1993 Fiscal Year Final Research Report Summary
The study of pathophysiology and treatment in multiple organ failure with hepatic failure caused by sepsis
| Project/Area Number |
03670719
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| Research Category |
Grant-in-Aid for General Scientific Research (C)
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| Allocation Type | Single-year Grants |
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| Research Field |
麻酔学
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| Research Institution | Chiba University |
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Principal Investigator |
OHTAKE Yoshio Chiba University School of Medicine assistant, 医学部・附属病院, 助手 (50194189)
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| Co-Investigator(Kenkyū-buntansha) |
ODA Shigeto Chiba University School of Medicine assistant, 医学部・附属病院, 助手 (90204205)
SUGAI Takao Chiba University School of Medicine instructor, 医学部・附属病院, 講師 (10187627)
HIRASAWA Hiroyuki Chiba University School of Medicine assistant professor, 医学部・附属病院, 助教授 (80114320)
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| Project Period (FY) |
1991 – 1993
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| Keywords | sepsis induced multiple organ failure / hapatic failure / hapatic cellular energy metabolism / systemic energy metabolism / mediator / plasma exchange / continuous gemofiltration(CHF) / continuous hamodiafiltraion(CHFD) |
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| Research Abstract |
The present study was undertaken to investigate systemic and hepatic energy metabolism in sepsis induced multiple organ failure with hepatic failure(MOF) and compare them with those in fulminant pepatitis(FH). MOF patients suffer from systemic cellular damages wheres in FH ratients the celluler damage is rather linited to within the liver. MOF patients showed typermetabolism. There was a significant positive correlation between AKBR and RQ.As energy substrate, fat was used in MOF patients even though extrinsic fat was not administrated. On the other hand glucose was used in FH patients even thouht the values of AKBR was below 0.7. These results indicate that there was a significant difference in energy metabolism between MOF patients and FH patients even when they show the same mulue of AKBR.Therefore we shoule select the volume of calory and energy srbstrates administered according to the values of AKBR, total ketone body, pyruvate/lactate, RQ, energy expenditure and exergy metabolic rates.
Plasma exchange(PE) can not only supply cagulation factors. albumin and opsonic proteins, but also remove umdesirable substances such as hepatic toxins. In addition to them, PE sould improve hepatic cellular energy metabolism. Continuous henodiafiltration (CHDF) has been a requisite tool for anuric critically ill patients as an artificial kidney. Pn the other hand, CHDF cluld not only remove mediators, but also improve hapatic encephalopathy. Therefore the combination therapy with PE and CHDF has been applied to the patients with FH.The combination therapy with PE and CHDF could not significanly improve the survival rate of FH compared to that with conventional therapy using PE alone, but CHDF could significantly improve hepatic encephalophthy. These result indicate that CHDF can be applied as an artificial liver support.
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