日本における小児重症心不全患者の病院間搬送：単施設経験の検討

Jun Narita; 成田淳; Shigetoyo Kogaki; 小垣滋豊; Ryo Ishii; 石井良; Hidekazu Ishida; 石田秀和; Takayoshi Ueno; 上野高義; Yoshiki Sawa; 澤芳樹; Keiichi Ozono; 大薗恵一

doi:10.9794/jspccs.36.57

日本における小児重症心不全患者の病院間搬送：単施設経験の検討Interhospital Transport of Children with Severe Heart Failure in Japan: Analysis of a Single-Center Experience

成田淳¹，小垣滋豊²，石井良¹，石田秀和¹，上野高義³，澤芳樹³，大薗恵一¹Jun Narita¹, Shigetoyo Kogaki², Ryo Ishii¹, Hidekazu Ishida¹, Takayoshi Ueno³, Yoshiki Sawa³, Keiichi Ozono¹

¹ 大阪大学大学院医学系研究科小児科Department of Pediatrics, Osaka University of Graduate School of Medicine ◇ Osaka, Japan

² 大阪府立急性期・総合医療センター小児科新生児科Department of Pediatrics and Neonatology, Osaka General Medical Center ◇ Osaka, Japan

³ 大阪大学大学院医学系研究科心臓血管外科Department of Cardiovascular Surgery, Osaka University of Graduate School of Medicine ◇ Osaka, Japan

受付日：2019年5月30日Received: May 30, 2019

受理日：2019年11月21日Accepted: November 21, 2019

発行日：2020年3月1日Published: March 1, 2020

背景：改正臓器移植法施行後，全国から小児重症心不全患者の相談が増加するのに伴い，ハイリスク患者の病院間搬送も重要な課題となっている．

方法：2010年7月～2018年12月に重症心不全のため病院間搬送となった42症例を対象とした．患者背景，搬送形態，搬送後補助人工心臓（VAD）装着状況，予後を調査し，病院間搬送に伴う課題を検討した．

結果：原疾患は，拡張型心筋症25例，拘束型心筋症12例，急性心筋炎5例であり，搬送形態は，陸路26例，空路16例であった．人工呼吸管理22例（52.3％），補助循環装着14例（33.3％）と集中治療継続下の搬送が多く，搬送直後に治療強化を要する例が8例あり，より低年齢の症例で必要となる傾向にあった．最終的に8割以上がVAD装着となり，10例が心臓移植に到達，死亡例は11例であった．

結語：小児重症心不全患者の病院間搬送には，早期からの情報共有と状況に応じた搬送計画が重要であり，人員の確保と経験を要する特殊な領域である．同時に中枢ルート確保時の留意や家族ケアにも配慮が必要であり，よりよい病院間搬送の体制づくりが望まれる．

Background: The number of medical consultations for severe heart failure in pediatric patients has been increasing in all regions in Japan. As a result, high-risk interhospital transport is becoming a more challenging task.

Methods: Forty-two pediatric patients with severe heart failure who were transferred to our hospital between July 2010 and December 2018 were reviewed. We investigated patient characteristics, type of transport, and outcomes after transportation, including implantation of a ventricular assist device. We also discuss practical issues of interhospital transportation in Japan.

Results: The underlying cardiac diseases were dilated cardiomyopathy in 25 patients, restrictive cardiomyopathy in 12 patients, and acute myocarditis in 5 patients. Twenty-six patients were transferred by land and 16 patients by air. The continuation of intensive care was mandatory especially in 22 cases (52.3％) with ventilator and 14 (33.3％) with PCPS. More than 80％ of cases required VAD implantation after interhospital transport. In addition, 8 cases who needed treatment intensification after transportation tend to be younger. Ten patients underwent heart transplantation, whereas 11 cases were deceased. It is also important to consider appropriate blood access and to provide sufficient information to family members.

Conclusion: Early interhospital collaboration and transport planning based on a patient’s condition are essential for the treatment of severe heart failure in pediatric patients. Interhospital transportation should be supported by a medical team with special experience. To improve the prognosis of severe heart failure in children, we need to consider further improvement in the management of interhospital medical transport.

Key words: pediatric heart failure; pediatric heart transplantation; transport; ventricular assist device

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

原著Original

日本における小児重症心不全患者の病院間搬送：単施設経験の検討Interhospital Transport of Children with Severe Heart Failure in Japan: Analysis of a Single-Center Experience