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 38(1): 3-14 (2022)
doi:10.9794/jspccs.38.3

ReviewReview

一般小児科医のための小児循環動態の考え方小児の心疾患を診るこつApproach to Pediatric Hemodynamics for General Pediatricians: Tips for Treating Pediatric Heart Disease

手稲渓仁会病院小児科Department of Pediatric Cardiology, Teine-Keijinkai Hospital ◇ Sapporo, Japan

発行日:2022年2月1日Published: February 1, 2022
HTMLPDFEPUB3

小児診療においては,一般小児科医であっても先天性心疾患(CHD)や小児の循環評価に携わらなければならない場面にしばしば遭遇する.循環の役割は肺で取り込まれた酸素を身体の各臓器に必要なだけ届けることであり,そのための心拍出量を保つことである.心内や大血管の間で短絡がある場合は,心室以降は肺体血管抵抗の違いによって,心房間では両心室のコンプライアンスの違いによって短絡方向・量が規定される.種々のCHD管理を考えるうえでは,肺血流が増多する疾患か減少する疾患かに分類するとシンプルでわかりやすい.一般小児科医が未診断のCHD患者に出会ったときには,最低限,酸素投与を行ってよいか,なるべくしないほうがよいか,動脈管開存が必要な疾患か否かを判断する必要がある.小児の循環動態を評価するためにはもちろん詳細な問診や身体診察が重要であり,また心臓超音波検査は簡便で有益な所見を得られるツールであるが,他のモダリティもあわせて総合的に判断することが求められる.

Congenital heart disease is a common condition in children, and general pediatricians are frequently called in to access the hemodynamics of the disease. The role of circulation is to deliver enough oxygen, taken up by the lungs, to each organ in the body while maintaining cardiac output for that purpose. If there are defects or shunts in the heart or between large blood vessels, the direction and amount of the shunt are defined by the difference in systemic and pulmonary vascular resistance in posttricuspid shunts (ventricular septal defect, patent ductus arteriosus, etc.) and by the difference in compliance between both ventricles in pretricuspid shunts (atrial septal defect). When it comes to managing various congenital heart diseases, it is simple to understand whether the disease is classified by an increase or decrease in pulmonary blood flow. When a general pediatrician encounters a patient with undiagnosed congenital heart disease, the least they should do is determine whether the disease requires patent ductus arteriosus and whether oxygen administration is necessary. Although echocardiography is the simplest and most useful tool for evaluating children’s hemodynamics at bedside, pediatricians should make a comprehensive decision by including other modalities.

Key words: pediatric hemodynamics; congenital heart disease; heart failure; general pediatricians; practitioners

This page was created on 2022-03-31T16:45:55.865+09:00
This page was last modified on 2022-05-25T19:42:30.000+09:00


このサイトは(株)国際文献社によって運用されています。