日本未熟児新生児学会雑誌　第19巻　第2号　79～84頁（2007年）

日本未熟児新生児学会雑誌　19(2)：245-250；2007　

受付日：平成18．05．30

受理日：平成18．10．01

先天性心疾患と先天性外科疾患との重複症例に関する検討

A Study on Neonates Who Had Overlapping Complications of Congenital Heart Disease and Neonatal Surgical Disorder

＊1近畿大学医学部奈良病院　小児科，＊2同　小児外科

＊1　Department of Pediatrics，Nara Hospital，Kinki University School of Medicine，＊2　Department of Pediatric Surgery, Nara Hospital, Kinki University School of Medicine

扇谷綾子＊1・吉澤弘行＊1・久保里美＊1・吉林宗夫＊1・三崎泰志＊1・北村則子＊1・鎌田航也＊1・米倉竹夫＊2・小角卓也＊2・大割　貢＊2・箕輪秀樹＊1

Ayako OHGITANI＊1，Hiroyuki YOSHIZAWA＊1，Satomi KUBO＊1，Muneo YOSHIBAYASH I＊1， Yasushi MISAKI＊1，Noriko KITAMURA＊1，Koya KAMADA＊1，Takeo YONEKURA＊2， Takuya KOSUMI＊2，Mitsugu OWARI＊2，Hideki MINOWA＊1

Key Words：congenital heart disease，congenital surgical disease，long-term hospitalization，family support

　先天性心疾患と先天性外科疾患とを重複合併した症例（以下，重複症例）に関する臨床的検討を行った。1999年10月から2005年3月までの5年6か月間に当院NICUで入院管理した498例のうち重複症例は26例であった。そのうち染色体異常および奇形症候群の合併は20例（77％），手術を要した症例は23例（88％）であった。重複症例は周術期管理を含め高度医療を要し，基礎疾患に伴う合併症のために平均入院日数は170±175日と長期におよんだ。NICUから自宅へ直接退院した症例は4例（15％）のみで，小児病棟へ転棟後に退院した症例が18例（69％），死亡退院が3例（12％），転院が1例であった。重複症例は医療的ケアを要する重症例が多く，そのため各症例毎の重症度に応じた迅速な各科の連携や，退院後には呼吸管理を含めた医療的ケアと療育機能を併せもつ施設の整備，さらには在宅支援システムの整備が必要であると思われた。

　We clinically examined neonates who had overlapping complications of congenital heart disease and neonatal surgical disorder（hereafter to be referred to as neonates with overlapping complications）. During a period of 5 years and 6 months between October 1999 and March 2005, 498 neonates were admitted to the neonatal intensive care unit（NICU） of our hospital, 26 of whom were neonates with overlapping complications. Of the 26 neonates, 20（77％）were complicated by chromosomal aberrations and anomaly syndromes and 23（88％）required surgery. Neonates with overlapping complications necessitated sophisticated medical care including perioperative management, and the average length of hospital stay was as long as 170±175 days due to complications which were associated with underlying disease. There were only 4（15％）neonates with overlapping complications who were discharged directly from NICU to home, with 18（69％）who were discharged from the hospital after their transfer to the pediatric ward, 3（12％）who were discharged dead from the hospital, and 1（4％）who moved to another hospital. Many of neonates with overlapping complications present severe disease and require advanced medical care, thus warranting 1）the expeditious multidisciplinary cooperation in parallel with the severity of each neonate's disease, 2）maintenance of facilities which can provide both medical care（including respiratory management after discharge）and habilitation function, 3）and maintenance of a domiciliary care-supporting system.