| Japanese |
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| Title | 食道癌根治術々後管理における動脈圧波形解析法の有用性について―一回拍出量変化を中心に― |
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| Subtitle | 症例 |
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| Authors | 笠置益弘*, 山口敬介*, 竹内和世*, 岩沼佳見**, 梶山美明**, 鶴丸昌彦**, 釘宮豊城*, 稲田英一* |
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| Authors(kana) | |
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| Organization | *順天堂大学医学部麻酔科学・ペインクリニック講座, **順天堂大学医学部上部消化管外科学講座 |
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| Journal | 循環制御 |
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| Volume | 32 |
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| Number | 1 |
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| Page | 26-31 |
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| Year/Month | 2011/4 |
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| Article | 報告 |
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| Publisher | 日本循環制御医学会 |
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| Abstract | 「はじめに」食道癌根治手術は, 開胸開腹術と広範囲なリンパ節郭清を必要とする最も侵襲の大きな手術の一つである. 近年の低侵襲手術の導入や高サイトカイン血症対策により, 手術の安全性は向上した. しかし, 患者は高齢のことが多く, 基礎疾患に心血管系や呼吸器合併症をもつだけでなく, 術前の喫煙, 栄養状態の不良な場合も多い. また, 縦隔郭清や胸管合併切除が施行された場合, 術後血管外スペースへの体液喪失が著明となり, 循環血液量の不足による高度な脱水が長時間持続することにより臓器潅流圧が低下し, 臓器不全を惹起させる誘因となる. 一方, 過剰輸液による循環血液量過多は, うっ血性心不全や肺合併症の原因となり, 術後の予後を左右する因子となる. 食道癌根治術のような体液シフトが大きい手術を受ける高齢者においては輸液管理を慎重に行う必要がある. 従来, 術後輸液管理の指標には, 観血的動脈圧測定(arterial blood pressure: ABP)や心拍数(heart rate: HR), 中心静脈圧(central venous pressure: CVP), 尿量, 尿比重などから総合的に循環血液量を推察してきたが, 客観的に測定した報告は少ない1)2). |
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| Practice | 基礎医学・関連科学 |
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| Keywords | spontaneous respiration, stroke volume variation: SVV, esophagectomy, arterial pressure wave analysis, perioperative management |
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| English |
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| Title | Usefulness of Arterial Pressure-Based Cardiac Output (APCO) and Stroke Volume, Variation (SVV) to Determine Fluid Therapy in the Perioperative Period of Esophagogastrectomy |
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| Subtitle | |
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| Authors | Yoshihiro Kasagi*, Keisuke Yamaguchi*, Kazuyo Takeuchi*, Yoshimi Iwanuma**, Yoshiaki Kajiyama**, Masahiko Tsurumaru**, Toyoki Kugimiya*, Eiichi Inada* |
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| Authors(kana) | |
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| Organization | *Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, **Department of Esophageal and Gastroenterological Surgery, Juntendo University School of Medicine |
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| Journal | Circulation Control |
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| Volume | 32 |
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| Number | 1 |
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| Page | 26-31 |
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| Year/Month | 2011/4 |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control in Medicine |
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| Abstract | The aim of this study was to assess the usefulness of an arterial pressure-based cardiac output (APCO) monitoring system in the postperative management of patients undergoing esophagectomy. The FloTrac monitor (Edwards Lifescience) was used in three extubated patients who underwent radical operation for transthoracic esophagectomy with three field lympho node resection. Stroke volume variation, calculated for each respiratory cycle and displayed on the Vigileo monitor, could predict intravascular hypovolemia. It is suggested that the Vigileo monitor with FloTrac is an accurate predictor of intravascular hypovolemia and is a useful indicator for assessing the appropriateness and timing of applying fluid for improving circulatory stability during the postperative period of esophagectomy under spontaneous respiration. |
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| Practice | Basic medicine |
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| Keywords | spontaneous respiration, stroke volume variation: SVV, esophagectomy, arterial pressure wave analysis, perioperative management |
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