日本未熟児新生児学会雑誌　第23巻　第1号　95～100頁（2011年）

日本未熟児新生児学会雑誌　23(1)：95-100；2011　

受付日：平成22．03．29

受理日：平成22．07．06

当センターにおける18トリソミー児に対する積極的医療介入による治療と予後の変化

Management and Outocome in Trisomy 18 Syndrome

大阪市立総合医療センター　新生児科

Department of Neonatology, Osaka City General Hospital

岩見裕子・寺田明佳・松村寿子・原田明佳・大西　聡・田中裕子・江原英治・市場博幸

Hiroko IWAMI，Sayaka TERADA，Hisako MATSUMURA，Sayaka HARADA，Satoshi OHNISHI，Yuko TANAKA，Eiji EHARA，Hiroyuki ICHIBA

Key Words：trisomy 18 syndrome，survival，intensive care，cardiac surgery，causes of death

　1994年以降，大阪市立総合医療センターNICUに入院した18トリソミー児30症例について診療録を後方視的に解析し，18トリソミー児に対する心臓外科治療を含む積極的な医療介入が生存日数や在宅への移行を増加させるかどうか，また死因に変化を与えるか否かを検討した。治療方針変更前後で在胎期間や出生体重などの症例の特徴に有意差はなく，合併症についても偏りを認めなかった。生存率は，日齢1，7，生後1か月，6か月で方針変更後の方が有意に高かった。在宅へ移行できる児の割合も方針変更後の方が高かった。生存期間1か月未満の症例の死因のほとんどが，呼吸不全と心不全であったのに対して，生存期間6か月以上の症例では感染症を契機に死亡する症例が半数以上を占めた。心臓血管外科を含む積極的な介入を行うことで，18トリソミー児の生存期間は延長し，在宅へ移行できる児の割合も増加した。このことは死因にも変化をもたらした。

　Newborn babies with trisomy 18 have not been intensively treated because of its poor prognosis. As such, we have withheld treatments for the babies with trisomy 18, but began properly treating them after 2005. This treatment included respiratory support like mechanical ventilation and palliative cardiovascular operation, by referring to new reports from all over the world indicating that the intensive care for those babies could lead to a better prognosis. We studied effectiveness of intensive management of 30 cases with Trisomy 18 who were administered in NICU of Osaka City General Hospital from 1994 to 2009. We obtained data on duration of survival, cause of death, and number of patients who returned home, and cross referenced them for differences between the management policies, to withhold or to treat intensively. The survival rate of a week, a month, and a half an year were examined and found that a significantly higher rate was seen with intensive care treatment. Concomitantly, an increase was seen in the number of patients able to be discharged from NICU to stay home with their families. The main cause of death has changed from heart failure and respiratory failure to infection. It is obvious that the proper care has improved the state of the patients’ life.