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 Ⅴ．主な循環器救急疾患を診る

急性心不全・心原性ショック

著者： 中野宏己¹ 田原良雄²

所属機関： ¹東京医科大学病院循環器内科学分野 ²国立循環器病研究センター心臓血管内科部門

ページ範囲：P.640 - P.647

Point
・心不全の原因にかかわらず急性期の治療目標は心拍出量を増加させ，左室拡張末期圧を軽減させることである．
・Nohria-Stevenson分類に基づき患者の状態を把握し初期治療を開始する．
・急性心不全患者のなかでも“Wet ＆ Cold”の患者は特に重症であり注意が必要である．

参考文献

1) McKee PA, Castelli WP, McNamara PM, Kannel WB:The natual history of congestive heart failure:The Framingham Heart Study. N Engl J Med 285:1441-1446, 1971

2) Roberts E, Ludman AJ, Dworzynski K, et al;NICE Guideline Development Group for Acute Heart Failure:The diagnostic accuracy of the natriuretic peptides in heart failure:systematic review and diagnostic meta-analysis in the acute care setting. BMJ 350:h910, 2015

3) Forrester JS, Diamond G, Chatterjee K, Swan HJ:Medical therapy of acute myocardial infarction by application of hemodynamic subsets（second of two parts）. N Engl J Med 295:1404-1413, 1976

4) Nohria A, Tsang SW, Fang JC, et al:Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure. J Am Coll Cardiol 41:1797-1804, 2003

5) Ponikowski P, Voors AA, Anker SD, et al;ESC Scientific Document Group.:2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 37:2129-2200, 2016

6) Cuffe MS, Califf RM, Adams KF Jr, et al;Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure（OPTIME-CHF）Investigators:Short-term intravenous milrinone for acute exacerbation of chronic heart failure;a randomized controlled trial. JAMA 287:1541-1547, 2002

7) Bikdeli B, Strait KM, Dharmarajan K, et al:Intravenous Fluids in Acute Decompensated Heart Failure. J Am Coll Cardiol HF 3:127-133, 2015

8) Mebazaa A, Gheorghiade M, Piña IL, et al:Practical recommendations for prehospital and early in-hospital management of patients presenting with acute heart failure syndromes. Crit Care Med 36:S129-S139, 2008

9) Abraham WT, Adams KF, Fonarow GC, et al;ADHERE Scientific Advisory Committee and Investigators;ADHERE Study Group:In-hospital mortality in patients with acute decompensated heart failure requiring intravenous vasoactive medications:an analysis from the Acute Decompensated Heart Failure National Registry（ADHERE）. J Am Coll Cardiol 46:57-64, 2005

10) De Backer D, Biston P, Devriendt J, et al;SOAP Ⅱ Investigators.:Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med 362:779-789, 2010

11) Binanay C, Califf RM, Hasselblad V, et al;ESCAPE Investigators and ESCAPE Study Coordinators:Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness:the ESCAPE trial. JAMA 294:1625-1633, 2005