@article{oai:twinkle.repo.nii.ac.jp:00019981,
 author = {TAKESHIGE, Tetsu and YAGUCHI, Arino and HANAFUSA, Shigeki and HARADA, Tomoyuki and SUZUKI, Tadashi},
 issue = {10/11},
 journal = {東京女子医科大学雑誌},
 month = {Nov},
 note = {PMX-DHP (direct hemoperfusion with polymyxin B immobilized fiber)は1994年にエンドトキシン吸着療法として日本で認可された治療法であり,現在敗血症症例を中心に広く臨床応用されているが,その臨床的有効性の評価および機序については今も議論のあるところである.筆者らは当センターでPMX-DHPを施行した敗血症症例に対し,近赤外線法(NIRS)を用いて測定可能なcytochrome a,a3 (Cyt a,a_3),酸化ヘモグロビン(Oxy-Hb),還元型ヘモグロビン(Deoxy-Hb),総ヘモグロビン(Total Hb)をPMX-DHP前後で比較することにより,細胞レベルでの組織酸素代謝と血液量の再分布の変化を検討した.対象は東京女子医科大学救命救急センター集中治療室に入室し,PMX-DHPを施行した18症例である.近赤外線装置は前額部,前腕部の2ヵ所に装着し,PMX-DHPを中心に約3時間連続して計測した.また,全身の組織酸素代謝の指標としてSwan-Ganz catheterを使いVO_2 (oxygen consumption), DO_2 (oxygen delivery), O_2EI (oxygen extraction index), SVRI (systemic vascular resistance index), SvO_2 (mixed venous oxygen saturation)を測定し,血液検査からはblood lactate concentration, base excess, IL-6を測定した.前腕部の近赤外線法による結果はPMX-DHP前後でCyt a, a_3(p<0.05), Oxy-Hb (p<0.01), Deoxy-Hb(p<0.05), TotalHb (p<0.01),すべてに有意差をもって増加した.前額部の前頭葉の近赤外線法による結果は,PMX-DHP前後でCyt a,a_3, Oxy-Hbに変化はなく,Deoxy-Hb (p<0.01), TotalHb (p<0.01)は,有意差をもって減少した.また,VO_2, DO_2, O_2EI, SVRI, SvO_2, blood lactate concentration, base excess, IL-6はPMX-DHPの前後での有意差は認めなかった.結論としてPMX-DHPにより全身の組織酸素代謝の指標に変化を認めなかった.しかし近赤外線法による測定結果は前腕骨格筋での血液量は増加し,さらにミトコンドリア内における電子伝達系の酸素代謝は亢進した.また前頭葉の血液量の分布はPMX-DHPにより改善された.これらの結果はPMX-DHPの有効性を示唆していると考えられた., Near-infrared spectroscopy (NIRS) is a continuous, non-invasive measurement to relatively evaluate tissue oxygen delivery and cellular aerobic metabolism. In the present study, to more understand the therapeutic efficacy of direct hemoperfusion with polymixin B-immobilized fibers (PMX-DHP), we investigated changes of tissue oxygenation by using NIRS and compared before and after PMX-DHP treatment. We measured oxygenated hemoglobin (Oxy-Hb), deoxygenated hemoglobin (Deoxy-Hb), total hemoglobin (Total Hb) and cytochrome a,a_3 (Cyt a,a_3) at forehead and forearm using NIRS. Data obtained by using a Swan-Ganz catheter was used to derive systemic VO_2 (oxygen consumption), DO_2 (oxygen delivery), O_2EI (oxygen extraction index), SVRI (systemic vascular resistance index) and SvO_2 (mixed venous oxygen saturation). At forearm, Cyt a,a_3 significantly increased after PMX-DHP (p<0.05). At forehead, there were no changes of Cyt a,a_3 (p=0.39) between before and after PMX-DHP. And there were no significant changes in VO_2, DO_2, O_2EI, SVRI, SvO_2 blood lactate concentration, base excess and IL-6. After PMX-DHP treatment, Oxy-Hb, Deoxy-Hb, Total Hb and Cyt a,a_3 increased at the forearm. But at forehead, Cyt a,a_3 was unchanged. This result suggests PMX-DHP could increase blood volume and tissue oxygen metabolism in skeletal muscles in septic shock.},
 pages = {400--409},
 title = {Evaluation of Changes in Oxygenation by Near Infrared Spectroscopy during Direct Hemoperfusion with Polymyxin B Immobilized Fibers},
 volume = {76},
 year = {2006}
}