Hemodynamics management using cerebral autoregulation monitoring in patients undergoing cardiovascular surgery

2022 Fiscal Year Final Research Report

• Project/Area Number: 18K16400
• Research Category: Grant-in-Aid for Early-Career Scientists
• Allocation Type: Multi-year Fund
• Review Section: Basic Section 55030:Cardiovascular surgery-related
• Research Institution: Jichi Medical University
• Principal Investigator: Hori Daijiro 自治医科大学, 医学部, 准教授 (90742461)
• Project Period (FY): 2018-04-01 – 2023-03-31
• Keywords: 脳自動調整能 / 人工心肺 / 周術期管理 / 血管内皮機能 / 脈波伝播速度 / 至適血圧 / 心臓大血管手術 / バイオマーカー

Outline of Final Research Achievements

An evaluation method for "optimal blood pressure", which delivers sufficient blood flow to the major organs during cardiovascular surgery, has not yet been established. In this study, we evaluated optimal blood pressure in individual patients based on changes in cerebral blood flow and blood pressure. We further examined factors associated with optimal blood pressure.
Hemodynamic management below the optimal blood pressure was associated with higher incidence of acute kidney injury after surgery. Factors associated with lower limit of optimal blood pressure included vascular stiffness and vascular function. Further, vascular stiffness and vascular function were associated with incidence of acute kidney injury after surgery. Preoperative measurement of vascular function to evaluate the risk for acute kidney injury and hemodynamic management based on optimal blood pressure may provide therapeutic approach to prevent major organ dysfunction after cardiovascular surgery.

Free Research Field

心臓血管外科

Academic Significance and Societal Importance of the Research Achievements

心臓大血管手術の多くは人工心肺装置を使用し、手術中心臓を停止させるなど侵襲度が高い手術となる。重要臓器への負担も多く、脳梗塞や腎機能障害、腸管不全などの合併症も散見される。これら合併症の予防策として術前の危険因子の評価、そして周術期においては重要臓器に十分な血流を確保できる血圧管理が必要である。重要臓器に十分な血流を確保できる「至適血圧」の評価法がない中、当研究では脳の血流を一定に保つ血圧管理が術後腎機能障害の発症も低減させることが証明された。また血管の硬さや血管機能、血管の炎症も術後腎機能障害と関連しており重要な評価項目であることが明らかとなった。