著者

新井 達潤

出版者

Okayama Medical Association

雑誌

岡山医学会雑誌 (ISSN:00301558)

巻号頁・発行日

vol.89, no.1-2, pp.21-36, 1977-02-28 (Released:2009-03-30)

参考文献数

59

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Ventricular fibrillation was induced in fifteen monkeys by electric stimulation using a bipolar intracardiac pacemaker electrode which was inserted through a femoral vein. The monkeys were defibrillated and resuscitated after several minutes. Cerebral blood flow (CBF), intracranial pressure (ICP) and EEG were monitored continuously. CBF autoregulation was checked regularly before and after ventricular fibrillation to study the relation between it and other parameters such as CBF, ICP, EEG.Fifteen monkeys were divided into two groups, a burr-hole group and a no burr-hole group. ICP was measured in the burr-hole group (10 monkeys). The purpose of having two groups was to ascertain the effect of a burr-hole (artificial injury in the skull and dura) on the parameters CBF, EEG and autoregulation. CBF was measured with electromagnetic flowmeter at internal carotid artery.The conclusion of the experiment was as follows;(1) Autoregulation was lost in all monkeys after resuscitation. In the monkeys which had had autoregulation before cardiac arrest, the autoregulation recovered in three (no burr-hole group) to five (burr-hole group) hours after resuscitation, if resuscitation took place within five minutes. In the monkeys whose autoregulation had already been lost before cardiac arrest, it did not return despite successful cardiac resuscitation.(2) Immediately after resuscitation, BP, ICP and CBF increased for 20-60 minutes. In the monkeys who had no recovery of autoregulation after resuscitation, the rate of increase of ICP was much larger than those whose autoregulation recovered, and at the peak of ICP, the CBF decreased. Impairment of autoregulation itself, indicates that the ballance of circulatory dynamics of the brain is easily impaired by noxious stimulation such as hypoxia.(3) In the monkeys with recovery of autoregulation, general status was good after resuscitation but in the monkeys without recoverey, symptomes of increased ICP were seen and the prognosis was poor.(4) Six minutes of cardiac arrest would appear to be the upper limit for monkeys to survive after resuscitation.(5) Before ventricular fibrillation, corresponding changes in the CBF and the frequency of the EEG wave recorded, but after resuscitation the frequency of the EEG wave decreased despite an increase in CBF. This is probably the same mechanism as occures in the “luxury perfusion syndrome”.There was no relation between EEG and autoregulation, but when EEG showed dominant slow or flat waves, there was no autoregulation.

著者

新井 達潤

出版者

日本臨床麻酔学会

雑誌

日本臨床麻酔学会誌 (ISSN:02854945)

巻号頁・発行日

vol.24, no.9, pp.395-406, 2004 (Released:2005-05-27)

参考文献数

45

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科学的観点に立った心肺蘇生法(CPR)の開発は1900年代に入ってから始まり, 現在実施されている心肺蘇生法の基本骨格は1960年頃には完成した. 米国心臓協会(AHA)はこれらを総合し, 1974年に最初の心肺蘇生法ガイドラインを出版した. その後絶えず改善を重ね, 2000年には第5版(G2000)を出版した. G2000は蘇生に関する世界的協議会ILCOR(International Liaison Committee On Resuscitation)との緊密な連携のもとに作られたもので, 蘇生における世界的ガイドラインと考えて矛盾はない. AHAのガイドラインはヒトでの有効性が科学的に証明されたもののみを採用し, とくにG2000はEvidence-based medicineの立場を強調している. しかし, 必ずしも科学的には証明できないまま経験的有効性から採り入れられている部分もあり, また, 一般市民をも対象とするため妥協せざるを得ない部分もみられる. 本稿では現在のG2000を基準とした心肺蘇生法が, どのような考えのもとに作られ発展してきたか, また, どのような問題点を含んでいるのか, とくに作用機序の面から考察する.

著者

新井 達潤

出版者

克誠堂出版

雑誌

麻酔 (ISSN:00214892)

巻号頁・発行日

vol.43, no.4, pp.p600-611, 1994-04

被引用文献数

3