臨牀透析 Vol.33 No.9(2-3)


特集名 透析医療における情報技術の進歩・展開
題名 モニタリング(3)透析量(透析排液中溶質濃度)モニタの活用
発刊年月 2017年 08月
著者 森實 篤司 新生会第一病院臨床工学部
【 要旨 】 血液透析は血液中に含まれる尿毒症物質を,ダイアライザにて拡散・濾過することで透析液側に除去する治療法である.透析効率は生命予後と関係が深く,透析効率の低下を防ぐ点で,血中の尿毒症物質量を知ることはきわめて重要である.しかし透析治療ごとの採血検査は患者への負担や治療コストも増大するため不可能に近い.一方,近年,LEDなどの技術の進歩により,透析排液に紫外光を照射することで透析排液中の溶質濃度を連続で評価できる透析量モニタが内蔵された透析装置が市販され,治療現場で応用が進んできている.これら排液中溶質濃度をもとにリアルタイムに透析効率(Kt/V)の解析が可能で,透析中のKt/Vを評価し長時間透析や在宅透析へも応用可能であると考える.また連続測定できる点もモニタとして有効であり,透析治療における患者動態をリアルタイムに把握できる今後の重要なモニタリング技術の一つと考える.
Theme Advance and evolution of information technology in dialysis therapy
Title Monitoring dialysate solute consistency in waste fluids
Author Atsushi Morizane Department of Clinical Engineering, Shinseikai Daiichi Hospital
[ Summary ] The Diamond Lisa system is used to identify urine poisoning substances present in the blood as spread by filtration. As a result, hemodialysis patients may be rid of uremic substance by removing them from the dialysate solution. It is very important to know the uremic mass in the blood up to that point, including convalescence. This information may be used to stop decline in dialysis efficiency. However, using this information may increase in the burdens on patients concerning treatment costs. Blood test checks during every dialysis treatment session are a near impossibility. But dialysis equipment by which dialysis levels may be monitored can estimate solute consistency in the dialysis waste fluid continuously by employing UV light irradiation of dialysis waste fluids. This is due to technological progress in LED systems in recent years. Examining, waste fluid solute levels, it is possible to analyze dialysis efficiency in subsequent, Kt/V in real time. We may estimate dialyzing Kt/V and apply that information to dialysis patients who keep a treatment log at home. Subsequent measurements are also effective in monitoring levels. That information corresponds to real time data used to grasp patients' progress in dialysis treatment.
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