2023 Fiscal Year Final Research Report
Elucidation of the hemodynamics of the vena cava system during inferior vena cava and aorta occlusion
| Project/Area Number |
20K17904
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| Research Category |
Grant-in-Aid for Early-Career Scientists
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| Allocation Type | Multi-year Fund |
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| Review Section |
Basic Section 55060:Emergency medicine-related
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| Research Institution | Jichi Medical University |
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Principal Investigator |
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| Project Period (FY) |
2020-04-01 – 2024-03-31
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| Keywords | 肝背側下大静脈損傷 / IVC損傷 / 静脈還流 / 大動脈遮断バルーン / REBOA / Phase contrast MRI / IVC遮断 |
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| Outline of Final Research Achievements |
Retrohepatic vena cava injury is highly lethal and requires prompt procedures for temporary hemostasis. We used a porcine shock model under general anesthesia to investigate the great venous hemodynamic changes during Resuscitative endovascular aortic balloon occlusion (REBOA) and inferior vena cava (IVC) occlusion. A REBOA was placed in zone one, and Rummel tourniquets were set up at the level of the proximal and distal sides of the liver in the IVC. After drawing 20% of the total blood volume, we measured the superior vena cava and IVC blood flow by phase contrast MRI and vital signs. Vital signs improved with REBOA alone, but venous return did not improve. Vital signs did not improve and the amount of venous return decreased significantly with REBOA and IVC occlusion combined. REBOA can avoid temporary cardiac arrest, but it does not improve venous return. Treatment interventions that do not reduce venous return will be required in conjunction with REBOA.
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| Free Research Field |
外傷 外傷外科 外傷手術 外傷手術シミュレーション教育
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| Academic Significance and Societal Importance of the Research Achievements |
これまで出血性ショックに対して行われるREBOAとIVC遮断を同時に行った場合の大静脈の血行動態変化を観察した研究は殆ど見当たらない。本研究の成果は、大静脈系の止血と循環動態の維持を両立する優れた止血方法を切り開くうえで、その基礎をなす外科的介入時の大静脈循環の変化を解明することに学術的な意味がある。
また、肝背側下大静脈損傷による出血に対して下大静脈クランプやREBOA等の外科的止血介入が行われる際に、大静脈系の血行動態や心拍出量の変化を解明することで、肝背側下大静脈損傷に対する有効な止血方法が開発され患者救命に貢献する可能性がある。
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