| 特集名 | 透析患者の血圧管理の実際 | |
|---|---|---|
| 題名 | 透析低血圧の発症機序と対策 | |
| 発刊年月 | 1997年 09月 | |
| 著者 | 仲里 聰 | 中頭病院内科 |
| 著者 | 城間 陽子 | 那覇市立病院内科 |
| 著者 | 久保 和雄 | 東京女子医科大学第四内科 |
| 【 要旨 】 | 透析低血圧は種々の合併症を招来するため，その原因の究明と対策の確立が求められている．透析低血圧の発症機序は未だ不明な点が多いが，hypovolemia，自律神経機能障害，血漿浸透圧の低下，血管作動性物質の関与，venous capacityの変化などがその原因として挙げられる．対策としては，水分管理をはじめ，透析条件の設定，非観血式連続的Ht測定(CRIT-LINE®)によるモニター，昇圧薬の投与，高浸透圧液の注入，高Na透析などがあるが，治療に難渋する場合には透析方法の変更，すなわちCAPDへの移行も考慮しなければならない．また，症例は限られるが，腎移植はもっとも有効な治療法である． | |
| Theme | Blood Pressure Control in Chronic Renal Failure | |
|---|---|---|
| Title | Dialysis hypotension : Mechanism and treatment | |
| Author | Satoshi Nakazato | Nakagami Hospital |
| Author | Youko Shiroma | Naha City Hospital |
| Author | Kazuo Kubo | Tokyo Women's Medical College |
| [ Summary ] | Dialysis hypotension is one of the major complications of longterm hemodialysis, and leads to many problems. The mechanism and treatment of dialysis hypotension are not still sufficiently established, and further investigation is needed. Many factors affect dialysis hypotension, such as hypovolemia, autonomic dysfunction, reduction of plasma osmolality, actions of vasoactive substances, changes in venouscapacity, and so on. Treatment of dialysis hypotension includes reduction of the weight gain associated with inter-dialysis sessions, arrangement of dialysis, monitoring of blood volume with on optoelectric instrument (CRIT-LINE), administration of vasoconstrictive drugs, infusion of hyperosmolar solutions, and high sodium dialysate, etc.. If dialysis hypotension seems to be refractory to treatment, we should consider a change in the dialysis method, that is from hemodialysis to CAPD. Renal transplantation is the most effective treatment for dialysis hypotension. |
|