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転がるイシあたま
中山間地・島・三角州……様々な田舎や町や街を転々として様々な経験をしてきた１９５０年代生まれの内科医の呟きです（最近はリハ科も兼任しています）。昔の思い出・今の思いなどを、アトランダムに語ります。「次に一体何が出てくるか」と楽しみにしてもらえるようなブログを目指します。
「偉い医師」は存在するが「医師だからエライ」ではない、がモットーの一つです。「先生様」でも「患者様」でもなく、お互いに「さん」で呼び合えるような世の中に、が秘かな望みです（書いちゃいましたけど）。
タイトル履歴
2008年４月に「医師アタマ」という本の存在を知り、あまりに似ているので本ブログのタイトルを「いしあたま（医師頭）」から「転がるイシは苔むさず」に変更しました。ただ、前のタイトルへの愛着捨てがたく、同年５月31日に「転がるイシあたま」に再変更しています。
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元気に明るく生きて行ける社会のために、医者のホンネを綴りたい
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医者独特のことば「腔」（くう） >
2008.08.05 06:55
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読書感想『スポーツで心臓が止まる時』
書誌情報『
スポーツで心臓が止まる時
』海老根東雄 著､ 悠飛社、2004年、1600円（税別）
「健康のためなら死んでも良い」なんてブラックジョークがありますが、本当に、健康のために良いと思っていた運動中に急死する人がいます。（ジョギングを世界中に広めたフィックスは、そのジョギング中に急死しました）
有名なところでは、1986年バレーの日立対ダイエーの試合中に倒れて急死したハイマン、2003年夏コンフェデレーション杯準決勝中に急死したカメルーン代表のフォエ、2002年スカッシュ中に急死した高円宮……
ハイマンはマルファン症候群（大動脈瘤ができやすい）でした。フォエも体格からその疑いがあるそうです。高円宮は心室細動でしたが、その原因については本書には書いてありませんでした。虚血性心疾患でも起されたのでしょうか。
著者は東京都監察医務院にある突然死のデータ（1987年〜99年）29,699例のカルテを全部ひっくり返し、その中の0.5%の141例「運動中の急死例」を見つけます。死亡原因は冠動脈疾患78例・心機能不全15例・解離性大動脈瘤12例など多くが心血管疾患でした。他に急性心筋炎なども突然死の原因として考えられるでしょう。
ならば運動中の突然死を防ぐためには「病気があるかどうか検診を厳しくしたらよい」でしょうか。もちろん明らかな病気の人は運動禁止でしょうが、実は話はそれほど簡単ではありません。厳しいスポーツで鍛えると、心臓は「スポーツ心」と呼ばれる状態になります。このスポーツ心は、スポーツの種類などによって肥大型と拡張型に分けられます。そして肥大型スポーツ心は肥大型心筋症・大動脈弁狭窄症・高血圧心疾患と、拡張型スポーツ心は拡張型心筋症・僧帽弁閉鎖不全症・大動脈弁閉鎖不全症とよく似ているのです。もしかしたら過度の運動は心臓には不健康、と言って良いのかもしれません。
さらに原因不明の急死もあります。「心震盪」と呼ばれる状態で、ボールが胸に当たった程度でも心停止をきたしてしまうことがあるのです。これは事前のチェックが不可能です。不整脈源性右室異形成症（ＡＲＶＤ）やブルガダ症候群も突然の心室細動を起す原因として注目されています。
では目の前で急性心停止が起きたらどうするか。医療関係者なら即答ですね。「蘇生のＡＢＣ」です。本書にはそのことも（基礎的なことではありますが）書いてあります。ただ面白いことに、柔道の活法も載っています。異物を気道から除去するためにハイムリッヒ法が行われますが、活法の中にはハイムリッヒ法よりも気道内圧を上げることができる方法があるのだそうです。本書には解説と図がありますので、興味のある方はご覧ください。よく時代劇で失神している人に「ふん」と言いながら活を入れますが、それが医療に応用できるとは知りませんでした。
オマケです。近年「救急蘇生法で、短時間だったら必ずしも人工呼吸は必要ない（心臓マッサージだけでもいける）」と言われるようになっていますが、これは広く知られているでしょうか。
http://www.naruoseikei.com/hakuzan/18/18.html
http://www.sakakibara-hp.com/AED/AED.htm
ただ、早合点して最初から闇雲に胸を押すのはやめて欲しいとは思います。脈が触れないことを確かめて欲しいし、そもそも空気の通り道がちゃんと開いていなかったらいくら効果的に心臓マッサージをやっても無駄ですから。それと、これも誤解が多いのですが、ＡＥＤは「とまった心臓をまた動かすようにする器械」ではありません。「電気ショックを与えたらまた動くようになる状態の心臓に電気ショックを適切に与える器械」です。医療関係者でもそのことがわかっていない人が時々いるのは困ったものです。
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