臨牀透析 Vol.20 No.4(6)


特集名 急性血液浄化療法の展開
題名 ICUにおける急性血液浄化療法の問題点
発刊年月 2004年 04月
著者 鈴木 忠 東京女子医科大学救命救急センター
【 要旨 】 多発外傷,重症感染症,中枢神経疾患,肝不全,腎不全,心不全,呼吸不全,中毒などあらゆる病態の重症患者が収容されるのが救命救急センターの特色である.感染源になりうる患者と,栄養不全や免疫低下で感染リスクが高い患者を同じ場で治療することになる.急性血液浄化療法を要す患者が多いが,これらの患者の大部分に外科手術や人工呼吸管理,循環補助などを同時に行う必要がある.そのため急性血液浄化療法施行に際し,以下の事項が求められる.(1) 厳重な感染対策,(2) 適切な血液浄化療法の種類と方法の選択,(3) 幅広く,かつ高レベルの技能と経験を有す医療スタッフによるチーム医療.
Theme New Turn of Acute Blood Purification
Title The problem of acute blood purification in ICU of critical care medicine
Author Tadashi Suzuki Critical Care Medical Center of Tokyo Women's Medical University
[ Summary ] It is the distinctive peculiarity of critical and emergency medical care departments to accommodate many critical patients of all kinds, due to complicated traumatic injuries, infections, central nervous diseases, liver dysfunction, cardiac insufficiency, respiratory failure, intoxication, etc. There are two types of these patients, one is the patient with infections which lead to further infections, and the other is the high risk patients with infections because of poor nutritional and or immunologic condition. Acute blood purification is necessary for many patients with these conditions. Surgical operations, artificial respiration and circulatory management are simultaneous measures called for. The following three conditions must be kept in mind concerning procedures for acute blood purification in ICU and emergency medical care departments: (1) strict control of infection, (2) appropriate methods for blood purification, (3) adequate medical staff having a great deal of experience and high skill levels.
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