研究者詳細 - 西山　慶

論文 - 西山　慶

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巨大甲状腺腫のため心肺停止した患者を蘇生させた後、外科的気道確保を施行し救命させた1症例査読

廣津聡子, 水津悠, 西山慶, 嘉田真平, 七野力

人工呼吸 36 ( 2 ) 173 - 177 2019年11月

Combined Approach Versus 2 Conventional Approaches in Ultrasound-Guided Central Venous Catheterization: A Randomized Controlled Trial. 査読国際誌

Jun Takeshita, Kei Nishiyama, Atsushi Fukumoto, Nobuaki Shime

Journal of cardiothoracic and vascular anesthesia 33 ( 11 ) 2979 - 2984 2019年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: The authors compared the occurrence of posterior wall puncture using the short-axis out-of-plane and long-axis in-plane approaches with that using the combined short-axis-and-long-axis approach that the authors previously showed to be effective in observational and manikin studies. DESIGN: Randomized controlled study. SETTING: Single tertiary institution. PARTICIPANTS: One hundred twenty patients who underwent cardiac or vascular surgery under general anesthesia. INTERVENTIONS: The patients were divided randomly into combined short-axis-and-long-axis (n = 40), short-axis out-of-plane (SA-OOP) (n = 40), and long-axis in-plane (LA-IP) (n = 40) groups and received ultrasound-guided central venous catheterization at the right internal jugular vein. MEASUREMENTS AND MAIN RESULTS: Successful guidewire insertion without posterior wall puncture was performed in 40 patients (100%) in the combined short-axis-and-long-axis approach group, 28 (70%) in the short-axis out-of-plane approach group, and 38 (95%) in the LA-IP approach group (combined short-axis-and-long-axis v SA-OOP, p = 0.0002 [relative risk = 1.43; 95% CI: 1.17-1.75]; combined short-axis-and-long-axis v LA-IP, p = 0.49 [relative risk = 1.05; 95% CI: 0.98-1.13]). Procedure durations were 28.5 (24.1-36.4) seconds in the combined short-axis-and-long-axis group, 31.7 (24.4-40.6) seconds in the SA-OOP group, and 24.3 (20.8-32.1) seconds in the long-axis in-plane group (combined short-axis-and-long-axis v SA-OOP, p = 0.53; combined short-axis-and-long-axis v LA-IP, p = 0.044). CONCLUSION: The combined short-axis-and-long-axis approach for ultrasound-guided central venous catheterization had a lower posterior wall puncture rate than the SA-OOP approach, but there was no significant difference with the long-axis in-plane approach.

DOI： 10.1053/j.jvca.2019.03.051

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巨大甲状腺腫のため心肺停止した患者を蘇生させた後、外科的気道確保を施行し救命させた1症例

廣津聡子, 水津悠, 西山慶, 嘉田真平, 七野力

人工呼吸 36 ( 2 ) 173 - 177 2019年11月

Superiority of Dynamic Needle Tip Positioning for Ultrasound-Guided Peripheral Venous Catheterization in Patients Younger Than 2 Years Old: A Randomized Controlled Trial. 査読国際誌

Jun Takeshita, Takayuki Yoshida, Yasufumi Nakajima, Yoshinobu Nakayama, Kei Nishiyama, Yukie Ito, Yoshiyuki Shimizu, Muneyuki Takeuchi, Nobuaki Shime

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies 20 ( 9 ) e410-e414 - e414 2019年9月

よく使う日常治療薬の正しい使い方抗不整脈薬 : 不整脈と抗不整脈薬のイメージをつかみ,苦手意識を払拭しよう

西山慶

レジデントノート 21 ( 7 ) 1287 - 1292 2019年8月

中枢神経疾患と管理近赤外線分光法(NIRS)

西山慶

救急・集中治療 31 ( 2 ) 338‐339 2019年7月

Dynamic Needle Tip Positioning for Ultrasound-Guided Arterial Catheterization in Infants and Small Children With Deep Arteries: A Randomized Controlled Trial. 査読国際誌

Jun Takeshita, Takayuki Yoshida, Yasufumi Nakajima, Yoshinobu Nakayama, Kei Nishiyama, Yukie Ito, Yoshiyuki Shimizu, Muneyuki Takeuchi, Nobuaki Shime

Journal of cardiothoracic and vascular anesthesia 33 ( 7 ) 1919 - 1925 2019年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: Arterial catheterization for infants and small children is technically challenging. This study evaluated whether the dynamic needle tip positioning (DNTP) technique improved the success rate of ultrasound-guided radial artery catheterization in patients with a radial artery depth ≥4 mm compared with the conventional ultrasound-guided technique. DESIGN: Randomized controlled study. SETTING: Single institution, Osaka Women's and Children's Hospital. PARTICIPANTS: Patients (n = 40; age <3 years) with artery depth ≥4 mm. INTERVENTIONS: Patients were divided randomly into 2 groups. The DNTP group received ultrasound-guided radial artery catheterization with DNTP; the conventional group received catheterization without DNTP. MEASUREMENTS AND MAIN RESULTS: First-attempt success rates were 85% and 50% in the DNTP and conventional groups, respectively (p = 0.018; relative risk = 1.7; 95% CI: 1.06-2.73). Overall success rates within 10 minutes were 95% and 60% in the DNTP and conventional groups, respectively (p = 0.008; relative risk = 1.58; 95% CI: 1.09-2.3). Posterior wall puncture rates were 5% and 50% in the DNTP and conventional groups, respectively (p = 0.0014; relative risk = 0.1; 95% CI: 0.014-0.71). Significantly fewer attempts were made in the DNTP group (median = 1 v 1.5; p = 0.01). The median catheterization times were 38 seconds (34-55.5) and 149 seconds (49.5-600) in the DNTP and conventional groups, respectively (p = 0.0003). CONCLUSION: Dynamic needle tip positioning improved first-attempt and overall success rates of ultrasound-guided radial artery catheterization in pediatric patients with a radial artery depth ≥4 mm.

DOI： 10.1053/j.jvca.2018.12.002

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Comparing Combined Short-Axis and Long-Axis Ultrasound-Guided Central Venous Catheterization With Conventional Short-Axis Out-of-Plane Approaches. 査読国際誌

Jun Takeshita, Kei Nishiyama, Atsushi Fukumoto, Nobuaki Shime

Journal of cardiothoracic and vascular anesthesia 33 ( 4 ) 1029 - 1034 2019年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: Visualizing the needle tip using the short-axis out-of-plane (SA-OOP) ultrasound-guided central venous catheterization approach is difficult and results in posterior wall puncture (PWP). To improve needle tip visualization in the long-axis view, combining the SA-OOP and the long-axis in-plane approaches has been suggested. The authors, who previously reported on the utility of this technique using a manikin model, examined the feasibility of this novel method (referred to as the combined short-axis and long-axis [CSLA] approach) and compared the CSLA approach with the SA-OOP approach in humans for the present study. DESIGN: Prospective observational study. SETTING: Single institution, Rakuwakai Otowa Hospital. PARTICIPANTS: Patients undergoing cardiac or vascular surgeries. INTERVENTIONS: The CSLA and SA-OOP approaches were used for ultrasound-guided right jugular venous puncture. The puncturing procedures were determined arbitrarily preoperatively without consideration of the patient's neck anatomy and were based on the operator's preference without randomization. MEASUREMENTS AND MAIN RESULTS: The study comprised 100 patients. Successful guidewire insertion without PWP was performed in 48 patients (96%) in the CSLA approach group and 33 (66%) in the SA-OOP approach group; the rate was significantly higher in the CSLA approach group (p = 0.0001). The procedural durations were 27.5 (range 17.0-122.0) seconds in the CSLA approach group and 25.0 (range 15.0-158.0) seconds in the SA-OOP approach group (p = 0.19). CONCLUSIONS: This study showed that the CSLA approach to ultrasound-guided central venous catheterization might help prevent PWP.

DOI： 10.1053/j.jvca.2018.08.005

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低血糖を契機に診断に至ったANCA関連血管炎の一例

吉崎航, 土屋旬平, 別府賢, 笹橋望, 西山慶

日本臨床救急医学会雑誌 22 ( 2 ) 359 - 359 2019年4月

レジストリーデータから臨床知識へ J-POPレジストリ活用の事例

中谷友香, 西山慶, 高橋由光, 中山健夫

日本臨床知識学会学術集会 3回 85 - 85 2019年3月

Dynamic needle tip positioningを用いた小児患者の超音波ガイド下末梢静脈穿刺ランダム化比較試験

竹下淳, 伊東幸恵, 稲田雄, 中嶋康文, 中山力恒, 西山慶, 籏智武志, 清水義之, 竹内宗之, 志馬伸朗

日本集中治療医学会雑誌 26 ( Suppl. ) [O52 - 1] 2019年2月

保存的に加療し得た上腸間膜動脈解離の一症例

中田愛, 寺嶋真理子, 川口理佐, 土屋旬平, 村上博基, 上田忠弘, 吉田浩輔, 濱中訓生, 田中博之, 別府賢, 土井康佑, 笹橋望, 西山慶

日本腹部救急医学会雑誌 39 ( 2 ) 346 - 346 2019年2月

アルコール多飲に合併した急性壊死性食道炎の1例

森本まゆみ, 村上博基, 上田忠弘, 土屋旬平, 川口理佐, 寺嶋真理子, 笹橋望, 西山慶

日本腹部救急医学会雑誌 39 ( 2 ) 350 - 350 2019年2月

Implementation of an empirical antimicrobial protocol in a critical care setting: A single-center retrospective observational cohort study in bacteremic patients. 査読国際誌

Ken-Ichi Kano, Nobuaki Shime, Kei Nishiyama

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 24 ( 12 ) 965 - 968 2018年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

In the treatment of severe infections in critical care settings, the selection of initial empirical antimicrobials affects patient outcomes and antimicrobial overuse. The application of a comprehensive treatment guidance might facilitate appropriate antimicrobial selection. Therefore, we developed such an antimicrobial guidance for use in emergency and critical care center and verified its efficacy. We retrospectively analyzed the data of 195 patients (96 patients before guidance introduction [control group] and 99 after guidance introduction [intervention group]) who were ultimately diagnosed with bacteremia to assess the effects of the guidance (the intervention). The appropriateness of the empirical therapy was greater in the intervention than in the control group (96% vs. 90%, respectively; P = 0.10). Moreover, the rate of carbapenem use was significantly lower in the intervention than in the control group (6% vs. 20%, respectively; P < 0.01). The control and intervention groups had similar 28-day survival rates of 81% and 85%, respectively; P = 0.50). These findings imply that introducing an empirical antimicrobial guidance in emergency outpatient and emergency intensive care settings could improve antimicrobial stewardship without affecting patient mortality. The data of this study can be used as a reference for establishing the study design of a large-scale prospective trial, aimed at verifying guidance efficacy.

DOI： 10.1016/j.jiac.2018.08.014

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救急・ICUの頻用薬を使いこなせ!薬の実践的な選び方や調整・投与方法がわかり,現場で迷わず処方できる第1章循環 3.抗不整脈薬頻脈性不整脈の診療アルゴリズム

西山慶, 西山慶, 西山慶, 西山慶

レジデントノート 20 ( 11 ) 1805‐1812 2018年10月

電気的除細動,ペーシング (特集循環器救急の最前線 : 初期診療と循環管理を極める) -- (初期診療に必須の検査と処置をマスターする)

村上博基, 西山慶

循環器ジャーナル 66 ( 4 ) 545 - 551 2018年10月

Geriatric Nutritional Risk Index for independent walking function in maintenance hemodialysis patients: A single-facility retrospective cohort study. 査読

Tanaka T, Nishiyama K, Yamamura O, Watase H, Yokoyama Y, Horiguchi T, Konishi T, Hayashi H

Geriatrics & gerontology international 18 ( 11 ) 1556 - 1561 2018年10月

交通外傷後、遅発性に発生した多発性仮性脾動脈瘤の一例

濱中訓生, 上田忠弘, 田中博之, 別府賢, 笹橋望, 西山慶

日本救急医学会雑誌 29 ( 10 ) 546 - 546 2018年10月

敗血症に伴う二次性の血球貪食症候群(HPS)が疑われた一例

幡輝世, 勅使川原学, 上田忠弘, 吉田浩輔, 濱中訓生, 田中博之, 別府賢, 笹橋望, 西山慶

日本救急医学会雑誌 29 ( 10 ) 438 - 438 2018年10月

院外心停止患者の転帰改善に向けて Goal directed CPRのためのデバイスの開発

西山慶, 別府賢, 寺嶋真理子, 田中博之, 濱中訓生, 村上博基, 吉田浩輔, 川口理佐, 上田忠弘, 土屋旬平, 笹橋望

日本救急医学会雑誌 29 ( 10 ) 316 - 316 2018年10月

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