山田 博胤, 坂東 美佳

Hirotsugu YAMADA, Mika BANDO

徳島大学大学院医歯薬学研究部地域循環器内科学

Department of Community Medicine for Cardiology, Tokushima University Graduate School of Biomedical Sciences

キーワード : focused cardiac ultrasound, limited echocardiography, portable ultrasound diagnostic machine, education, point-of-care ultrasound

心臓に対する超音波の臨床応用には約70年の歴史があるが，その大きな転換期は，バッテリーで駆動する小型の携帯型超音波診断装置の登場である．これにより，心エコー図検査を行う場所が検査室外に大きく広がっただけでなく，それまではそれを専門の生業とする医師や技師が行う検査であったのが，救急医や麻酔科医，プライマリケア医など心エコーを専門としない医師が心エコー図検査を利用するようになった．そして，このような目の前の患者に対して，医師が病態の評価やマネージメントあるいは処置のガイドのために行う超音波検査をPoint-of-Care 超音波（POCUS）と呼ぶようになった．POCUSの心エコー図検査は，救急医や麻酔科医など心エコーの非専門家がプロトコールに即して施行するfocused cardiac ultrasound examination（FoCUS）と，系統的心エコー図検査の高度な知識と技術を有する循環器内科医がベッドサイドで行うlimited echocardiographyに大別される．FoCUSは，そのプロトコールや評価法がほぼ確立され，その効果を証明するエビデンスも蓄積されつつある．本邦においても普及しつつあるが，教育システムが確立されているとはいえず，医学生や研修医に対する教育をどうするかについても，今後議論が必要であろう．循環器分野のPOCUSが広く普及しても，聴診が不要になるということはない．むしろ，身体診察の流れの中で視診，触診，聴診に加えて，エコー診を加えることが，患者にとって大きな恩恵をもたらすことになるだろう．

Although clinical application of ultrasound to the heart has a history of about 80 years, its big turning point was the emergence of a portable ultrasound diagnostic machine. As a result, the place where echocardiography is performed widely spread outside the examination room, and the people who perform echocardiography have also greatly increased. Emergency physicians, anesthesiologists and primary care physicians became interested in echocardiography and started using it. Such ultrasonic examinations performed by a doctor for assessment of disease condition, management or guidance of treatment at bedside has been called point-of-care ultrasound (POCUS). Echocardiography in POCUS is divided into a focused cardiac ultrasound examination (FoCUS) performed by non-experts in echocardiography such as emergency physicians and anesthesiologists, and limited echocardiography performed by cardiologists who are experts in echocardiography. FoCUS has an established protocol and evaluation method, and evidence to prove its effect is mounting. Although FoCUS is becoming popular in Japan, an educational program for FoCUS has not been established, and discussion on how to educate medical students and interns will be necessary. Even if POCUS in cardiovascular medicine becomes widespread, auscultation will still be necessary. Rather, adding echocardiography to inspection, palpation and auscultation in the flow of physical examinations will benefit the patient greatly.