1 静岡県立こども病院循環器科Department of Cardiology, Shizuoka Children’s Hospital ◇ Shizuoka, Japan
2 静岡県立こども病院循環器集中治療科Cardiac Intensive Care Unit, Shizuoka Children’s Hospital ◇ Shizuoka, Japan
背景：機械的呼吸循環補助（cardiopulmonary support; CPS）は，蘇生や周術期管理において重要な位置を占めており，離脱へ向けては積極的な治療介入を要することが多い．
目的および方法：2007年6月から2015年10月に当院で施行したCPS下のカテーテル治療（CI）の経験について診療録をもとに検討し報告する．
結果：期間中CPS装着は71例，CPS下で10例に心臓カテーテルを施行し，うち6例にのべ7回のCIを行った．CPS導入理由は開心術後人工心肺離脱不可2例，呼吸不全，循環不全，あるいは右室流出路からのハイブリッド治療のため，選択的にCPS導入した例が4例であった．CI前からCPS装着していた4例は手技成功後平均4.3日で全例離脱可能となった．選択的にCPS導入した2例は手技終了後速やかにCPSから離脱した．CI終了と同時にCPSを離脱した1例で出血が多く，翌日外科的な止血術を要し引き続き縦隔洞炎を発症したが，他に合併症は認めなかった．
結語：CPS下CIは，多彩でありながらも安全に施行可能であり，CPS離脱率すなわち救命率向上に有用であった．心機能低下例では選択的CPSを導入下のハイブリッド治療も考慮すべきである．
Background: Cardiopulmonary support (CPS) plays an important role in cardiopulmonary resuscitation and peri-operative management. In addition, active therapeutic intervention is often necessary for weaning from the support system.
Purpose and Method: Retrospective study of the catheter interventions (CIs) experienced in our institute since June 2007 until October 2015 are included and assessed in this study.
Results: In the study period, CPS was installed in 71 cases, and of them, 10 cases underwent cardiac catheterization including 6 cases (7 sessions) of catheter-based therapeutic procedures. Failure to be weaned off the cardiopulmonary bypass after surgery, respiratory or circulatory failure, and preparation for hybrid approach by right ventricular outflow tract puncture were the reasons for installation of CPS. Four cases to which CPS was installed before CI were weaned from it mean 4.3 days after the CI. In two cases, CPS was prepared electively and weaned off immediately after the CI. A case of hybrid procedure was complicated by excessive bleeding after decannulation that required surgical hemostasis next day and subsequent mediastinitis. There were no other complications related to the procedures.
Conclusions: CIs under CPS in this study featured wide variety and safe performance, and contributed to successful weaning and survival. In the cases of poor circulatory status, it will be one of favorable options to prepare CPS before the hybrid procedure.
Key words: cardiopulmonary support; extracorporeal membrane oxygenation; catheter intervention; postoperative period; hybrid procedure
© 2018 日本Pediatric Interventional Cardiology学会© 2018 Japanese Society of Pediatric Interventional Cardiology
This page was created on 2018-01-31T13:32:17.662+09:00
This page was last modified on 2018-08-07T13:31:46.364+09:00
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