation injury (PDI) score. Methods: We retrospectively identified patients with inhalation injury at four tertiary care centers in Japan between 2012 and 2018. We included patients aged 15 or older and excluded those intubated within 30 min after hospital arrival. Predictors for delayed intubation were identified with univariate analyses and scored on the basis of odds ratios. The PDI score was evaluated with the area under the receiver operating characteristic (AUROC) curve and compared with other scaling systems for burn injuries. Results: Data from 158 patients were analyzed; of these patients, 18 (11.4%) were intubated during the delayed phase. Signs of respiratory distress, facial burn, and pharyngolaryngeal swelling observed on laryngoscopy, were identified as predictors for delayed intubation. The discriminatory power of the PDI (AUROC curve = 0.90; 95% confidence interval, 0.83 to 0.97; p < 0.01) was higher than that of the other scaling systems. Conclusions: We developed a novel scale for predicting delayed intubation in inhalation injury. The score should be further validated with other population.

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Delays in Surgical Intervention and Temporary Hemostasis Using Resuscitative Endovascular Balloon Occlusion of the aorta (REBOA): Influence of Time to Operating Room on Mortality

Yamamoto R., Cestero R.F., Muir M.T., Jenkins D.H., Eastridge B.J., Funabiki T., Sasaki J.

American Journal of Surgery （American Journal of Surgery） 220 （ 6 ） 1485 - 1491 2020年

共著, ISSN 00029610

© 2020 Elsevier Inc. Background: The optimal candidates for resuscitative endovascular balloon occlusion of the aorta (REBOA) remain unclear. We hypothesized that patients who experience delays in surgical intervention would benefit from REBOA. Methods: Using the Japan Trauma Databank (2014–2019), patients transferred to the operating room (OR) within 3 h were identified. Patients treated with REBOA were matched with those without REBOA using propensity scores, and further divided based on the transfer time to OR: ≤ 1 h (early), 1–2 h (delayed), and >2 h (significantly-delayed). Survival to discharge was compared. Results: Among 5258 patients, 310 underwent REBOA. In 223 matched pairs, patients treated with REBOA had improved survival (56.5% vs. 31.8%; p < 0.01), although in-hospital mortality was reduced by REBOA only in the delayed and significantly-delayed subgroups (HR = 0.43 [0.28–0.65] and 0.42 [0.25–0.71]). Conclusions: REBOA-treated trauma patients who experience delays in surgical intervention (>1 h) have improved survival.

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Modified abbreviated burn severity index as a predictor of in-hospital mortality in patients with inhalation injury: development and validation using independent cohorts

Yamamoto R., Shibusawa T., Aikawa N., Sasaki J.

Surgery Today （Surgery Today） 51 （ 2 ） 242 - 249 2020年

共著, ISSN 09411291

© 2020, Springer Nature Singapore Pte Ltd. Purpose: The ability to accurately evaluate the severity of inhalation injury can help to optimize patient care. However, there is no accepted severity grading system, especially for inhalation injury. Methods: We screened a multicenter burn registry and included adult patients who required oxygen treatment or mechanical ventilation. After the patient data were divided into development and validation cohorts, missing values were replaced with multiple imputation. Twelve potential predictors were analyzed using multivariate logistic regression to identify prognostic variables for in-hospital mortality and scores were assigned to each predictor based on odds ratios to develop the Modified Abbreviated Burn Severity Index, mABSI. The mABSI was validated using c-statistics and calibration curves. Results: We randomly assigned 1377 and 919 patients to the development and validation cohorts, respectively. Age, self-inflicted injury, cutaneous burn area, and mechanical ventilation requirement were identified as independent predictors, and the mABSI (1–17 scale) was, thus, developed. The mABSI has a high discriminatory power (c-statistic = 0.94; 95% CI 0.92–0.97), and both estimated and observed in-hospital mortalities increased from 1% at score ≤ 5 to almost 100% at score ≥ 14 with linear calibration plots. Conclusions: We developed and validated the mABSI which accurately predicts in-hospital mortality.

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Hospital Preparedness for COVID-19: The Known and The Known Unknown

Kaito Daiki, Matsumura Kazuki, Yamamoto Ryo

Ｔｈｅ　Ｋｅｉｏ　Ｊｏｕｒｎａｌ　ｏｆ　Ｍｅｄｉｃｉｎｅ（The Keio Journal of Medicine） 70 （ 2 ） 25 - 34 2020年

共著, ISSN 0022-9717

<p>In late March 2020, we faced a nosocomial outbreak of novel coronavirus disease 2019 (COVID-19) at Keio University Hospital, Tokyo, Japan. Presently, COVID-19 is an unprecedented worldwide biohazard, and a nosocomial outbreak can occur in any hospital at any time. Therefore, we reviewed the literature regarding hospital preparedness, the initial management of COVID-19, and the surveillance of healthcare workers (HCWs) to find information that would be generally useful for physicians when confronted with COVID-19. In terms of hospital preparedness, each hospital should develop an incident management system and establish a designated multidisciplinary medical team. To initiate case management, COVID-19 should be suspected based on patient symptoms and/or high-risk history and then should be confirmed by viral testing, such as reverse transcription polymerase chain reaction (RT-PCR) analysis. Although some patients will become critically ill, the guidelines for respiratory failure and septic shock for non-COVID-19 cases can be followed for supportive treatment. Antiviral medications should be carefully selected because the available information is confused by the large volume of preprint literature and unreliable data. HCWs who have come into contact with patients with COVID-19 can generate new in-hospital clusters of COVID-19 cases. Quarantine following contact tracking with risk stratification is effective in preventing transmission, and the essentials of medical surveillance include monitoring different types of symptoms, delegation of supervision, and continuation of surveillance regardless of the RT-PCR results. Preparation for COVID-19 is recommended before the first COVID-19 case is encountered.</p>

Hydrogen gas distribution in organs after inhalation: Real-time monitoring of tissue hydrogen concentration in rat

Yamamoto R., Homma K., Suzuki S., Sano M., Sasaki J.

Scientific Reports （Scientific Reports） 9 （ 1 ） 1255 - 1255 2019年12月

研究論文（学術雑誌）, 共著

© 2019, The Author(s). Hydrogen has therapeutic and preventive effects against various diseases. Although animal and clinical studies have reported promising results, hydrogen distribution in organs after administration remains unclear. Herein, the sequential changes in hydrogen concentration in tissues over time were monitored using a highly sensitive glass microsensor and continuous inhalation of 3% hydrogen gas. The hydrogen concentration was measured in the brain, liver, kidney, mesentery fat and thigh muscle of rats. The maximum concentration, time to saturation, and other measurements representing the dynamics of distribution were obtained from the concentration curves, and the results obtained for different organs were compared. The time to saturation was significantly longer (20.2 vs 6.3–9.4 min. P = 0.004 in all cases) and increased more gradually in muscle than in the other organs. The maximum concentration was the highest in liver and the lowest in the kidney (29.0 ± 2.6 vs 18.0 ± 2.2 μmol/L; P = 0.03 in all cases). The concentration varied significantly depending on the organ (P = 0.03). These results provide the fundamentals for elucidating the mechanisms underlying the in vivo favourable effects of hydrogen gas in mammalian systems.

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Epinephrine during resuscitation of traumatic cardiac arrest and increased mortality: A post hoc analysis of prospective observational study

Yamamoto R., Suzuki M., Hayashida K., Yoshizawa J., Sakurai A., Kitamura N., Tagami T., Nakada T., Takeda M., Sasaki J.

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine （Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine） 27 （ 1 ） 74 - 74 2019年08月

研究論文（学術雑誌）, 共著

© 2019 The Author(s). Background: The beneficial effect of epinephrine during resuscitation from out-of-hospital cardiac arrest (OHCA) has been inconclusive, and potential harm has been suggested, particularly in trauma victims. Although no significant improvement in neurological outcomes has been found among resuscitated patients using epinephrine, including trauma patients, the use of epinephrine is recommended in the Advanced Trauma Life Support protocol. Given that the use of vasopressors was reported to be associated with increased mortality in patients with massive bleeding, the undesirable effects of epinephrine during the resuscitation of traumatic OHCA should be elucidated. We hypothesised that resuscitation with epinephrine would increase mortality in patients with OHCA following trauma. Methods: This study is a post-hoc analysis of a prospective, multicentre, observational study on patients with OHCA between January 2012 and March 2013. We included adult patients with traumatic OHCA who were aged ≥15 years and excluded those with missing survival data. Patient data were divided into epinephrine or no-epinephrine groups based on the use of epinephrine during resuscitation at the hospital. Propensity scores were developed to estimate the probability of being assigned to the epinephrine group using multivariate logistic regression analyses adjusted for known survival predictors. The primary outcome was survival 7 days after injury, which was compared among the two groups after propensity score matching. Results: Of the 1125 adults with traumatic OHCA during the study period, 1030 patients were included in this study. Among them, 822 (79.8%) were resuscitated using epinephrine, and 1.1% (9/822) in the epinephrine group and 5.3% (11/208) in the no-epinephrine group survived 7 days after injury. The use of epinephrine was significantly associated with decreased 7-day survival (odds ratio = 0.20; 95% CI = 0.08-0.48; P < 0.01), and this result was confirmed by propensity score-matching analysis, in which 178 matched pairs were examined (adjusted odds ratio = 0.11; 95% CI = 0.01-0.85; P = 0.02). Conclusions: The relationship between the use of epinephrine during resuscitation and decreased 7-day survival was found in patients with OHCA following trauma, and the propensity score-matched analyses validated the results. Resuscitation without epinephrine in traumatic OHCA should be further studied in a randomised controlled trial.

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Impact of cardiopulmonary resuscitation time on the effectiveness of emergency department thoracotomy after blunt trauma

Yamamoto R., Suzuki M., Nakama R., Kase K., Sekine K., Kurihara T., Sasaki J.

European Journal of Trauma and Emergency Surgery （European Journal of Trauma and Emergency Surgery） 45 （ 4 ） 697 - 704 2019年08月

共著, ISSN 18639933

© 2018, Springer-Verlag GmbH Germany, part of Springer Nature. Purpose: Debate remains about the threshold cardiopulmonary resuscitation (CPR) duration associated with futile emergency department thoracotomy (EDT). To validate the CPR duration associated with favorable outcomes, we investigated the relationship between CPR duration and return of spontaneous circulation (ROSC) after EDT in blunt trauma. Methods: A retrospective observational study was conducted at three tertiary centers over the last 7 years. We included bluntly injured adults who were pulseless and required EDT at presentation, but excluded those with devastating head injuries. After multivariate logistic regression identified the CRP duration as an independent predictor of ROSC, receiver operating characteristic curves were used to determine the threshold CPR duration. Patient data were divided into short- and long-duration CPR groups based on this threshold, and we developed a propensity score to estimate assignment to the short-duration CPR group. The ROSC rates were compared between groups after matching. Results: Forty patients were eligible for this study and ROSC was obtained in 12. The CPR duration was independently associated with the achievement of ROSC [odds ratio 1.18; 95% confidence interval (CI) 1.01–1.37, P = 0.04], and the threshold CPR duration was 17 min. Among the 14 patients with a short CPR duration, 13 matched with the patients with a long CPR duration, and a short CPR duration was significantly associated with higher rates of ROSC (odds ratio 8.80; 95% CI 1.35–57.43, P = 0.02). Conclusions: A CPR duration < 17 min is independently associated with higher ROSC rates in patients suffering blunt trauma.

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Self-inflicted burn injury is independently associated with increased mortality in a more economically developed country: A propensity score matching analysis

Yamamoto R., Shibusawa T., Kurihara T., Sasaki J.

Journal of Burn Care and Research （Journal of Burn Care and Research） 40 （ 2 ） 228 - 234 2019年02月

共著, ISSN 1559047X

© American Burn Association 2019. All rights reserved. Self-inflicted burn accounts for considerable morbidity and mortality in more economically developed countries, and there is a substantial debate regarding the pathophysiological relevance between self-inflicted burns and unfavorable outcomes. To validate whether self-inflicted injury is an independent predictor of high mortality regardless of the severity of burn, they conducted a retrospective observational study using the Japan Trauma Data Bank, a nationwide database including over 200 major tertiary care centers. Among 2006 patients with burn who had arrived at collaborating centers between 2004 and 2016, they included patients aged ≥15 years, those who did not present with cardiopulmonary arrest upon arrival, and those who had ≥10 percent total body surface area burns. Patients with missing survival data or unknown mechanism of injury were excluded. In total, 1094 patients were eligible, of whom 222 (20.3 percent) had self-inflicted burns. The patients were divided into the self-inflicted and non-self-inflicted groups, and propensity score was calculated using the demographic information of the patients, injury variables, time from injury to hospital arrival, and other survival predictors. Via a propensity score matching, 98 pairs were selected, and the self-inflicted group had a higher mortality than the non-self-inflicted group (43.9 vs 28.6 percent, hazard ratio = 1.77; 95% confidence interval = 1.10-2.86; P =.02). Inverse probability weighting and multivariate logistic regression were performed as sensitivity analyses, and results validated that self-inflicted burn was independently associated with increased in-hospital mortality. Therefore, patients with self-inflicted burns should receive judicious management, regardless of burn injury severity.

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A novel scoring system to predict the requirement for surgical intervention in victims of motor vehicle crashes: Development and validation using independent cohorts

Yamamoto R., Kurihara T., Sasaki J.

PLoS ONE （PLoS ONE） 14 （ 12 ） e0226282 2019年

研究論文（学術雑誌）, 共著

© 2019 Yamamoto et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Given that there are still considerable number of facilities which lack surgical specialists round the clock across the world, the ability to estimate the requirement for emergency surgery in victims of motor vehicle crashes (MVCs) can ensure appropriate resource allocation. In this study, a surgical intervention in victims of MVC (SIM) score was developed and validated, using independent patient cohorts. Methods We retrospectively identified MVC victims in a nationwide trauma registry (2004–2016). Adults ≥ 15 years who presented with palpable pulse were included. Patients with missing data on the type/date of surgery were excluded. Patient were allocated to development or validation cohorts based on the date of injury. After missing values were imputed, predictors of the need for emergency thoracotomy and/or laparotomy were identified with multivariate logistic regression, and scores were then assigned using odds ratios. The SIM score was validated with area under the receiver operating characteristic curve (AUROC) and calibration plots of SIM score-derived probability and observed rates of emergency surgery. Results We assigned 13,328 and 12,348 patients to the development and validation cohorts, respectively. Age, motor vehicle collision and vital signs on hospital arrival were identified as independent predictors for emergency thoracotomy and/or laparotomy, and SIM score was developed as 0–9 scales. The score has a good discriminatory power (AUROC = 0.79; 95% confidence interval = 0.77–0.81), and both estimated and observed rates of emergency surgery increased stepwise from 1% at a score ≤ 1 to almost 40% at a score ≥ 8 with linear calibration plots. Conclusions The SIM score was developed and validated to accurately estimate the need for emergent thoracotomy and/or laparotomy in MVC victims.

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Resuscitative endovascular balloon occlusion of the aorta (REBOA) is associated with improved survival in severely injured patients: A propensity score matching analysis

Yamamoto R., Cestero R., Suzuki M., Funabiki T., Sasaki J.

American Journal of Surgery （American Journal of Surgery） 218 （ 6 ） 1162 - 1168 2019年

研究論文（学術雑誌）, 共著, 査読有り, ISSN 0002-9610

© 2019 Elsevier Inc. Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique for temporary control of arterial hemorrhage. However, its effectiveness and clinical outcomes are unclear. Methods: Using a nationwide database (2004–2016) in Japan, trauma patients with survival data were identified. Patients were divided between REBOA and non-REBOA groups, and a propensity score was developed using multivariate logistic regression. Survival to discharge was compared between the groups after propensity score matching. Results: Among 82,371 patients included in this study, 385 were treated with REBOA. After propensity score matching, 117 pairs were selected. Survival to discharge was significantly higher among patients treated with REBOA than among those treated without REBOA (53 [45.3%] vs. 38 [32.5%]; odds ratio = 1.72; 95% CI = 1.01–2.93; p = 0.04). Conclusions: REBOA use was associated with improved survival to discharge and should therefore be considered during the management of severely injured trauma patients.

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Damage control orthopedics and decreased in-hospital mortality: A nationwide study

Yamamoto R., Udagawa K., Nishida Y., Ono S., Sasaki J.

Injury （Injury） 50 （ 12 ） 2240 - 2246 2019年

研究論文（学術雑誌）, 共著, ISSN 00201383

© 2019 Introduction: While various strategies of fracture fixation in trauma victims have been discussed, the effect of damage control orthopedics (DCO) on significant clinical outcome is inconclusive. We examined the mortality of patients managed with DCO, comparing those without DCO, using a nationwide trauma database. Patients and Methods: We retrospectively identified patients with extremity injury, defined as patients with an Abbreviated Injury Scale (AIS) of ≥2 in an upper or lower extremity, in the database that included more than 200 major hospitals from 2004 to 2016. We included those who were age ≥15 years and underwent ORIF. Patients with missing survival data or invalid vital signs at hospital arrival were excluded. Patient data were divided into DCO or non-DCO groups, and propensity scores were developed to estimate the probability of being assigned to the DCO group, using multivariate logistic regression analyses adjusted for known survival predictors, such as age, vital signs at arrival, Abbreviated Injury Scale in extremity, ISS, presence of vascular injury, surgical procedure before fracture treatment, and transfusion requirement. The primary outcome, in-hospital mortality, was compared between the two groups after propensity score matching. Survival analyses were performed, and hazard ratio was adjusted according to age, systolic blood pressure on arrival, and Injury Severity Score. Results: Of the 19,319 patients included in this study, 4407 (22.8%) underwent DCO. After the propensity score matching, 3858 pairs were selected. In-hospital mortality was significantly lower among patients in the DCO than those in the non-DCO groups (40 [1.0%] vs. 66 [1.7%]; odds ratio = 0.60; 95% confidence interval [CI] = 0.41–0.89; P = 0.01). Survival analyses showed that DCO was independently associated with decreased mortality in patients with extremity injury (adjusted hazard ratio = 0.30; 95% CI = 0.20–0.46; P < 0.01). Conclusions: DCO was associated with decreased in-hospital mortality in patients with major fractures. Further clinical study on DCO by selecting patient population should be considered eventually to develop an appropriate strategy for major fractures.

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Early Complications Following Facial Laceration Repair Performed by Emergency Physicians After One Year of Wound Closure Training.

Yamamoto R, Homma K, Masuzawa Y, Shimizu C, Ogata T, Hori S, Sasaki J

AEM education and training （AEM Education and Training） 2 （ 4 ） 259 - 268 2018年10月

共著

© 2018 by the Society for Academic Emergency Medicine Objective: Facial lacerations, which are common in the emergency department, have usually been repaired by non–facial trauma specialists, such as emergency physicians. Given the ongoing discussion regarding quality assurance or the optimal training model on facial laceration repair for nonspecialists, we sought to determine the impact of a 1-year wound closure training provided to emergency physicians. We hypothesized a decrease in early complications following facial wound closure after the training. Methods: A retrospective observational study was conducted between 2013 and 2015 at an academic center. We included patients with isolated facial lacerations that were repaired by emergency physicians and reviewed by board-certified plastic surgeons during a follow-up visit. Patients whose wounds were not reviewed within 3 days were excluded. The 1-year training curriculum, which consisted of several sessions of lecture, hands-on practice, and case review, had been developed by a multidisciplinary team and provided to emergency physicians. Patient data were divided between nonparticipant and participant groups, and a propensity score was developed to estimate the probability of being assigned to the participant group. The incidence of early complications, defined as the need for additional suturing or resuturing due to wound dehiscence, was compared among the groups after propensity score matching. Results: Although 132 patients satisfied all the inclusion criteria, 11 were excluded due to delayed initial wound review. Among the 70 patients who were eventually included in the participant group, 40 were matched with those in the nonparticipant group. The incidence of early complications was significantly lower in the participant group than in the nonparticipant group (5.0% vs. 20.0%, odds ratio = 0.21, 95% confidence interval = 0.07–0.61, p = 0.04). Conclusions: The 1-year training provided to emergency physicians reduced the incidence of early complications following facial laceration repair. Accordingly, future wound closure training models should consider the 1-year training curriculum presented herein.

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Rapid decay of transthoracic echocardiography skills at 1 month: A prospective observational study

Yamamoto R., Clanton D., Willis R., Jonas R., Cestero R.

Journal of Surgical Education （Journal of Surgical Education） 75 （ 2 ） 503 - 509 2018年03月

研究論文（学術雑誌）, 共著, ISSN 19317204

© 2017 Association of Program Directors in Surgery Objective: Focused transthoracic echocardiography (FTTE) is an emerging tool in the management of critically ill patients, but the lack of adequate training models has limited the expansion of this technology. Although basic FTTE training courses have been shown to be sufficient in developing echocardiography skills, limited data exist regarding skill retention. In an effort to develop an adequate FTTE training model, we sought to determine the degree of skill retention after FTTE training. Design: A prospective, observational study. Setting: An academic center. Participants: Surgical residents and medical students: 31 subjects were enrolled from February to June 2016. Results: Participants underwent a 2-hour FTTE course including didactics and a hands-on session measuring ejection fraction of left ventricle (LV) and inferior vena cava (IVC) diameter. Written knowledge and performance examinations applying FTTE were conducted before the course, immediately after, and at 1- and 3-month intervals, which were evaluated on a 0 to 9 scale and analyzed with paired t-tests. Performance examination scores obtaining the LV and IVC views preinitial and postinitial training increased from 1.7 to 6.5 (LV) and from 2.0 to 6.8 (IVC) (p < 0.01), decreased to 5.0 and 4.8, respectively, at 1 month (posttraining vs 1 month, p < 0.01), and did not significantly change at 3 months (5.4 and 5.0, respectively). Written examination scores increased from 42% to 62% (pretraining vs posttraining, p < 0.01), decreased to 48% in 1 month (posttraining vs 1 month, p < 0.01), and further decreased to 34% at 3 months (1 month vs 3 month, p < 0.01). Conclusions: Although a short training course appears sufficient to impart basic FTTE skills and knowledge, skills are significantly decayed at 1 month and knowledge continually decreases at 1 and 3 months. Future FTTE training models should consider the rapid degradation of knowledge and skills in determining frequency of refresher training and ongoing evaluation.

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Colon Trauma: Evidence-Based Practices

Yamamoto R., Logue A., Muir M.

Clinics in Colon and Rectal Surgery （Clinics in Colon and Rectal Surgery） 31 （ 1 ） 11 - 16 2018年01月

共著, ISSN 15310043

© 2018 by Thieme Medical Publishers, In. Colon injury is not uncommon and occurs in about a half of patients with penetrating hollow viscus injuries. Despite major advances in the operative management of penetrating colon wounds, there remains discussion regarding the appropriate treatment of destructive colon injuries, with a significant amount of scientific evidence supporting segmental resection with primary anastomosis in most patients without comorbidities or large transfusion requirement. Although literature is sparse concerning the management of blunt colon injuries, some studies have shown operative decision based on an algorithm originally defined for penetrating wounds should be considered in blunt colon injuries. The optimal management of colonic injuries in patients requiring damage control surgery (DCS) also remains controversial. Studies have recently reported that there is no increased risk compared with patients treated without DCS if fascial closure is completed on the first reoperation, or that a management algorithm for penetrating colon wounds is probably efficacious for colon injuries in the setting of DCS as well.

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鈍的外傷による心肺停止患者に対する救急室開胸の適応に関する検討

山元良, 中間楽平, 加瀬建一, 関根和彦, 栗原智宏, 佐々木淳一

日本救急医学会雑誌（(一社)日本救急医学会） 28 （ 9 ） 454 - 454 2017年09月

査読有り, ISSN 0915-924X

SSCG（surviving sepsis campaign guidelines）2016．

山元良, 藤島清太郎

Thrombosis Medicine （先端医学社）（ 4 ） 85 - 88 2017年

腹部緊急手術を施行した敗血症性DIC症例に関する検討

山元良, 篠崎浩治, 加瀬建一, 小林健二

日本腹部救急医学会雑誌（Japanese Society for Abdominal Emergency Medicine） 35 （ 3 ） 195 - 200 2015年

ISSN 1340-2242

トロンボモジュリン製剤である遺伝子組換え型ヒトトロンボモジュリンは，敗血症性DICの治療薬として近年注目されてきているが，腹部緊急手術後の使用に注目した研究は少ない。そこで，当院で過去約3年間に経験した腹部緊急手術を要した敗血症性DIC症例を対象に，同製剤の使用と周術期の治療成績を後方視的に検討した。投与群24例，非投与群19例であり，投与群でAPACHE Ⅱ scoreが有意に高く (p＝0.02），術後ICU入室率，人工呼吸器使用率が高かった (p＜0.001，p＝0.004）。出血性合併症や死亡率に有意差はなく，投与群では敗血症性DIC診断後の新鮮凍結血漿の投与量が少なかった (p＝0.02）。以上により，同製剤は腹部緊急手術の周術期でも安全に使用できることが確認され，敗血症性DIC診断後の輸血量を減らせる可能性が示唆された。

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大動脈遮断バルーンカテーテル(IABO)による重症外傷症例の救命率向上と合併症対策

折田智彦, 船曳知弘, 山崎元靖, 清水正幸, 松本松圭, 豊田幸樹年, 山元良, 佐久間淳, 風巻拓, 山根隆, 井上征雄, 松坂陽至, 北野光秀

IVR: Interventional Radiology （(一社)日本インターベンショナルラジオロジー学会） 28 （ Suppl. ） 177 - 177 2013年04月

ISSN 1340-4520

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