米川　力 (ﾖﾈｶﾜ ﾁｶﾗ)

We constructed a prototype community first responder (CFR) dispatch system. The system sends incident information, including a map, to the chosen CFR's mobile phone. We tested it in a simulation of 30 out-of-hospital cardiac arrest incidents which had occurred in the town of Motegi during the previous year. Thirty off-duty firefighters acted as CFRs and were sent to the same locations. The mean response time (from the CFR receiving dispatch information to arrival at the scene) was 3 min 37s faster than the actual response time in the corresponding historical control, i.e. the response time was reduced by 36% (P< 0.01). The median travel distance of the CFRs was 3.4 km and there was a positive correlation between response time and travel distance. The study showed that interactive communication between dispatcher and CFR was important for effective operation and that CFRs could reach an OHCA patient before the Emergency Medical Service arrives.

Nine patients with postoperative liver failure were treated with plasma exchange (PE) or PE and continuous hemodiafiltration (CHDF), and various biochemical parameters were determined before and after treatment. Although citrate levels increased significantly after treatment compared with pretreatment levels in both the PE group and the PE + CHDF group (P < 0.0001 and P < 0.0001, respectively), the percentage of the increase in citrate levels was significantly higher in the PE group than in the PE + CHDF group (P=0.0051). Total bilirubin (T-Bil) levels were significantly lower after treatment in both the PE and PE + CHDF groups (P<0.0001 and P=0.0001, respectively). There were no significant differences in T-Bil levels between the two groups (P = 0.5181). There were no significant differences in interleukin (IL)-6 levels before and after treatment in both the PE and PE + CHDF groups (P=0.1281 and P=0.2273, respectively). IL-18 levels were significantly lower after treatment in both the PE and PE+CHDF groups (P<0.0001 and P=0.0002, respectively), but there were no significant differences in the removal rate of IL-18 in both the PE and PE + CHDF groups (P=0.8749). These results indicate that combining PE and CHDF in a series-parallel circuit is an effective modality for suppressing the elevation of blood citrate levels. This finding may have important implications for the development of an effective treatment for patients with postoperative liver failure.

Interleukin (IL)-15, an inhibitor of tumor necrosis factor (TNF)-α, causes liver injury in mice. We determined levels of IL-15, IL-6, and IL-18 by enzyme-linked immunosorbent assays in 20 patients with acute hepatic failure and examined relationship between these proinflammatory cytokines and IL-15. A significant correlation was observed between the levels of IL-18 and IL-15 (p=0.0118). IL-15 levels in the nonsurvivors were significantly higher than those in the survivors (p=0.0357). Our results suggest that IL-15 overexpression may cause liver injury in human. Copyright © 2004 By PJD Publications Limited.

目的：近年病院前救護活動や災害時における情報伝達手段として様々な無線機器が存在する。各機器にはそれぞれ特徴があり，導入費用にも差が見られる。我々は近年普及が進んできたIP 無線を始めに各種無線機器を試用し，その特徴を生かした情報伝達手段構築について考察した。方法：当院のドクターカー活動に各種無線機を試用し，通信距離を比較した。さらに医療従事者が使用可能な無線機を調査しその特徴について比較検討した。結果：IP 無線はこれまで災害に強いと言われているMCA 無線と比較して遜色のない通信性能であった。また業務用無線やMCA 無線では通信距離を長くするために設備拡張などの追加費用が必要で資格や免許申請などの手続きも必要であった。考察：無線による情報伝達手段を考える際，活動範囲を考えた上で機器を検討する必要がある。比較的小規模な活動から災害時における広範囲での活動を考えた場合，IP 無線は有効なツールになり得る。