大阪母子医療センター小児循環器科Department of Pediatric Cardiology, Osaka Women’s and Children’s Hospital ◇ Osaka, Japan
背景：先天性心疾患は，成人期に心不全で死亡する患者が増加している．慢性心不全の緩和ケアが重要視されてきているが，若年での心不全緩和ケアの報告は少ない．
方法：2000年から2020年に当院で死亡した10歳以上の小児心疾患患者のうち心不全死の7症例を対象とした．心不全死の頻度，患者の背景，終末期症状，各薬物使用状況，人工呼吸器の使用，多職種カンファレンス，本人告知，心理士介入について後方視的に検討した．
結果：心不全での死亡時年齢は中央値15歳（10～24歳）．多職種カンファレンスは2例（29％），本人告知は1例であった．鎮静薬は5例（71％）で使用されていたが，経口挿管患者以外のオピオイド使用は0％であった．呼吸困難はほぼ全例で認めた．
結論：心不全のコントロールだけでなく，疼痛や精神的な症状に対する緩和ケアを行うために，多職種連携を行った緩和医療体制の確立が必要である．
Background: With the improved outcomes of congenital heart diseases, the number of patients dying from heart failure in adulthood is increasing. Palliative care for chronic heart failure is becoming increasingly important, but only few studies have reported on pediatric palliative care for patients with heart failure.
Methods: Pediatric cardiac patients aged ＞10 years who died between 2000 and 2020 were included. The characteristics of the patients who died from heart failure, including their clinical symptoms, medications, ventilators, multi-professional conferences, informed consent, psychologist intervention, and chest compressions, were studied retrospectively.
Results: Seven patients died from heart failure, which was the most common cause of death. The median age at the time of death from heart failure was 15 years (range, 10–24 years). Multi-professional palliative conferences were held for two cases (29％), and informed consent was provided for one case. Sedation drugs were used in five patients (71％), but opioids were not used in any of the cases except for the orally intubated patients. Dyspnea was present in almost all the patients.
Conclusion: Palliative care for patients with pediatric heart failure is still developing, and a multi-professional palliative care team and system must be established.
Key words: palliative care; pediatric; heart failure; end of life; congenital
© 2021 特定非営利活動法人日本小児循環器学会© 2021 Japanese Society of Pediatric Cardiology and Cardiac Surgery
This page was created on 2021-11-30T15:25:34.543+09:00
This page was last modified on 2021-12-17T11:29:32.000+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。
