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(6): 485-497 (2016)
doi:10.9794/jspccs.32.485

ReviewReview

学校管理下突然死の現状と課題:救急蘇生・AED普及に伴うパラダイムシフトSudden Death under School Supervision: A Paradigm Shift with Resuscitation and Automated External Defibrillator Availability in Emergencies

日本大学医学部小児科学系小児科学分野Department of Pediatrics and Child Health, Nihon University School of Medicine ◇ Tokyo, Japan

受付日:2016年6月9日Received: June 9, 2016
受理日:2016年8月27日Accepted: August 27, 2016
発行日:2016年11月1日Published: November 1, 2016
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学校管理下の心臓系突然死は,1980年代には発生率約0.5件(/10万生徒・年)であったが,徐々に減少し,2010年以降は0.1件(/10万生徒・年)未満まで低下した.その要因として,学校教職員による救急救命処置とくにAEDの使用効果が大きいと考えられる.原因疾患の一部は学校心臓検診などにより事前に予想された例もあるが,発症前の病歴や検診では異常なく,予期されない心停止として発症し,解剖を行っても原因不明の例が多い.その中には致死的遺伝性不整脈の例が多いと考えられ,解明のため遺伝的情報を集める体制を策定する必要がある.また,現在の心臓検診で発見できない疾患が解剖で判明することもあり,監察医制度の意義は大きいが,日本では地域が限定されている問題があり,剖検で発見されやすい疾患に焦点を当てて検診方法を見直す必要もあろう.心臓系突然死の減少傾向は明らかになったが,中枢神経疾患や,乳幼児突然死症候群に分類される事例については,まだ病態の解明と対策は十分とは言えない.これらの課題に対して,日常診療や検診による危険性予知と,救命措置の充実との両面から,突然死の克服が更に進むことが望まれる.

The number of sudden deaths of school students has been decreasing year by year in Japan. The incidence of sudden death in Japanese schools after 2010 decreased to lower than 0.1 per 100,000 students per year from 0.5 in the 1980’s. The use of an automated external defibrillator (AED) by caregivers in schools may have contributed to this result. Some cases of sudden death occur because of previously diagnosed cardiovascular disease identified by the screening system for students in Japanese schools. However, more than half of cases of sudden cardiac arrest in schools are not previously diagnosed with cardiac disease and are partly identified on autopsy. A large part of these are probably caused by genetic life-threatening arrhythmias; therefore, it is necessary to perform as many genetic examinations as possible. Autopsies occasionally reveal structural heart disease as the cause of sudden unexpected cardiac arrest. However, the Japanese forensic system is limited to several big cities. It may be necessary to reconsider the screening system for discovering causative cardiac disease that is often discovered on autopsy. Besides sudden death due to cardiovascular disease, some cases are secondary to central nervous system issues. Sudden unexpected deaths in preschool children, including sudden infant death syndrome, are also reported every year. These also need to be analyzed and discussed for prevention. Cooperation of the screening system and the chain of survival will be expected to contribute to a more marked advance for preventing sudden death.

Key words: school; sudden death; cardiac arrest in school; basic life support; automated external defibrillator

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This page was last modified on 2016-12-02T15:47:34.659+09:00


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