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
〒162-0801東京都新宿区山吹町358-5アカデミーセンター Japanese Society of Pediatric Cardiology and Cardiac Surgery Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Pediatric Cardiology and Cardiac Surgery 32(5): 365-378 (2016)
doi:10.9794/jspccs.32.365

ReviewReview

心筋炎から学ぶ:小児循環器分野を学ぶ医師のアウトカムを中心にOutcome-Based Clinical Training on Myocarditis for Physicians from Residents to Board-Certified Pediatric Cardiologists

1日本大学医学部医学教育企画・推進室Division of Medical Education Planning and Development, Nihon University School of Medicine ◇ Tokyo, Japan

2日本大学医学部附属板橋病院小児科Department of Pediatrics and Child Health, Nihon University School of Medicine ◇ Tokyo, Japan

発行日:2016年9月1日Published: September 1, 2016
HTMLPDFEPUB3

致死性心筋炎の死亡頻度は10万人あたり0.46人で,ウイルス性の原因が多い.神経症状や消化器症状などの心外症状から心筋炎を鑑別することが重要である.劇症化の予測として心電図や血液検査所見の経時的変化の観察が重要である.画像診断として心エコーでの収縮能低下や心膜液貯留は,専門医資格のない医師にとっても視覚的に理解しやすい所見である.急性期を脱した時点でのMRI, 核医学検査は専門医として診断に有用な低侵襲性モダリティである.致死的不整脈の合併は劇症型心筋炎に高頻度であり,回復期に不整脈が残存する症例には電気生理学的検査が必要な場合もある.治療について低心拍出状態や致死的不整脈合併例では補助循環療法の導入を積極的にすべきで,導入および離脱の施設基準が明確であることが望ましい.小児への大動脈内バルーンパンピングの心筋炎への使用は議論がある.免疫グロブリン療法およびステロイド療法の心筋炎に対する一定の治療的コンセンサスは得られていない.小児の劇症型心筋炎は急性期死亡も多いが,急性期に生還した症例であれば,神経学的後遺症を含め必ずしも予後不良な疾患ではない.

Here we describe outcome-based clinical training on myocarditis based on the achievement level of the physicians as follows: epidemiology, symptoms, blood examinations, imaging, pharmacotherapy, treatment devices, and prognosis. The mortality rate of fatal myocarditis is 0.46 per 10 million patients. Fulminant myocarditis should be considered based on the clinical findings, including any neurological or gastric symptoms. It is useful in the identification of advanced myocarditis to observe temporal changes from electrocardiography or blood examinations. Echocardiography sometimes demonstrates poor systolic function or pericardial effusion, which are specific findings in advanced myocarditis, and are also easy findings for residents to understand. Magnetic resonance imaging and nuclear medicine are minimally invasive diagnostic modalities and are available for the evaluation of impaired myocardium during the clinical course after the acute phase. Electrophysiological studies can be performed on patients if they still have arrhythmias during the convalescent phase. Venoatrial extracorporeal membrane oxygenation should be initiated using clear criteria from each institution for weaning off the device if the patients suffer from low output or fatal arrhythmias. The utility of intraaortic balloon pumping for children is still controversial. We have no clear consensus concerning the usefulness of steroid or immunoglobulin therapy. Patients who develop fulminant myocarditis do not always have an unfavorable prognosis if they can survive sudden terrible disease in acute phase.

Key words: arrhythmia; extracorporeal membrane oxygenation; fulminant; low output; nuclear medicine

This page was created on 2016-08-30T15:16:39.793+09:00
This page was last modified on 2016-09-28T20:03:19.991+09:00


このサイトは(株)国際文献社によって運用されています。