山下 千鶴

We report a case in which excessive negative pressure may have been applied to the proximal side hole of a drainage cannula during venovenous extracorporeal membrane oxygenation (V-V ECMO), resulting in abnormal stenosis of the drainage cannula. V-V ECMO was introduced in a 71-year-old male patient who was transferred from another hospital for severe respiratory failure associated with varicella pneumonia and acute respiratory distress syndrome. Drainage was performed using a PCKC-V™ 24Fr (MERA, Japan) cannula via the right femoral vein with the tip of the cannula near the level of the diaphragm under fluoroscopy. Reinfusion was performed via the right internal jugular vein. Due to poor systemic oxygenation, the drainage cannula was withdrawn caudally and refixed to reduce the effect of recirculation. Two days later, drainage pressure dropped rapidly, and frequent ECMO flow interruption occurred due to poor drainage. An abdominal X-ray revealed abnormal stenosis of the proximal side hole site of the drainage cannula. We diagnosed that the drainage cannula was damaged, and it was replaced with another, namely a Medtronic Bio-Medicus™ 25 Fr (GETINGE, Sweden) cannula. However, the removed drainage cannula was not damaged, suggesting that the cannula was temporarily stenosed by momentary excessive negative pressure. In a multi-stage drainage cannula, the main drainage site is the proximal side hole, with little negative pressure applied at the apical foramen in a mock experimental ex vivo drainage test in a water tank. Hence, improvement of a multi-stage drainage cannula is recommended, such as adequate reinforcement of the side hole site with a wire.

【目的】胃がん手術後の体重減少は,生活の質の低下など影響をおよぼす重要な課題である.今回,低侵襲胃がん手術後1ヵ月の体組成変化と除脂肪体重減少の要因について検討した.【対象および方法】2021年4月から2022年8月で低侵襲胃がん手術の術前および術後1ヵ月に体組成測定した88例を対象とした.術後1ヵ月の除脂肪体重減少率の中央値(2.4%)以下46例をLow群(以下,L群と略),中央値より大きい42例をHigh群(以下,H群と略)とし比較検討した.また,重回帰分析にて除脂肪体重減少のリスク因子を検討した.【結果】L群,H群の術後1ヵ月の変化は体重-5.4%,-7.1%,体脂肪量-16.3%,-13.9%であった.重回帰分析の結果,術前体脂肪率(p<0.01)が有意な変数として抽出された.【結論】術前体脂肪率低値は,術後1ヵ月の除脂肪体重減少の有意な危険因子であり,術前からの介入を要すると考えられた.(著者抄録)