| Project/Area Number |
21K09039
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Multi-year Fund |
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| Section | 一般 |
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| Review Section |
Basic Section 55060:Emergency medicine-related
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| Research Institution | Chiba University |
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Principal Investigator |
Hayashi Yosuke 千葉大学, 大学院医学研究院, 特任助教 (60867266)
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| Co-Investigator(Kenkyū-buntansha) |
松村 洋輔 千葉大学, 大学院医学研究院, 特任助教 (00466707)
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| Project Period (FY) |
2021-04-01 – 2024-03-31
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| Project Status |
Completed (Fiscal Year 2023)
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| Budget Amount *help |
¥4,160,000 (Direct Cost: ¥3,200,000、Indirect Cost: ¥960,000)
Fiscal Year 2023: ¥390,000 (Direct Cost: ¥300,000、Indirect Cost: ¥90,000)
Fiscal Year 2022: ¥1,560,000 (Direct Cost: ¥1,200,000、Indirect Cost: ¥360,000)
Fiscal Year 2021: ¥2,210,000 (Direct Cost: ¥1,700,000、Indirect Cost: ¥510,000)
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| Keywords | REBOA / IRI / Partial REBOA / organ perfusion / Occlusion tolerance / 出血性ショック / Post-REBOA IRI / % balloon volume / 血液浄化 / サイトカイン吸着 |
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| Outline of Research at the Start |
近年，難治性出血性ショックや心停止に対する蘇生手段としてREBOAが普及してきた.しかし遮断強度・遮断時間とIRIの重症度の関係や，有効な治療についての検証はなく，今後の課題である．Post-REBOA IRIに対する血液浄化療法を用いたPost-REBOA IRIの制御法確立が本研究の目的である.生体ブタ出血性ショックモデルにおけるPost-REBOA IRIのバイオマーカー測定, それに基づきサイトカイン吸着能の有無で分けた3種類の血液浄化膜による血液浄化療法の効果を検証する.
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| Outline of Final Research Achievements |
A phlebotomy was performed to induce hemorrhagic shock. The REBOA catheter was placed in the thoracic aorta to maintain the balloon position in zone 1 and fixed. Total REBOA was performed on both the continuous renal replacement therapy (CRRT) (n=4) and control (n=4) groups for 90 min after hemorrhagic shock induction. CRRT treatment was performed immediately before REBOA deflation until 3 h later.
Two swine in the CRRT group and one in the control group survived; no significant differences were observed in survival rates between the groups (p=0.45). Although there were no significant differences in the transition of biomarkers and histopathological grades between the groups, the CRRT group showed a tendency to increase pH and base excess, decrease lactate, lower elevation of potassium and cytokine levels, and lower intestine histopathological grade than the control group. CRRT may mitigate acute-REBOA-related ischemia-reperfusion injury by controlling biomarkers.
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| Academic Significance and Societal Importance of the Research Achievements |
出血性ショックの蘇生で用いられるREBOAは動脈性出血の制御と中枢臓器灌流維持が期待される．一方，遠位臓器虚血や虚血再灌流障害といった合併症を来しうるが，その有効な治療についての検証はこれまでなかった．
本研究では統計学的有意差は示せなかったが，代謝性アシドーシスやカリウム，サイトカインを含むバイオマーカーの制御，腸管ダメージの軽減といった血液浄化療法の有効性を示唆した点に学術的意義がある．また追加検証が必要だが，血液浄化療法は類似病態ですでに一般的な治療法で臨床応用が容易である．血液浄化療法の効果を明確化できれば難治性出血性ショック患者の救命や機能温存予後改善に貢献でき，社会的意義は大きい．
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