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		<h1 class="catchCopy">心不全が1テーマ3分でわかる！心不全診療のエッセンス</h1>
		

		<h1 class="title titleWidth">心不全の基礎知識100<span class="version">第2版</span></h1>
		

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					著：佐藤幸人（兵庫県立尼崎総合医療センター循環器内科部長）
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">難解な解説になりがちな心不全を，豊富な図表と1テーマ3分程度で読める分量で分かりやすく説いた，現在の心不全診療を俯瞰できる手引き書．医師中心の治療のみならず，施設・職種に依らず治療に介入できる可能性も示唆している．心不全の診療に不可欠な知識を厳選して収録しており，心不全診療にかかわる全ての職種の共通言語となり得る1冊．最新の治療や緩和ケアを含めた医療システムの知識を大幅にアップデートした改訂版．</section><section class="preface">第2版序文<br><br>　第1版を出版してから早くも8年が経過しました．当時は心不全の本といえば基礎研究など難解なものが多く，専門家にしか理解できないものが大半でした．一方で，心不全患者は増加し，社会的問題となる様相を呈しつつあった時代でした．そこで，誰でも簡単に心不全を理解できるような，あえて簡単な本を作成しようというのがねらいでした．さらに，心不全は医学的視点だけでは解決できないことが多いこともあり，多職種チーム医療の観点も盛り込んだ内容としました．<br>　しかし今，読み返してみると当時は客観的なことが書けずに主観的な記述で終わっていた箇所や推測や願望の域を出ない記述が多くあります．8年間に出てきた社会的・医学的話題も多く，特に厚生労働省が「地域包括ケアシステム」の構築を打ち出し，心不全の緩和ケアにも診療報酬が認められたことは今後の診療体制に大きく影響を及ぼすと考えています．そこでPart.4，5は項目自体を大きく変更しました．また，さらなる10年間を見越してPart.6を設けました．学術的内容は最新のガイドラインに準拠し，その一方で心不全チーム医療の実践，最新の栄養指導や緩和ケアなどの話題を多く盛り込んでいます．<br>　今回，このような改訂を加えることができたのは，多職種チーム医療を10年間続けられたおかげであります．ともに患者を診てきた兵庫県立尼崎総合医療センターの医師，看護師，薬剤師，管理栄養士，心臓リハビリ室のスタッフ，ソーシャルワーカーのメンバーに感謝するとともに，多くの新しい取り組みを私に教えてくださった，全国のチーム医療を行っているメディカルスタッフの皆さんにも心より感謝いたします．患者さんとその家族が，心不全という難治性・進行性・致死性の病気と闘いながらも，よりよい人生を過ごされることを心より願います．<br><br>2019年1月<br>兵庫県立尼崎総合医療センター循環器内科部長<br>佐藤幸人</section><section class="indexes">Part.01　概念・病態<br>　1 はじめに心不全の原因疾患と悪化因子，予後不良因子を理解する<br>　2 心不全の疫学データの注意点<br>　3 心不全の評価項目に完璧なものは存在しない<br>　4 慢性心不全と急性心不全は連続した概念でとらえる<br>　5 右心不全と左心不全の関係<br>　6 収縮機能障害と拡張機能障害の疫学<br>　7 前負荷と後負荷と心拍出量の概念<br>　8 心血管イベントの代理指標としての心筋リモデリング<br>　9 神経体液性因子説とは<br>　10 心不全悪化因子1　交感神経系<br>　11 心不全悪化因子2　レニン- アンジオテンシン系<br>　12 レニン-アンジオテンシン系の下流であるアルドステロン<br>　13 心不全悪化因子3　バソプレシン<br>　14 心不全悪化因子4　炎症性サイトカイン<br>　15 心不全改善因子　ナトリウム利尿ペプチド<br>Part.02　診断<br>　16 NYHA分類・AHA／ACCステージ分類と早期からの治療介入<br>　17 簡単で大事な自覚症状　呼吸困難<br>　18 簡単で大事な身体所見　体重変化<br>　19 簡単な臨床所見で病態を把握する　Nohria／Stevenson分類<br>　20 必須検査1　胸部X線<br>　21 必須検査2　心電図<br>　22 必須検査3　心不全での一般血液検査<br>　23 必須検査4　バイオマーカーBNP，NT-proBNP<br>　24 必須検査5　心エコー<br>　25 急性心不全での必須検査　血液ガス<br>　26 日常臨床で使える腎機能の指標<br>　27 冠動脈CTの心不全患者への応用<br>　28 心臓カテーテル検査は心不全の原因，病態を知るうえで重要<br>　29 現在のSwan-Ganzカテーテル検査の意義<br>　30 心筋生検が必要な場合とは<br>Part.03　治療<br>　31 収縮能が低下した心不全治療のかなめ薬1　ACE阻害薬・ARB<br>　32 収縮能が低下した心不全治療のかなめ薬2　β遮断薬<br>　33 収縮能が低下した心不全治療の追加薬　抗アルドステロン薬（MRA）<br>　34 ループ利尿薬は心不全治療薬の仕上げに使う<br>　35 ループ利尿薬抵抗性の水分貯留にはバソプレシン受容体拮抗薬<br>　36 忘れられつつある薬剤ジギタリスの価値とは<br>　37 経口強心薬は重症心不全，末期心不全で考慮<br>　38 心筋梗塞後の心不全患者の必須薬1　アスピリン<br>　39 心筋梗塞後の心不全患者の必須薬2　スタチン<br>　40 心房細動合併時の抗凝固薬1　ワルファリン<br>　41 心房細動合併時の抗凝固薬2　直接作用型経口抗凝固薬（DOAC）<br>　42 アミオダロンの突然死予防効果は期待しすぎない程度に<br>　43 不整脈のデバイス治療　心臓再同期療法と植込み型除細動器<br>　44 心房細動治療（薬物治療版）　リズムコントロールvsレートコントロール<br>　45 心房細動治療（非薬物治療版）　アブレーション<br>　46 拡張機能障害の治療は，心不全発症のリスクの段階からスタート<br>　47 心不全に多い腎不全の合併，心腎連関の介入点の検討<br>　48 慢性心不全に合併する貧血の治療は，補正のしすぎに注意<br>　49 合併する高血圧・脂質異常症・糖尿病はセットで考える<br>　50 睡眠時無呼吸に注意<br>　51 チーム医療に期待の場　心臓リハビリテーション<br>　52 弁膜症のカテーテル治療　TAVIとMitraClip<br>　53 増加しつつある　植込み型非拍動式補助人工心臓<br>　54 増加しつつある　心臓移植の適応判定<br>　55 急性心不全の初期対応の目的は，救命と血行動態の安定<br>　56 点滴強心薬は，臓器低灌流時には速やかに使用する<br>　57 PDE阻害薬は血管拡張薬の次の一手<br>　58 硝酸薬は，古典的ではあるが有用な血管拡張薬<br>　59 ナトリウム利尿ペプチド　わかっていること，わかっていないこと<br>　60 急性心不全における利尿と血液浄化<br>　61 急性心不全における呼吸管理<br>　62 急性心不全における補助循環装置<br>　63 知っておくべき救命処置<br>Part.04　管理<br>　64 肥満予防は小児期から<br>　65 心血管イベントを抑制する食事<br>　66 高血圧予防食は心不全発症も予防する　減塩・DASH食<br>　67 脂肪酸：動物性の脂，魚の油，植物の油，マーガリンについて<br>　68 末期心不全では低栄養に注意<br>　69 シンプルな低栄養の評価<br>　70 栄養付加の観点からの食事指導の実際<br>　71 水分と塩分指導の新たな注意点<br>　72 絶対!!　禁煙と禁酒<br>　73 ワクチン接種のススメ　インフルエンザ・肺炎球菌ワクチン<br>　74 安全な入浴のための注意点<br>　75 安全な旅行のための注意点<br>　76 心不全患者における性的問題の考え方<br>　77 心不全患者における妊娠の考え方<br>Part.05　医療システム<br>　78 心不全チーム医療の歴史<br>　79 患者自身のセルフチェックは，チーム医療の中心とすべき<br>　80 心不全チーム医療のメンバー　多職種の役割<br>　81 心不全チーム医療の動線　超急性期から外来まで<br>　82 ガイドライン推奨治療の遵守率チェックの必要性<br>　83 心不全手帳の作成　患者教育<br>　84 心不全手帳の作成　セルフモニタリング<br>　85 QOLの評価法<br>　86 地域包括ケア構想　在宅診療へ向けて診療の連続性が重要<br>　87 外来点滴の可能性<br>　88 心不全における緩和ケア導入の歴史と厚生労働省の方向性<br>　89 緩和ケアを行うことの前提条件　医療倫理など<br>　90 意思決定支援とアドバンス・ケア・プランニング<br>　91 多職種で支える意味<br>　92 がんの緩和ケアにおけるエビデンス<br>　93 緩和ケアで使用する薬剤<br>　94 人工呼吸器・透析などの差し控えの可能性<br>Part.06　心不全診療の今後<br>　95 新薬：LCZ696とイバブラジン<br>　96 遠隔モニタリングの意義<br>　97 和温療法とエビデンス<br>　98 今後の治療　再生医療<br>　99 成人になった先天性心疾患・がん治療に伴う心不全<br>　100 チーム医療での臨床研究の意義について<br>索引<br>あとがき</section></article>
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