研究者詳細 - 西山　慶

論文 - 西山　慶

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Anti-shivering Drug Influences the Characteristics of Electroencephalographic Shivering Noise During Targeted Temperature Management: A Case Report. 国際誌

Hiroyuki Honda, Kei Nishiyama

Cureus 17 ( 5 ) e84509 2025年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

We report a case of a 75-year-old male patient who underwent targeted temperature management (TTM) following cardiopulmonary resuscitation and subsequently experienced uncontrolled shivering. Rocuronium was administered to alleviate shivering; however, the shivering recurred, necessitating continuous administration of dexmedetomidine. Analysis of the electroencephalography (EEG) recorded for neuromonitoring demonstrated that both pharmacological agents significantly reduced the power of the alpha and beta waves at 10 and 60 minutes post-administration. Dexmedetomidine also influenced the delta and theta waves, coinciding with the cessation of shivering, whereas muscle relaxants exhibited minimal effects on these frequency bands. These findings suggest that shivering-induced noise causing EEG changes is drug-dependent and predominantly affects high-frequency regions, potentially impacting the neurological prognosis predictions and detection of nonconvulsive status epilepticus (NCSE). This case illustrates the need to recognize the effects of shivering and anti-shivering medications on EEG monitoring during post-resuscitation care. Further research is warranted to evaluate the impact of these factors on EEG-based prognostication and NCSE detection, and to optimize strategies for managing shivering-induced artifacts during TTM.

DOI： 10.7759/cureus.84509

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A Case of Concurrent Metformin-Associated Lactic Acidosis and Euglycemic Diabetic Ketoacidosis. 国際誌

Daisuke Tomita, Yuuki Bamba, Naoko Kuwabara, Shota Akakabe, Yasuhiro Matsubayashi, Saori Nakagawa, Hirohito Sone, Kei Nishiyama

The Journal of emergency medicine 2025年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Combination therapy with metformin and sodium-glucose cotransporter 2 (SGLT2) inhibitors is strongly recommended for adults with type 2 diabetes mellitus who have inadequate glycemic control. These inhibitors are particularly indicated for patients with a history or high risk of atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease. Consequently, the number of patients receiving both metformin and SGLT2 inhibitors is expected to increase. However, these treatments pose a risk of life-threatening acidoses, specifically metformin-associated lactic acidosis (MALA) and euglycemic diabetic ketoacidosis (euDKA), which require prompt differentiation and distinct treatments. CASE REPORT: We present the case of a woman in her 50s with chronic heart failure who had been treated for type 2 diabetes for 15 years. After dehydration caused by working in hot conditions and fluid restriction, she presented with dehydration, fatigue, respiratory distress, hypotension, tachypnea, hypothermia, acute renal failure, hypoglycemia, and severe metabolic acidosis. Despite supportive care, lactic acidosis persisted, leading to a diagnosis of MALA. Hemodialysis improved lactate levels, but a persistent anion gap and elevated β-hydroxybutyrate level confirmed euDKA. Metabolic abnormalities resolved with continuous insulin infusion and the patient was discharged without sequelae. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The combination of MALA and euDKA represents rare but potentially fatal conditions requiring distinct diagnostic and therapeutic approaches. With their growing use for type 2 diabetes management and cardiovascular/kidney benefits, emergency physicians are more likely to encounter complications associated with these medications.

DOI： 10.1016/j.jemermed.2025.02.018

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山岳・海難救助事案における救助ヘリコプターの傷病者搬送プロトコル化による医療機関直接搬送の効果：単施設後ろ向き観察研究(Effectiveness of direct transport to hospitals by rescue helicopters in mountain and marine casualty rescue cases with protocols for patient transport: A single–center, retrospective observational study)

出内主基, 山川敬一朗, 三島世奈, 山口勝一朗, 上村夏生, 本多忠幸, 西山慶

Nihon Kyukyu Igakukai Zasshi: Journal of Japanese Association for Acute Medicine 36 ( 2 ) 35 - 42 2025年2月

掲載種別：研究論文（学術雑誌）出版者・発行元：Wiley

要旨

【目的】傷病者を救助ヘリコプターで搬送する際のプロトコルを確立することによる，山岳・海難救助事案における医療機関への直接搬送の有効性を単施設後ろ向き観察研究で検証した。【対象】2012年10月31日から2023年12月31日までに新潟県消防防災航空隊・新潟県警察航空隊によりヘリコプターで救助され，新潟県東部ドクターヘリ運航管理室に情報提供された56例を対象とした。プロトコル運用前9例，運用後25例が解析対象となった。【結果】プロトコル運用前にドクターヘリが現場直近のランデブーポイントで接触した患者では，救助完了から病院到着までは37 [IQR; 20 – 51] 分を要したが，プロトコル実施後に救助ヘリコプターで基地病院へ直接搬送した患者では10 [9 – 15] 分（p < 0.01）であった。救助完了から医師接触までの時間は，プロトコル実施前は11 [7 – 15] 分であったが，プロトコル実施後は10 [9 – 15.5] 分（p = 0.51）であった。【結語】救助ヘリコプターで医療機関へ直接搬送するプロトコルの導入は，医師接触時間を遅延させることなく病院到着時間を大幅に短縮し，ドクターヘリが対応困難な山岳・海難救助事案において有効であった。

DOI： 10.1002/jja2.12967

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A case of toxic epidermal necrolysis like vancomycin-induced linear IgA bullous dermatosis without autoantibody for type VII collagen. 国際誌

Mai Higuchi, Ryota Hayashi, Miki Sato, Mahoko Oginezawa, Shingo Takei, Yu Kashiwazaki, Masataka Hiruma, Kei Nishiyama, Norito Ishi, Riichiro Abe

The Journal of dermatology 52 ( 5 ) e347-e348 2025年1月

ステントグラフト内挿術施行後12年目に生じた二次性大動脈十二指腸瘻の1例

石川博補, 滝沢一泰, 三浦宏平, 本田博之, 大橋さとみ, 西山慶

日本救急医学会雑誌 35 ( 11 ) 628 - 628 2024年11月

当院における急性期onlineHDF施行症例の後方視的検討

土田雅史, 本多忠幸, 本田博之, 大橋さとみ, 西山慶

日本救急医学会雑誌 35 ( 11 ) 661 - 661 2024年11月

Point-of-care ultrasound for Lemierre's syndrome during the COVID-19 pandemic: A case report.

Yosuke Kawai, Kei Nishiyama

Journal of general and family medicine 25 ( 5 ) 274 - 276 2024年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

Lemierre's syndrome is a fatal condition characterized by septic thrombophlebitis of the internal jugular vein (IJV). Early diagnosis of Lemierre's syndrome in primary care remains challenging because of its rarity and common initial symptoms like fever and sore throat. The COVID-19 pandemic has increased the difficulty of diagnosis, along with many diagnostic delays. Herein, we report a case in which an IJV thrombus was detected using point-of-care ultrasound (POCUS), leading to the diagnosis of Lemierre's syndrome. During the COVID-19 pandemic, POCUS was a simple and noninvasive technique for screening Lemierre's syndrome without radiation and low droplet exposure.

DOI： 10.1002/jgf2.708

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Neurological prognosis prediction for cardiac arrest patients using quantitative imaging biomarkers from brain computed tomography 国際誌

Takahiro Nakamoto, Kanabu Nawa, Kei Nishiyama, Kosuke Yoshida, Daizo Saito, Masahito Horiguchi, Yuki Shinya, Takeshi Ohta, Sho Ozaki, Yuki Nozawa, Masanari Minamitani, Toshikazu Imae, Osamu Abe, Hideomi Yamashita, Keiichi Nakagawa

Physica Medica 125 103425 - 103425 2024年9月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Elsevier BV

PURPOSE: We aimed to predict the neurological prognosis of cardiac arrest (CA) patients using quantitative imaging biomarkers extracted from brain computed tomography images. METHODS: We retrospectively enrolled 86 CA patients (good prognosis, 32; poor prognosis, 54) who were treated at three hospitals between 2017 and 2019. We then extracted 1131 quantitative imaging biomarkers from whole-brain and local volumes of interest in the computed tomography images of the patients. The data were split into training and test sets containing 60 and 26 samples, respectively, and the training set was used to select representative quantitative imaging biomarkers for classification. In univariate analysis, the classification was evaluated using the p-value of the Brunner-Munzel test and area under the receiver operating characteristic curve (AUC) for the test set. In multivariate analysis, machine learning models reflecting nonlinear and complex relations were trained, and they were evaluated using the AUC on the test set. RESULTS: The best performance provided p = 0.009 (<0.01) and an AUC of 0.775 (95% confidence interval, 0.590-0.960) for the univariate analysis and an AUCof0.813 (95% confidence interval, 0.640-0.985) for the multivariate analysis. Overall, the gray level with the maximum gradient in the histogram of the three-dimensionally low-pass-filtered image was an important feature for prediction across the analyses. CONCLUSIONS: Quantitative imaging biomarkers can be used in neurological prognosis prediction for CA patients. Relevant biomarkers may contribute to protocolized computed tomography image acquisition to ensure proper decision support in acute care.

DOI： 10.1016/j.ejmp.2024.103425

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アニオンギャップを用いたリチウム中毒判定法の評価単施設後方視研究

本田博之, 栗田秀一郎, 晝間優隆, 本多忠幸, 西山慶

日本集中治療医学会雑誌 31 ( Suppl.1 ) S529 - S529 2024年9月

Diagnostic accuracy of the anion gap to identify toxic lithium concentrations: a single-center retrospective observational study. 国際誌

Hiroyuki Honda, Kazuki Deuchi, Makusu Fukasawa, Katsuichiro Yamaguchi, Kei Nishiyama

Clinical toxicology (Philadelphia, Pa.) 62 ( 8 ) 506 - 511 2024年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

INTRODUCTION: Lithium exhibits a narrow margin between therapeutic doses and toxic blood concentrations, which can pose a substantial risk of toxic effects. Reportedly, lithium toxicity may be associated with a reduced anion gap; however, the precise relationship remains unclear. This study examined several different anion gap calculation methods to detect toxic lithium concentrations without directly measuring blood lithium concentrations. METHODS: Our retrospective study analyzed blood samples collected for lithium concentration measurements. The anion gap was determined using three different methods, both with and without albumin and lactate concentration corrections. Samples were categorized into two groups based on lithium concentration (<1.5 or ≥1.5 mmol/L), and anion gap values were compared. Correlation and logistic regression analyses were used to assess the relationship between each anion gap indicator and lithium concentration. Receiver operating characteristic curves were used for diagnostic analysis. RESULTS: Overall, 24 measurements were collected, with 41.7% of samples falling within the toxic range. The high-lithium concentration group exhibited significantly smaller anion gaps. Correlation and logistic regression analyses revealed a significant association between anion gap values and lithium concentrations. Areas under the receiver operating characteristic curve were: conventional anion gap 0.77 (95% CI: 0.55-0.94); albumin-corrected anion gap 0.85 (95% CI: 0.66-1.00); and both albumin- and lactate-corrected anion gap 0.86 (95% CI: 0.66-1.00). DISCUSSION: The anion gap is calculated as the difference between measured cations and anions. Accumulation of lithium (a cation) may decrease measured cations and decrease the calculated anion gap. Abnormal albumin and lactate concentrations may also alter the anion gap and affect its usefulness as a diagnostic marker for elevated serum lithium concentrations. A negative likelihood ratio of 0.1 suggests that the anion gap might be valuable in excluding toxicity. CONCLUSIONS: The corrected anion gap, accounting for albumin and lactate concentrations, may be beneficial in suggesting the possibility of toxic lithium concentrations.

DOI： 10.1080/15563650.2024.2380771

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循環器医は「メディカルコントロール協議会」への参画を病院前での循環器救急医療の実情に関するアンケート結果から

菊地研, 田原良雄, 加藤正哉, 今村浩, 竹内一郎, 笠岡俊志, 西山慶, 花田裕之, 三宅章公, 山本剛, 佐藤直樹, 大倉宏之

心臓 56 ( 8 ) 808 - 819 2024年8月

医療経済政策とドクターヘリ・救急医療DX

西山慶

新潟県医師会報 ( 892 ) 16 - 19 2024年7月

日本救急医学会学生・研修医部会(SMAQ)合同企画救急医療を担う次世代のビジョン総合的な診療に興味のある医学生や研修医にとって、救急科という選択肢はアリである

川井洋輔, 西山慶

東北救急医学会総会・学術集会プログラム・抄録集 38回 65 - 65 2024年6月

ECMO脱血カニューレが上行腰静脈経由で下大静脈に留置されたが静脈造影下の抜去に成功した1例

本田博之, 栗田秀一郎, 松井亨, 大橋さとみ, 平田哲大, 堀井陽祐, 西山慶

日本救急医学会雑誌 35 ( 1 ) 22 - 27 2024年1月

ECMO脱血カニューレが上行腰静脈経由で下大静脈に留置されたが静脈造影下の抜去に成功した1例

本田博之, 栗田秀一郎, 松井亨, 大橋さとみ, 平田哲大, 堀井陽祐, 西山慶

日本救急医学会雑誌 35 ( 1 ) 22 - 27 2024年1月

中毒性表皮壊死症との鑑別を要したバンコマイシン誘発性線状IgA水疱性皮膚症の1例

柏崎優, 晝間優隆, 林良太, 本田博之, 大橋さとみ, 本多忠幸, 西山慶

日本救急医学会雑誌 34 ( 12 ) 810 - 810 2023年12月

救命センター・ICUに入院した超高齢者に対するAdvance Care Planning(ACP)の取得状況と臨床への影響

玉川大朗, 西山慶

新潟医学会雑誌 137 ( 12 ) 423 - 430 2023年12月

人工知能を用いた急性期脳CTにおける心停止後神経学的予後予測のための新しい定量的イメージングバイオマーカー(QIBs)の開発

西山慶, 玉川大朗, 川井洋輔, 上村夏生, 八幡えり佳, 林悠介, 本田博之, 大橋さとみ, 本多忠幸, 寺山毅郎, 石井亘, 齋藤大蔵

日本救急医学会雑誌 34 ( 12 ) 707 - 707 2023年12月

新潟県東部ドクターヘリにおけるDXの実装と展開

玉川大朗, 深澤眞楠, 柏崎優, 冨田大祐, 柴田健継, 青木志門, 本田博之, 大橋さとみ, 西山慶

日本救急医学会雑誌 34 ( 12 ) 895 - 895 2023年12月

Investigation of Mechanical Thrombectomy in Elderly Patients over 85 Years Old: A Multicenter Study.

Kohei Shibuya, Hitoshi Hasegawa, Tomoaki Suzuki, Haruhiko Takahashi, Kei Nishiyama, Makoto Oishi, Yukihiko Fujii

Neurologia medico-chirurgica 63 ( 9 ) 393 - 399 2023年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

In Japan, which has a super-aging society, there are increasing opportunities to perform mechanical thrombectomy for the elderly; however, there is no recorded evidence of thrombectomy for the elderly. This study examined the usefulness of thrombectomy in the elderly. We retrospectively analyzed patient data using a multicenter acute ischemic stroke registry (NGT-FAST). We examined outcomes in patients 75 years and older who underwent thrombectomies between January 1, 2021, and December 31, 2021. The patients were divided into two groups: the 75-84-year-old group and the 85+-year-old group. There was no difference in the pretreatment National Institutes of Health Stroke Scale score or Alberta Stroke Program Early Computed Tomography Score between the two groups, but the 85+-year-old group had a significantly lower rate of pre-stroke modified Rankin Scale (mRS) score of 0-2. There were no differences in time from onset to treatment or effective recanalization rate, but complications tended to be more common in the 85+-year-old group. The number of patients with a good outcome at discharge (an mRS score of 0-3) was significantly lower in the 85+-year-old group than in the 75-84-year-old group. In addition, 90.9% of patients in the 85+-year-old group with a pre-stroke mRS score of 3 deteriorated after treatment. The pre-stroke mRS score is very important in determining the indication for thrombectomy in the elderly because their preoperative condition is more likely to influence the outcome than that of younger patients.

DOI： 10.2176/jns-nmc.2023-0039

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