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): 192-201 (2020)
doi:10.9794/jspccs.36.192

ReviewReview

循環生理をわかって評価と治療循環不全の管理Hemodynamic Analysis-Based Therapeutic Intervention for Circulatory Failure in Pediatric Patients

岩手医科大学小児科学講座Department of Pediatrics and Pediatric Cardiology, Iwate Medical University School of Medicine ◇ Iwate, Japan

発行日:2020年10月1日Published: October 1, 2020
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循環不全は生命の危機に瀕した病態であり,“適切な治療によって循環動態を改善させること”は,小児循環器医師にとって最も重要な任務の一つである.不適切な治療戦略は循環を増悪させ,緊急手術や補助循環による治療を余儀なくする一方,適切な管理は,予後改善に直結する.心室血管統合関係の概念は,Frank–Starlingの心臓法則として心機能と前負荷の関係で論じられてきた循環管理の概念を,具体的に図示し,更に後負荷や拡張機能“同じ次元で考えられること”を明らかにした点で画期的である.この概念を用いることによって,数ある治療方針のなかで最も効率の良い治療を選択する根拠を示すことが可能となる.本稿では小児循環器病学の初学者を対象として,循環管理の考え方を症例とともに提示する.

Circulatory failure is a life threating condition for which every pediatric cardiologist should be prepared to perform physiological analyses, make optimal therapeutic decisions, and secure the best outcome. The correct approach for determining the cause of circulatory failure can accelerate the patients’ recovery from a critical condition, as well as mitigate in allowing their outcome, whereas patients can rapidly deteriorate if their management is inadequate. The integrated concept of cardio-vascular interactions, the pressure-volume relationship, is not novel, but it is vital in allowing clinicians to understand the underlying physiology of circulatory failure. Furthermore, the pressure-volume relationship has the advantage of describing both cardiac function and its loading condition in the same dimension. Accordingly, the pressure-volume relationship can help clinicians to determine the best available therapeutic intervention. This review aimes to convey the initial steps involved in assessing hemodynamic issues in children with circulatory failure.

Key words: circulatory failure; heart failure; Fontan circulation

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This page was last modified on 2020-10-19T14:54:48.000+09:00


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