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 36(3): 178-185 (2020)
doi:10.9794/jspccs.36.178

ReviewReview

循環生理を踏まえた呼吸管理,呼吸生理を踏まえた循環管理Respiratory Management Based on Cardiovascular Physiology, and Cardiovascular Management Based on Respiratory Physiology in Pediatric Cardiology

静岡県立こども病院 循環器集中治療科Department of Cardiac Intensive Care, Shizuoka Children’s Hospital ◇ Shizuoka, Japan

発行日:2020年10月1日Published: October 1, 2020
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生体に酸素を取り込み二酸化炭素を排出する点で小児と成人は同じである.心臓と呼吸の関係においても,心不全増悪時に左室拡張末期圧の上昇により肺鬱血を生じ,その対応に利尿剤や陽圧が有効なことも同様である.その認識のうえで,サイズが小さい,呼吸数が多い,胸郭コンプライアンスが高いなどの小児の生理学的特徴を考慮に入れるべきである.特に気道抵抗に与えるサイズの影響は大きく,小児では僅かな変化でも大きな影響を及ぼす.また死腔の影響も体格が小さいと無視できない.さらに先天性心疾患では肺血流と体血流が異なる場合が多く,肺血流増加による気道への影響や,酸素投与が肺血流に与える影響なども考慮しなければならない.二心室循環では左室補助となる陽圧呼吸がFontan循環では心拍出量が減る,といった特殊な動きもある.小児循環器疾患においては「循環生理を踏まえた呼吸管理,呼吸生理を踏まえた循環管理」が必須である.

From a physiologic perspective, children are equal to adults. In congestive heart failure, elevated left end-diastolic pressure causes pulmonary venous congestion, and leads to capillary leakage into the alveoli. In this situation, diuretics and positive airway pressure are useful in both adults and children; however, pediatricians should also consider children’s characteristics. For example, a child’s airway is small, which has an impact on airway resistance, particularly when it is swollen. Dead space is another key factor that needs to be considered. Furthermore, in many congenital heart diseases, pulmonary blood flow is not equal to systemic blood flow. Thus, pediatric cardiologists must consider the relationship between pulmonary blood flow and the airway, and the impact of oxygen therapy on pulmonary blood flow. Moreover, it is important to determine specific reactions in congenital heart diseases. For example, in normal circulation, positive intrathoracic pressure assists the left ventricle myocardium; however, in Fontan patients, positive intrathoracic pressure decrease cardiac output. Therefore, pediatric cardiologists must be familiar with cardiovascular physiology and respiratory physiology, and their interaction (i.e., the cardiopulmonary interaction).

Key words: pediatric cardiology; congenital heart disease; respiratory physiology; cardiovascular physiology; cardiopulmonary interaction

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This page was last modified on 2020-10-19T15:50:58.000+09:00


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