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
Pediatric Cardiology and Cardiac Surgery 38(2): 117-125 (2022)
doi:10.9794/jspccs.38.117

原著Original

先天性心疾患をもつ乳幼児の計画外入院に関する実態調査Unplanned Hospital Readmission of Infants with Congenital Heart Disease

豊島 めぐみ1,2，久山 かおる3，新田 紀枝3，早川 りか3，豊島 美樹4，小澤 秀登5，江原 英治6Megumi Toyoshima1,2, Kaoru Kuyama3, Norie Nitta3, Rika Hayakawa3, Miki Toyoshima4, Hideto Ozawa5, Eiji Ehara6

1 武庫川女子大学大学院看護学研究科博士後期課程Doctoral course, Graduate School of Nursing, Mukogawa Women’s University ◇ Hyogo, Japan

2 梅花女子大学看護保健学部Department of Nursing, Baika Women’s University ◇ Osaka, Japan

3 武庫川女子大学大学院看護学研究科Graduate School of Nursing, Mukogawa Women’s University ◇ Hyogo, Japan

4 大阪市立総合医療センター看護部Department of Nursing, Osaka City General Hospital ◇ Osaka, Japan

5 大阪市立総合医療センター小児医療センター小児心臓血管外科Department of Pediatric Cardiovascular Surgery, Osaka City General Hospital ◇ Osaka, Japan

6 大阪市立総合医療センター小児医療センター小児循環器内科Department of Pediatric Cardiology, Osaka City General Hospital ◇ Osaka, Japan

受付日：2021年12月8日Received: December 8, 2021
受理日：2022年4月6日Accepted: April 6, 2022
発行日：2022年5月1日Published: May 1, 2022
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背景：在宅で生活する乳幼児期の先天性心疾患児は，計画外に入院することがある．計画外入院を防ぐ支援を検討するためには，原因を明らかにする必要があると考え，患児数や原因などの実態を調査した．

方法：A病院で5年間に入院歴のある乳幼児期の先天性心疾患児のDPCと診療記録を対象にデータ収集し分析を行った．

結果：乳幼児期の先天性心疾患児の35.4％が計画外入院を要した．そのうち，0歳児は31.7％と有意に多く，染色体異常を合併する患児が多かった．主な原因は，肺炎や気管支炎などの呼吸器合併症，心不全，SpO2低下やチアノーゼ，低酸素血症などを含む呼吸状態の悪化であった．在宅酸素療法は50.3％，在宅人工呼吸療法は7.9％，在宅経管栄養療法は26.0％で使用していた．

結論：先天性心疾患児の計画外入院は，0歳児が最も多く，先天性心疾患による体肺循環の障害に加え，呼吸機能と循環機能の未発達さや脆弱性による影響があった．計画外入院を防ぐためには，病院から在宅と切れ目のない支援，訪問看護などの医療職の支援が必要である．

Background: Infants with congenital heart disease living at home may have unscheduled hospitalizations. Efforts to moderate unplanned hospitalizations require clarifying the causation of such incidents; therefore, we conducted a study to identify the related etiological factors along with the total number of children affected.

Methods: The medical records of children with congenital heart disease in infancy who had been hospitalized at hospital A during a period of 5 years were collected and analyzed.

Results: Unplanned hospitalization was required for 35.4％ of children with congenital heart disease in infancy. Most of these hospitalized patients were aged ＜1 year (31.7％), and many of them had chromosomal abnormalities. The main causes were respiratory complications such as pneumonia and bronchitis as well as worsening cardiorespiratory status, including heart failure, low SpO2, cyanosis, and hypoxemia. Home oxygen therapy was used in 50.3％, home ventilatory therapy in 7.9％, and home tube-feeding therapy in 26.0％.

Conclusions: Unplanned hospitalization of children with congenital heart disease was most common in children less than 1 year of age. It was affected by the underdevelopment and vulnerability of respiratory and circulatory functions. Minimizing unplanned hospitalizations will require seamless support from both medical professionals in the institution and nursing staff in the home.

Key words: congenital heart disease; infants; unplanned hospital readmissions

© 2022 特定非営利活動法人日本小児循環器学会© 2022 Japanese Society of Pediatric Cardiology and Cardiac Surgery

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