日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
Pediatric Cardiology and Cardiac Surgery 31(5): 240-245 (2015)
doi:10.9794/jspccs.31.240

原著Original

学校管理下における肥大型心筋症による心事故発生状況の変化Study of Cardiac Events Due to Hypertrophic Cardiomyopathy under School Management

阿部 百合子1，鮎沢 衛1，加藤 雅崇1，渡邉 拓史1，趙 麻美1，小森 暁子1，大熊 洋美1，市川 理恵1，神山 浩1，住友 直方2，伊東 三吾1，高橋 昌里1Yuriko Abe1, Mamoru Ayusawa1, Masataka Kato1, Hirofumi Watanabe1, Ami Cho1, Akiko Komori1, Hiromi Okuma1, Rie Ichikawa1, Hiroshi Kamiyama1, Naokata Sumitomo2, Sango Ito1, Shori Takahashi1

1 日本大学医学部小児科学系小児科学分野Division of Pediatrics and Child Health, Department of Pediatrics and Child Health, School of Medicine, Nihon University ◇ 〒173-8610 東京都板橋区大谷口上町30番1号30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo 173-8610, Japan

2 埼玉医科大学国際医療センター心臓病センター小児心臓科Department of Pediatric Cardiology, Heart Center, Saitama Medical University International Medical Center ◇ 〒350-1298 埼玉県日高市山根1397番地11397-1 Yamane, Hidaka-shi, Saitama 350-1298, Japan

受付日：2015年3月17日Received: March 17, 2015
受理日：2015年7月15日Accepted: July 15, 2015
発行日：2015年9月1日Published: September 1, 2015
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背景：肥大型心筋症（HCM）は学校管理下突然死の主要な原因の一つであるが，救急蘇生による救命例が報告され始め，予後が改善している可能性が予想される．

方法：2004年から2011年に学校災害共済給付制度に報告された心事故例中，原因がHCMと判断された例を検討した．

結果：調査期間中，HCMが原因の突然死は29例，蘇生後生存例は15例あった．生存例中，ICD埋込後1例を除く14例でAEDが使用された．死亡，生存例ともに男子が多かった．死亡例では幼稚園生や小学生を認めたが，生存例は中学・高校生のみであった．死亡例の48%，生存例の20%が事前にHCMと診断されていた．心事故は死亡，生存例とも運動中に多かった．

結論：非医療従事者によるAEDの使用が普及し，2007年以降はHCMによる学校管理下心停止の救命事例が報告され始めた．心臓系突然死予防のため，さらなるAED普及とICD適応の検討が重要と考えらえる．

Background: Hypertrophic cardiomyopathy (HCM) is a major cause of sudden death in children at school. However, more children with HCM are being successfully resuscitated after collapse due to the increasing availability and accessibility of basic life support systems. Therefore, the prognosis for children with HCM who experience cardiac events at school may be changing. This present study aimed to determine the outcome of cardiac events arising in children with HCM and the effect of automated external defibrillators (AED) applied under school supervision.

Methods: We retrospectively studied case reports of cardiac events submitted to mutual aid systems for schoolchildren with HCM between 2004 and 2011.

Results: Among 44 children with HCM who experienced sudden cardiac events at school, 29 died and 15 survived after resuscitation. An AED was applied to 14 of the survivors, and one already had an implantable cardioverter defibrillator (ICD). Males predominated among both the deceased and the survivors. Among children with HCM who experienced cardiac events in kindergarten, primary school, junior high school, and high school, only those in junior high school and high school survived. The ratios (%) of the deceased and the survivors that had been diagnosed with HCM before cardiac events occurred were 48% and 20%, respectively. Cardiac events occurred most frequently during exercise in both the deceased and the survivors.

Conclusions: The number of children with HCM who are resuscitated after cardiac arrest while at school has increased in Japan since 2007. Both AED and ICD are essential in preventing sudden death due to HCM in schoolchildren.

Key words: hypertrophic cardiomyopathy; sudden cardiac death; automated external defibrillator; implantable cardioverter defibrillator; schoolchildren

© 2015 特定非営利活動法人日本小児循環器学会© 2015 Japanese Society of Pediatric Cardiology and Cardiac Surgery

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