循環器ジャーナル66巻4号

2018年10月発行

特集 循環器救急の最前線—初期診療と循環管理を極める Ⅳ．循環管理を極める

心停止後症候群に対する体温管理療法

著者： 黒田泰弘¹

所属機関： ¹香川大学医学部救急災害医学

ページ範囲：P.577 - P.588

Point
・成人の心原性（推定を含む）心停止で，心拍再開後の循環動態が安定しているにもかかわらず昏睡状態の患者は，体温管理療法（32〜36℃の間の一定の体温で，少なくとも24時間）の適応となる．
・TTMは初期心電図波形がVF/VTの院外心停止に対して推奨されるが，電気ショック非適応の院外心停止や院内心停止に対しても行う．
・TTM施行方法には血管内冷却法や体表冷却法があるが効果に差はない．冷却輸液も院内では併用してよい．
・TTM施行時には適切に鎮静鎮痛などを行い，シバリングの予防と対策を行う．
・TTM施行時には発生が予想される合併症の予防と対策を行う．
・TTMの復温期，復温完了後の全身管理も重要である．TTM終了後も昏睡状態である場合，自己心拍再開から96時間は37.5℃程度に発熱をコントロールする．

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