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<meta name="description" content="心筋保護法は心臓外科に欠かせないが，近年若手医師を中心に臨床工学技士任せにする姿勢も見られ十分に知識が継承されているとは言えない．標準的でない方法をとっているため手術成績の低下を招いている施設も散見される．現状をふまえ，心臓手術に携わる医師・技師に標準的かつ正しい心筋保護法を伝えるべく日本心臓血管外科学会で編纂した．臨床で用いられる心筋保護法を概括しつつ理論的根拠や今後の改善点を記載．心臓手術に携">

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		<h1 class="catchCopy">心筋保護法のスタンダードを提示する！</h1>
		

		<h1 class="title titleWidth">心筋保護法標準テキストブック（電子版のみ）<span class="version"></span></h1>
		

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					編著：日本心臓血管外科学会
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				<ul class="property"><li class="disc">B5判・232頁・2色刷</li><li class="disc">ISBN&nbsp;978-4-8306-1928-1</li><li class="disc">2016年2月2日発行</li></ul>

				
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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">心筋保護法は心臓外科に欠かせないが，近年若手医師を中心に臨床工学技士任せにする姿勢も見られ十分に知識が継承されているとは言えない．標準的でない方法をとっているため手術成績の低下を招いている施設も散見される．現状をふまえ，心臓手術に携わる医師・技師に標準的かつ正しい心筋保護法を伝えるべく日本心臓血管外科学会で編纂した．臨床で用いられる心筋保護法を概括しつつ理論的根拠や今後の改善点を記載．心臓手術に携わる医療スタッフ，特に心臓血管外科専門医をめざす医師必読のテキストである．全国の施設から寄せられたクリニカルクエスチョン集を収録し臨床にも役立つ内容である．<br>☆モノクロ写真61点，イラスト39点，図版44点，表組32点</section><section class="preface">序　文<br><br>　今日の心臓外科の長足の進歩は，体外循環（人工心肺）と心筋保護の2大基盤の確立により，実現したといえるでしょう．約40 年前に膜型人工肺が市販されて，長時間の体外循環が可能となり，時を同じくして心筋保護法も研究開発されました．心筋保護法については，1970〜90年代に心臓外科手術に従事した外科医は心筋保護液の組成や注入方法など研究論文にも強い関心をもって，実験と臨床の両面で関与していました．当時は学会や研究会でも議論が交わされていましたが，昨今では心筋保護が単独のテーマとして取り上げられることは少なくなりました．体外循環と心筋保護は開心術に日常的に用いられており，整備・準備の手順，実施方法は施設ごとに定められています．この心臓手術における業務は，臨床工学技士，特に体外循環技術認定士が非常に大きな役割を果たすようになりました．その一方で，1990年代以降に修練を受けた心臓外科医は，体外循環回路や人工肺，心筋保護回路の構造，操作に加え，心筋保護液の組成についても知識が十分とはいえない状況にあると思います．もはや，体外循環技師の担当領域で，その操作は委ねるものであるという認識もあるのかもしれません．<br>　さて，日本心臓血管外科手術データベース（JACVSD）に集積された最近3〜4年の実績を解析すると，心拍動下の冠動脈バイパス術（体外循環も心筋保護も不要）では素晴らしい成績にもかかわらず，心筋保護を要する弁膜症手術や胸部大動脈手術では本邦の標準よりも成績がかなり悪い施設が散見されました．もちろん，手術手技は弁膜症や大動脈では冠動脈バイパス術とは異なりますが，調査の結果，心筋保護が不十分であることに起因すると考えられました．すなわち，施設によって異なる組成の心筋保護，温度，注入法で実施されているのですが，経年的に変遷し，例えば，血液の混合による希釈と添加薬の組成ならびに温度設定は，大きく変化していたのです．そこで，日本心臓血管外科学会の理事会で議論し，手術成績の向上には心筋保護法を会員に周知する必要があると判断しました．1980〜90年代には心筋保護に関するテキストも発刊されていましたが，最近ではほとんど目にしなくなりました．卒後研修で心筋保護を取り上げるのも一法ですが，日本心臓血<br>管外科学会としては，体外循環技術認定士にも読んでいただける心筋保護法の標準的テキストを刊行することに致しました．福田幾夫理事と秋田大学 山本浩史教授のお二人にテキストの企画編成をお願いしましたが，迅速に対応していただき，短期間で刊行できることになりました．本書が心筋保護に関する知識の獲得や確認にとどまらず，日常の心臓手術の成績向上に資することを願っております．<br>　多忙な日常業務のなか，本書の執筆を担当していただいた皆様に感謝いたします．<br><br>　2016年1月<br>　日本心臓血管外科学会　理事長<br>　上田　裕一</section><section class="indexes">1章　心臓の解剖・生理・代謝<br>　1）心臓の解剖と冠循環および心筋細胞<br>　2）心筋細胞の生理：興奮収縮連関<br>　3）心筋細胞の生理：細胞機能維持<br>　4）心筋細胞の代謝：細胞のエネルギー獲得<br>2章　未熟心筋とチアノーゼ<br>3章　加齢心筋，肥大心筋，不全心筋<br>4章　心筋の虚血再灌流傷害<br>5章　開心術における心筋保護の原則<br>6章　心筋保護・心保存の歴史的変遷<br>7章　現行心筋保護法<br>　1）晶質液心筋保護法<br>　2）血液心筋保護法<br>　3）心筋保護液の投与方式<br>　4）統合型血液心筋保護法<br>　5）常温心臓手術<br>　6）現行心筋保護法の問題点<br>8章　現行心保存法<br>9章　心保存の手技<br>10章　新しい心筋保護・心保存の未来像―心筋再生効果を有する薬剤を用いた新しい心筋虚血再灌流傷害治療法―<br>11章　術中心筋保護の手技<br>12章　術中心筋保護の管理<br>13章　手術室やICUにおける心筋保護効果の評価<br>14章　基礎（併存）疾患を有する症例の心筋保護<br>15章　各疾患における開心術中心筋保護<br>　1）はじめに：心筋保護法の現況と成績<br>　2）冠動脈疾患<br>　3）弁膜疾患<br>　4）心筋症<br>　5）大動脈疾患<br>　6）小児心臓疾患<br>16章　開心術中心筋保護や心保存に関するFAQ集（クリニカルクエスチョンとアンサー）<br>17章　開心術中心筋保護の現状（全国アンケート調査報告）<br>18章　心筋保護関連材料の現状および業務施行上の安全管理<br>19章　さらに勉強したい人のための参考図書および参考文献集<br>索引</section></article>
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