2019 Fiscal Year Final Research Report

The study of shock states using microcirculation or vascular endothelium as relevant indices

Research Project

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Project/Area Number	16K10948
Research Category	Grant-in-Aid for Scientific Research (C)
Allocation Type	Multi-year Fund
Section	一般
Research Field	Anesthesiology
Research Institution	Tokyo Women's Medical University
Principal Investigator	Komori Makiko 東京女子医科大学, 医学部, 教授 (60178332)
Co-Investigator(Kenkyū-buntansha)	西山圭子東京女子医科大学, 医学部, 准教授 (00155532) 冨澤康子東京女子医科大学, 医学部, 助教 (00159047) 市川順子東京女子医科大学, 医学部, 講師 (60318144) 小高光晴東京女子医科大学, 医学部, 臨床教授 (90280635)
Project Period (FY)	2016-04-01 – 2020-03-31
Keywords	微小循環 / ショック / 輸液蘇生
Outline of Final Research Achievements	The effects of hydroxyethyl starch (HES) on microcirculation, central venous oxygen saturation (ScvO2), and the central venous-to-arterial carbon dioxide gap (dCO2) are studied in a rabbit model of hemorrhagic shock for elucidating the advantages and drawbacks of resuscitation with HES compared with crystalloids.　An ear chamber and sublingual mucosa were used to examine blood vessels by intravital microscopy. Hemorrhagic shock was induced by removing nearly half of the blood volume. Rabbits received 100 mL of HES by intravenous infusion after blood letting. The other rabbits (control) were intravenously given 200 mL of normal saline solution (NSS). Evaluation of the effects of the fluid therapy on the microcirculation, ScvO2, and dCO2 in a rabbit model of hemorrhagic shock showed that the intravenous infusion of HES maintains the peripheral circulation, adequate tissue oxygenation and perfusion better than does NSS infusion.
Free Research Field	麻酔科
Academic Significance and Societal Importance of the Research Achievements	兎急性大量出血モデルの輸液蘇生において、膠質液である中分子量ヒドロキシエチルデンプン(HES)を用いた場合の微小循環（兎舌下粘膜の毛細血管血流、兎耳透明窓の細動脈血流）、中心静脈血酸素飽和度(ScvO2)、中心静脈血と動脈血の二酸化炭素分圧較差（dCO2）について、晶質液と比較検討した。急性大量出血時の輸液蘇生で中分子量HESは生食に比し、血圧、ScvO2、dCO2、微小循環動態に改善がみられた。微小循環が維持できないと、臓器への血流が絶たれ、多臓器不全に陥る。これを予防するには微小循環を維持し、ショック状態を改善することが重要である。