Updated on 2024/12/05

Information

 

写真a

 
IYONAGA TAKESHI
 
Organization
Kyushu University Hospital Emergency & Critical Care Center Assistant Professor
School of Medicine Department of Medicine(Concurrent)
Title
Assistant Professor
Profile
院外心停止症例に対する体外式膜型人工肺を用いた蘇生、心停止蘇生後の体温管理療法、その他、集中治療における循環管理を中心に診療を行いながら見識を広げ、研修医、学生等への講義、教育を行っている。
External link

Degree

  • Ph.D.

Research Interests・Research Keywords

  • Research theme:The effect of targeted temperature management on neurological outcomes in out-of-hospital cardiac arrest patients

    Keyword:out-of-hospital cardiac arrest, Targeted temperature management, neurological outcomes

    Research period: 2019.11

Awards

  • Hypertension Research Award

    2021.10   the Japanese Society of Hypertension  

Papers

  • ICU rehabilitation and outcomes in elderly pelvic ring fractures due to high-energy trauma

    Momii Kenta, Yagi Hiroki, Nezu Tomoyuki, Ohsaki Kanji, Man Chen, Tajimi Takahiro, Iyonaga Takeshi, Nishihara Masaaki, Shono Yuji, Maki Jun, Akahoshi Tomohiko, Nakashima Yasuharu

    The Journal of Physical Fitness and Sports Medicine   13 ( 4 )   131 - 137   2024.7   ISSN:21868131 eISSN:21868123

     More details

    Language:English   Publisher:The Japanese Society of Physical Fitness and Sports Medicine  

    <p>Pelvic fractures, accounting for 2–8% of skeletal injuries, present a significant burden in patients with trauma. High-energy incidents often result in severe pelvic trauma accompanied by comorbidities leading to high mortality rates. Managing these complications adds complexity to the treatment process, particularly in older patients who experience longer recovery times and higher injury severity. To improve the long-term quality of life, a multidisciplinary approach is essential. However, rehabilitation feasibility is influenced by the patient’s condition and pelvic fixation stability, necessitating individualized treatment. This study investigated the rehabilitation status and long-term outcomes of older patients with severe polytrauma and pelvic ring fractures caused by high-energy trauma. The results revealed that 79.2% of the patients achieved full weight-bearing, with a median time of 41.5 days, and eventually 58.3% were discharged home. Complications were observed in 83.3% of the patients, with various challenges affecting successful home discharge. Multidisciplinary rehabilitation programs are promising for optimizing outcomes and facilitating recovery in vulnerable patient populations. Still, larger, more focused studies are needed to gain more comprehensive insights into the treatment and recovery of older patients with pelvic ring fractures and severe polytrauma. Understanding these factors is crucial for guiding clinical decision-making and improving long-term outcomes in this population.</p>

    DOI: 10.7600/jpfsm.13.131

    CiNii Research

  • 【骨盤外傷のリハビリテーションに関する考察】高エネルギー外傷による高齢者の骨盤輪部骨折におけるICUでのリハビリテーションと転帰(【Insights into the rehabilitation of pelvic trauma】ICU rehabilitation and outcomes in elderly pelvic ring fractures due to high-energy trauma)

    Momii Kenta, Yagi Hiroki, Nezu Tomoyuki, Ohsaki Kanji, Man Chen, Tajimi Takahiro, Iyonaga Takeshi, Nishihara Masaaki, Shono Yuji, Maki Jun, Akahoshi Tomohiko, Nakashima Yasuharu

    The Journal of Physical Fitness and Sports Medicine   13 ( 4 )   131 - 137   2024.7   ISSN:2186-8131

     More details

    Language:English   Publisher:(一社)日本体力医学会  

    骨盤骨折は骨格損傷の2~8%を占めるが,高エネルギー事故で生じる骨盤外傷にはしばしば高い死亡率につながる合併外傷を伴う.これらの合併外傷の管理は,状態の改善までに時間がかかり,外傷の重症度が高い高齢骨盤輪骨折においては特に治療経過を複雑にする.患者の長期的なQOLを向上させるためには,集学的アプローチが不可欠であることが知られている.また,集学的アプローチにおいて,患者の早期離床に向けたリハビリテーションの重要性は認識されている.しかしながら,高エネルギー外傷により,全身状態が不良となり,さらに体幹の安定性に寄与する骨盤輪骨折を有する患者においては,リハビリテーションは患者の状態や骨盤固定の安定性に影響されるため,個別化された治療が必要となる.本研究では,高エネルギー外傷による重症多発外傷および骨盤輪骨折を有する高齢患者のリハビリテーション状況と長期転帰について検討した.その結果,79.2%の患者が全荷重での移動が可能になり,達成までの期間は中央値で41.5日,最終的に58.3%が自宅退院した.合併症は83.3%の患者に認め,多種の合併症が自宅退院に影響を与えた.集学的リハビリテーションプログラムは重症な骨盤輪骨折や骨盤骨折を含む多発外傷の高齢患者の転帰を改善させ,自宅退院を可能にするために有用であると考えられる.より包括的な知見を得るためには,大規模で焦点を絞った研究が必要である.この知見を得ることで臨床的意思決定をサポートし,長期的転帰を改善するために極めて重要である.(著者抄録)

  • 臨牀指針 マムシ咬傷により急性腎不全・腸管壊死に陥り死亡した1例

    高森 信乃介, 赤星 朋比古, 高橋 慶多, 籾井 健太, 彌永 武史, 西原 正章, 大澤 さやか, 生野 雄二, 牧 盾, 徳田 賢太郎, 山浦 健

    臨牀と研究   101 ( 6 )   735 - 738   2024.6   ISSN:0021-4965

     More details

    Language:Japanese   Publisher:大道学館出版部  

    症例は74歳女性で、蛇咬傷、左上肢の腫脹、疼痛を主訴とした。近医皮膚科を受診し手掌に咬傷2ヶ所を認め、抗生剤を処方された。翌日より腫脹の拡張、疼痛の増悪、筋逸脱酵素と肝逸脱酵素上昇を認め、マムシ咬傷を疑った。本例は受傷から24以上経過し左上肢全体の腫脹に全身症状を伴った(Grade V)。セファランチン・抗マムシ血清・抗生剤投与、急性腎不全に対する持続的血液濾過透析(CHDF)、DIC・敗血症に対する治療を行い、開腹し広範な腸管壊死を認めたが治療困難で、第18病日に死亡した。

  • Emphysematous pyelonephritis with ST elevation accompanied by reciprocal changes mimicking acute coronary syndrome

    Hatakeyama, K; Shono, Y; Hashimoto, T; Sakamoto, T; Nishihara, M; Iyonaga, T; Mizuguchi, S; Sakamoto, T; Maki, J; Akahoshi, T

    AMERICAN JOURNAL OF EMERGENCY MEDICINE   70   208e5 - 208e7   2023.8   ISSN:0735-6757 eISSN:1532-8171

     More details

    Language:English   Publisher:American Journal of Emergency Medicine  

    Patients with infectious diseases including sepsis can develop ST segment changes on an electrocardiogram (ECG) in the absence of coronary artery disease. However, ST elevation with “reciprocal ST segment depression (RSTD)”, which is recognized as a specific finding for ST-elevated myocardial infarction, is rare in such patients. Although a small number of cases have reported ST-segment elevation in gastritis, cholecystitis, and sepsis, regardless of coronary artery disease, none presented with reciprocal changes. Here, we describe a rare case of a patient with emphysematous pyelonephritis complicating septic shock who developed ST elevation accompanied by reciprocal changes with no coronary occlusion. Emergency physicians should consider the possibility of acute coronary syndrome mimicking, and choose non-invasive diagnostic procedures when investigating the causes of ECG abnormalities associated with critically ill patients.

    DOI: 10.1016/j.ajem.2023.06.038

    Web of Science

    Scopus

    PubMed

  • Hyperoxemia is Associated With Poor Neurological Outcomes in Patients With Out-of-Hospital Cardiac Arrest Rescued by Extracorporeal Cardiopulmonary Resuscitation: Insight From the Nationwide Multicenter Observational JAAM-OHCA (Japan Association for Acute Medicine) Registry

    Nishihara, M; Hiasa, K; Enzan, N; Ichimura, K; Iyonaga, T; Shono, Y; Kashiura, M; Moriya, T; Kitazono, T; Tsutsui, H

    JOURNAL OF EMERGENCY MEDICINE   63 ( 2 )   221 - 230   2022.8   ISSN:0736-4679 eISSN:1090-1280

     More details

    Language:English   Publisher:Journal of Emergency Medicine  

    Background: Previous studies have shown an association between hyperoxemia and mortality in patients with out-of-hospital cardiac arrest (OHCA) after cardiopulmonary resuscitation (CPR); however, evidence is lacking in the extracorporeal CPR (ECPR) setting. Objective: The aim of this study was to test the hypothesis that hyperoxemia is associated with poor neurological outcomes in patients treated by ECPR. Methods: The Japanese Association for Acute Medicine OHCA Registry is a multicenter, prospective, observational registry of patients from 2014 to 2017. Adult (18 years or older) patients who had undergone ECPR after OHCA were included. Eligible patients were divided into two groups based on the partial pressure of oxygen in arterial blood (PaO2) levels at 24 h after ECPR: the high-PaO2 group (n = 242) defined as PaO2 ≥ 157 mm Hg (median) and the low-PaO2 group (n = 211) defined as PaO2 60 to < 157 mm Hg. The primary outcome was the favorable neurological outcome, defined as a Cerebral Performance Categories Scale score of 1 to 2 at 30 days after OHCA. Results: Of 34,754 patients with OHCA, 453 patients were included. The neurological outcome was significantly lower in the high-PaO2 group than in the low-PaO2 group (15.9 vs. 33.5%; p < 0.001). After adjusting for potential confounders, high PaO2 was negatively associated with favorable neurological outcomes (adjusted odds ratio [aOR] 0.48; 95% confidence interval [CI] 0.24–0.97; p = 0.040). In a multivariate analysis with multiple imputation, high PaO2 was also negatively associated with favorable neurological outcomes (aOR 0.63; 95% CI 0.49–0.81; p < 0.001). Conclusions: Hyperoxemia was associated with worse neurological outcomes in OHCA patients with ECPR.

    DOI: 10.1016/j.jemermed.2022.05.018

    Web of Science

    Scopus

    PubMed

  • Delayed administration of epinephrine is associated with worse neurological outcomes in patients with out-of-hospital cardiac arrest and initial pulseless electrical activity: insight from the nationwide multicentre observational JAAM-OHCA (Japan Association for Acute Medicine) registry

    Enzan, N; Hiasa, K; Ichimura, K; Nishihara, M; Iyonaga, T; Shono, Y; Tohyama, T; Funakoshi, K; Kitazono, T; Tsutsui, H

    EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE   11 ( 5 )   389 - 396   2022.6   ISSN:2048-8726 eISSN:2048-8734

     More details

    Language:English   Publisher:European Heart Journal: Acute Cardiovascular Care  

    Aims: The delayed administration of epinephrine has been proven to worsen the neurological outcomes of patients with out-of-hospital cardiac arrest (OHCA) and shockable rhythm or asystole. We aimed to investigate whether the delayed administration of epinephrine might also worsen the neurological outcomes of patients with witnessed OHCA and initial pulseless electrical activity (PEA). Methods and results: The JAAM-OHCA Registry is a multicentre registry including OHCA patients between 2014 and 2017. Patients with emergency medical services (EMS)-treated OHCA and initial PEA rhythm were included. The primary exposure was the time from the EMS call to the administration of epinephrine. The secondary exposure was the time to epinephrine dichotomized as early (≤15 min) or delayed (>15 min). The primary outcome was the achievement of a favourable neurological outcome, defined as Cerebral Performance Categories Scale 1-2 at 30 days after OHCA. Out of 34-754 patients with OHCA, 3050 patients were included in the present study. After adjusting for potential confounders, the delayed administration of the epinephrine was associated with a lower likelihood of achieving a favourable neurological outcome [adjusted odds ratio (OR) 0.96; 95% confidence interval (CI) 0.93-0.99; P = 0.016]. The percentage of patients who achieved a favourable neurological outcome in the delayed epinephrine group was lower than that in the early epinephrine group (1.3% vs. 4.7%; adjusted OR 0.33; 95% CI 0.15-0.72; P = 0.005). A restricted cubic spline analysis demonstrated that delayed epinephrine administration could decrease the likelihood of achieving a favourable neurological outcome; this was significant within the first 10 min. Conclusions: The delayed administration of epinephrine was associated with worse neurological outcomes in patients with witnessed OHCA patients with initial PEA.

    DOI: 10.1093/ehjacc/zuac026

    Web of Science

    Scopus

    PubMed

  • Transient receptor potential vanilloid 1-expressing cardiac afferent nerves may contribute to cardiac hypertrophy in accompany with an increased expression of brain-derived neurotrophic factor within nucleus tractus solitarius in a pressure overload model

    Shibata, R; Shinohara, K; Ikeda, S; Iyonaga, T; Matsuura, T; Kashihara, S; Ito, K; Kishi, T; Hirooka, Y; Tsutsui, H

    CLINICAL AND EXPERIMENTAL HYPERTENSION   44 ( 3 )   249 - 257   2022.4   ISSN:1064-1963 eISSN:1525-6006

     More details

    Language:English   Publisher:Clinical and Experimental Hypertension  

    Introduction: Increased sympathetic output contributes to cardiac hypertrophy. Sympathoexcitation is induced by activating the cardiac sympathetic afferent nerves through transient receptor potential vanilloid 1 (TRPV1) in cardiac afferent endings. Brainstem nucleus tractus solitarius (NTS) receives the sensory cardiac afferent inputs. Brain-derived neurotrophic factor (BDNF) is released within NTS from sensory neurons in an activity-dependent manner. Additionally, BDNF in NTS tonically regulates sympathetic activity. Therefore, we hypothesized that TRPV1-expressing cardiac afferent nerves contribute to cardiac hypertrophy in accompany with an increased BDNF expression in NTS. Methods and Results: Abdominal aortic banding (AB) or sham operation was conducted in wild-type C57BL/6 J (WT-AB) and TRPV1 knockout mice (TRPV1 KO-AB). At 8 weeks post-operation, echocardiographic left ventricular wall thickness and heart weight/body weight ratio were significantly greater in WT-AB than WT-Sham mice, and these hypertrophic indexes were attenuated in TRPV1 KO-AB mice. Among the groups, left ventricular fractional shortening was not different. The protein levels of TRPV1 in heart and BDNF in NTS were significantly increased in WT-AB compared to WT-Sham mice, whereas BDNF expression in NTS was not increased by AB in TRPV1-KO mice. Chemical ablation of TRPV1-expressing cardiac afferents attenuated the AB-induced cardiac hypertrophy and increase in BDNF in NTS. Sympathetic activity analyzed using heart rate variability, and sympathoexcitatory responses to the stimulation of cardiac afferents were increased in WT-AB compared to WT-Sham mice. Conclusion: TRPV1-expressing cardiac afferent nerves may contribute to pressure overload-induced cardiac hypertrophy in accompany with the increased BDNF within NTS.

    DOI: 10.1080/10641963.2022.2029470

    Web of Science

    Scopus

    PubMed

  • Impact of Antithrombin Activity Levels Following Recombinant Antithrombin Gamma Therapy in Patients with Sepsis-Induced Disseminated Intravascular Coagulation

    Akahoshi, T; Kaku, N; Shono, Y; Yamamoto, Y; Takahashi, K; Iyonaga, T; Momii, K; Nishihara, M; Maki, J; Tokuda, K; Yamaura, K

    CLINICAL AND APPLIED THROMBOSIS-HEMOSTASIS   28   2022   ISSN:1076-0296 eISSN:1938-2723

     More details

    Publisher:Clinical and Applied Thrombosis/Hemostasis  

    Recombinant antithrombin gamma (rAT) is reported as an effective drug for patients with disseminated intravascular coagulation (DIC) in Japan. As the appropriate dose and targeted AT activity remain unknown, this study aimed to determine these aspects for sepsis-induced DIC. Thirty-one patients with septic shock and DIC with AT levels <70% were treated with rAT between May 2018 and December 2020. The recovery rates from DIC were 32.2% and 63.3% on day 3 and 5 post administration, respectively. Recovery and survival rates were significantly higher in patients who achieved AT activity ≥70% or 80% on day 3 post administration. Receiver operating characteristic curve analysis revealed that the cutoff values of post-treatment AT activity on day 3 for 28-day survival and 5-day recovery from DIC were 79.5% and 81.5%, respectively. Patients who did not achieve AT activity ≥80% on day 3 presented a lower base level of AT activity and lower dose supplementation. Our results suggest that targeted AT activity should be at least 70%, and ideally 80%, and sufficient doses to maintain this activity are required to achieve better outcomes.

    DOI: 10.1177/10760296221135790

    Web of Science

    Scopus

    PubMed

▼display all

Presentations

▼display all

Professional Memberships

  • Japanese society for palliative medicine

  • The Japanese association of cardiac rehabilitation

  • The Japanese society of intensive care medicine

  • Japanese Association for Acute Medicine

  • The Japanese Circulation Society

  • The Japanese Society if Internal Medicine

▼display all

Outline of Social Contribution and International Cooperation activities

  • 救命救急センターに見学に来られる海外からの留学生を対象とした体験学習、小講義を実施する。

Social Activities

  • 第21回心肺蘇生法 市民公開講座

    日本循環器学会  福岡サンパレス  2023.3

     More details

    Audience: General, Scientific, Company, Civic organization, Governmental agency

    Type:Lecture

  • 2022年7月、BLSコース アシスタントインストラクター 2023年2月、JMECC講習会 アシスタントインストラクター 2023年3月、ACLSコース アシスタントインストラクター

    2022

     More details

    2022年7月、BLSコース アシスタントインストラクター
    2023年2月、JMECC講習会 アシスタントインストラクター
    2023年3月、ACLSコース アシスタントインストラクター