人工呼吸依存患者における肺コンプライアンス低下の要因について：追跡研究

Background: Lung compliance is a parameter of lung expansion. In patients onventilator management, it affects ventilatory status and mortality. There are few studieson permanent ventilator dependence (PVD), a condition defined as when a patient hasbeen on ventilator management for more than three months. We aimed to clarify thelongitudinal factors affecting lung compliance during the chronic period in PVD subjects.Methods: A follow-up study was performed on 24 PVD subjects who had been onventilator management for approximately 6 years. Static (Cst) and dynamic (Cdyn) lungcompliance and alveolar-arterial PO2 difference (P(A-a)O2) were assessed twice between2019 and 2020, and the before and after results were compared for each assessment. Weexamined the correlation of changes in Cst and Cdyn over time with BMI, age, duration ofventilation dependence, and the incidence of pneumonia. The subjects were divided intotwo groups according to the presence of atelectasis, and changes in Cst, Cdyn, and P(A-a)O2 were compared between the two groups.Results: There were no significant changes in lung compliance between the twomeasurements in the follow-up. However, at the individual level, a decrease in BMIinhibited the decrease in Cst. There was no relationship between differences in Cst orCdyn and P(A-a)O2, age, ventilator management days, or the incidence of pneumonia.Differences in P(A-a)O2 were not observed between the two groups divided according tothe presence of atelectasis.Conclusions: Increased BMI affected lung compliance in PVD subjects during the chronicperiod. Regarding atelectasis, its relationship with differences in Cst and Cdyn was notclear, and impaired lung compliance was considered to resolve after several years of PVD

Mitochondrial DNA Mutations Induce Mitochondrial Dysfunction, Apoptosis and Sarcopenia in Skeletal Muscle of Mitochondrial DNA Mutator Mice

Background: Aging results in a progressive loss of skeletal muscle, a condition known as sarcopenia. Mitochondrial DNA (mtDNA) mutations accumulate with aging in skeletal muscle and correlate with muscle loss, although no causal relationship has been established. Methodology/Principal Findings: We investigated the relationship between mtDNA mutations and sarcopenia at the gene expression and biochemical levels using a mouse model that expresses a proofreading-deficient version (D257A) of the mitochondrial DNA Polymerase c, resulting in increased spontaneous mtDNA mutation rates. Gene expression profiling of D257A mice followed by Parametric Analysis of Gene Set Enrichment (PAGE) indicates that the D257A mutation is associated with a profound downregulation of gene sets associated with mitochondrial function. At the biochemical level, sarcopenia in D257A mice is associated with a marked reduction (35–50%) in the content of electron transport chain (ETC) complexes I, III and IV, all of which are partly encoded by mtDNA. D257A mice display impaired mitochondrial bioenergetics associated with compromised state-3 respiration, lower ATP content and a resulting decrease in mitochondrial membrane potential (Dym). Surprisingly, mitochondrial dysfunction was not accompanied by an increase in mitochondrial reactive oxygen species (ROS) production or oxidative damage. Conclusions/Significance: These findings demonstrate that mutations in mtDNA can be causal in sarcopenia by affecting the assembly of functional ETC complexes, the lack of which provokes a decrease in oxidative phosphorylation, without an increase in oxidative stress, and ultimately, skeletal muscle apoptosis and sarcopenia

早期からの理学療法介入により筋力やせん妄の改善が認められた心停止後症候群の1症例

金沢大学医薬保健研究域保健学系【目的】冠動脈の多枝病変により心停止後症候群に至った症例に対し,早期からの理学療法を実施し,改善したので報告する。【対象と方法】症例は86歳の男性,蘇生後の臥床期間が続いたことで,重度の呼吸不全やせん妄,筋力低下などを伴っており,基本的動作も全介助であった。これに対し,過負荷に考慮したうえで受動での体位療法や他動的な関節トレーニングから開始し,循環動態の安定とともに車椅子への離床を他職種協働にて行った。【結果】介入期間中の有害事象を認めず,安全に理学療法を実施できた。また,せん妄や筋力,基本的動作においても改善を認めた。【結語】急性期患者の病態は刻々と変化するため,安全性を担保するためにも医師や看護師との密な連携が必要になると思われた。また,心停止後症候群の患者に対して,早期から離床を行うことで呼吸機能のみでなく,筋力低下やせん妄の改善においても有効ではないかと考えられた

大腸穿孔患者の腹部 CT を用いた大腰筋断面積と歩行能力との関連

金沢大学医薬保健研究域保健学系【目的】大腸穿孔患者の退院時の歩行自立の可否と腰部主要筋の断面積との関連性を明らかにすることを目的とした。【方法】調査対象は，外科で大腸穿孔に対して緊急開腹術を施行し，術後ICU管理を行った63症例のうち，除外基準に相当する31例を除いた32例に対し，歩行自立群（n＝21）と歩行非自立群（n＝11）の2群に分類した。【結果】ロジスティック回帰分析にて歩行自立と関連する要因として抽出された項目は，APACHE IIスコア，転帰，大腰筋面積の1日当たりの変化率であった。【結論】ICU管理中での大腰筋断面積の低下はICU退室後の歩行能力の獲得に対して悪影響を及ぼす可能性があるため，できる限りICUでの早期離床を目指し，離床が困難な症例については，ベッド上で行える筋力トレーニングを積極的に行うことで，大腰筋の筋力低下を予防する必要があると思われた。Purpose: This study was conducted to examine the relationship between ambulation independence and cross-sectional area of the lumbar major muscle in patients with colon perforation. Methods: We retrospectively examined the cases of 32 colon perforation patients who underwent emergency laparotomy. We divided the patients into two groups: ambulation independence (n=21) and ambulation dependence (n=11). Results: A logistic regression analysis revealed that the APACHE II score, outcome, and the rate of change of the area of the psoas major were factors relevant to ambulation independence. Conclusion: As decreases in the cross-sectional area of the psoas major during intensive care possibly affect patients\u27 gait ability after being discharged from the ICU, it may be necessary to prevent any loss of the psoas major muscle strength by promoting early mobilization whenever possible or, if not possible, actively providing in-bed muscle training even for ICU patients

Effect of Body Weight-supported Walking on Exercise Capacity and Walking Speed in Patients with Knee Osteoarthritis: A Randomized Controlled Trial

Objective: To compare the effect of body-weight-supported treadmill training (BWSTT) and full-body-weight treadmill training (FBWTT) on patients with knee osteoarthritis (OA). Methods: Design was Randomized controlled trial. Patients with knee osteoarthritis (n = 30; mean age, 76.0±7.5 y) were randomly assigned to BWSTT or FBWTT group. All patients performed 20 min walking exercise twice a week for 6 weeks under the supervision of the therapist. Main measures were 10-meter walking test (10MWT), functional reach test (FRT), timed get up and go test (TUG), one-leg standing test, 6-minute walking test (6MWT), the parameters set on the treadmill, MOS Short-Form 36-Item Health Survey (SF36), Japanese Knee Osteoarthritis Measure (JKOM). Results: Twenty-five patients (10 men, 15 women; mean age, 76.5 ± 8.0 y) completed the experiment. Exercise capacity, indicated by the heart rate, was similar in both groups. After 3 weeks of BWSTT, the patients performed significantly better in the 10-m and 6-min walking tests. This was not the case with FBWTT even after 6 weeks training. Pain levels assessed were significantly improved after 3 weeks of BWSTT and 6 weeks of FBWTT. There were no significant improvements in either group assessed by the FRT, one-leg standing time test, TUG, or SF -36 questionnaire. Conclusions: BWSTT enhanced exercise capacity in terms of walking speed and pain reduction after 3 weeks; however, there was no significant improvement in patients’ functional abilities or quality of life

Influences of Changes in the Level of Support and Walking Speed on the H Reflex of the Soleus Muscle and Circulatory Dynamics on Body Weight-supported Treadmill Training: Investigation in Healthy Adults

[Purpose] To investigate the therapeutic usefulness of treadmill walking using a body weight support device (BWS), changes in circulatory dynamics and muscle activities with various levels of support were investigated. [Subjects and Methods] The subjects were divided into 3 groups: 20% BWS, 40% BWS, and full body weight (FBW). The subjects walked at maximum and normal speeds. Under each condition, H and M waves and skin temperature before and after walking and changes in the heart rate during walking were measured. [Results] The heart rate continued to increase after 3 minutes of FBW at the maximum walking speed, but a steady state was reached after 3 minutes under the other walking conditions. Regarding skin temperature, no significant difference from that at rest was noted 30 minutes after walking at the normal speed, but it was significantly higher than that at rest at 30 minutes after walking at the maximum speed. The H/M ratio was significantly higher after walking at the maximum walking speed in the FBW and 20% BWS groups compared with the 40% BWS groups. [Conclusion] Treatment with 40% BWS at the maximum walking speed was safe for the circulatory system and may be effective in elevating the skin temperature for a prolonged period compared with the effects of the other walking conditions at normal speed