| Project/Area Number |
17591655
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Single-year Grants |
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| Section | 一般 |
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| Research Field |
Anesthesiology/Resuscitation studies
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| Research Institution | Kurume University |
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Principal Investigator |
WATANABE Seiji KURUME UNIVERSITY, MEDICINE, ASSOCIATE PROFESSOR, 医学部, 助教授 (10201196)
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| Co-Investigator(Kenkyū-buntansha) |
HIRAKI Teruyuki KURUMEUNIVERSITY, MEDICINE, ASSITANT, 医学部, 助手 (30320237)
UEDA Nobuhide KURUMEUNIVERSITY, MEDICINE, ASSITANT, 医学部, 助手 (80373140)
KANO Tatsuhiko KURUME UNIVERSITY, MEDICINE, PROFESSOR, 医学部, 教授 (50040605)
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| Project Period (FY) |
2005 – 2006
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| Project Status |
Completed (Fiscal Year 2006)
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| Budget Amount *help |
¥3,600,000 (Direct Cost: ¥3,600,000)
Fiscal Year 2006: ¥1,100,000 (Direct Cost: ¥1,100,000)
Fiscal Year 2005: ¥2,500,000 (Direct Cost: ¥2,500,000)
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| Keywords | pulmonary embolism / perfusion lung scinchigraphy / multi detector CT / transesophageal echocardiography / postoperative complications / total hip arthroplasty / bone cement / 巨大塞栓子 / 経食道超音波検査 / MDCT / 肺血流シンチ / 肺血管内皮障害 / 二次血栓塞栓症 |
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| Research Abstract |
Pulmonary embolism (PE) is a well known complication of total hip arthroplasty (THA), and can lead to sudden death or severe cardiopulmonary impairment. Recent studies using transesophageal echocardiography (TEE) have clearly detected variable echogenic events, such as snowstorm and/or macro emboli in the bloodstream flowing into the right atrium (RA) in 90-98% of THA patients. The size of echogenic macro emboli was considerably large enough to plug into the lobar or segmental pulmonary vessels. Therefore, echogenic macro emboli detected by TEE might cause the acute development of PE during and following the procedure of THA. TEE has revealed a high incidence of the occurrence of echogenic macro embolic phenomena during THA with bone cement. However, it is still unknown whether intraoperative macro echogenic emboli crucially cause the pulmonary embolism (PE) on the day of surgery (POD0) in the THA patients. Methods. Intraoperative TEE images were continuously recorded by tape and the e
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chogenic events were evaluated throughout surgery. Forty two patients with the positive detection of macro echogenic emboli during surgery were enrolled in this study. The occurrence of the postoperative PE was confirmed by multi-detector computed tomography (MDCT) or perfusion lung scintigraphy (PLS). MDCT with contrast medium was performed on POD0 after the termination of surgery (MDCT group, n=22). Results. None of the patients in MDCT group presented the existence of PE on POD0. Hemodynamics and respiratory parameters including heart rate, arterial blood pressure, end-tidal carbon dioxide and oxygen saturation of peripheral artery did not differ between groups throughout the study. Each grading score of intraoperative TEE findings including the amount of echogenic particles in right atrium, the longest time of echogenesis, and the diameter and mean density of the largest echogenic particles did not differ between two groups. Conclusion Intraoperative echogenic macro emboli were not direct source of the obstruction of large pulmonary vasculature in the patients undergoing THA with bone cement on POD0. The secondary thrombi formation might cause the obstructions of pulmonary vasculature on POD1. Less
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