| 特集名 | 透析患者の血圧管理の実際 | |
|---|---|---|
| 題名 | 透析低血圧患者の血液浄化法の実際 | |
| 発刊年月 | 1997年 09月 | |
| 著者 | 田部井 薫 | 自治医科大学腎臓内科 |
| 【 要旨 】 | 透析低血圧には，安静時低血圧と透析時低血圧とがある．透析患者の安静時低血圧は，導入初期には高血圧であったものが，透析の長期化により次第に低血圧に移行していく低血圧症である． 安静時低血圧は，長期透析患者の8～20％にみられ，原因として，(1) 血管作動性物質に対する反応性の低下，(2) 心機能予備力の低下がある．一方，透析時低血圧の原因としては，(1) 除水による循環血液量の減少，(2) 自律神経機能の低下，(3) 酢酸不耐症，(4) 透析膜生体不適合，(5) 低血糖などがある．安静時低血圧では薬物による治療が選択されるが，透析時低血圧では，dry weightの適正化，透析方法の工夫などで多くは治療可能である．糖尿病患者のような自律神経機能異常の症例では薬物療法が適応となる． |
|
| Theme | Blood Pressure Control in Chronic Renal Failure | |
|---|---|---|
| Title | Dialysis induced hypotension | |
| Author | Kaoru Tabei | Department of Nephrology, Jichi Medical School |
| [ Summary ] | Hypotension in chronic dialysis patients includes sustained hypotension and dialysis-induced-hypotension. Sustained-hypotension is frequently seen in long-term hemodialys is patients who were hypertensive in the early hemodialysis period. The etiology of sustained-hypotension in long-term hemodialysis patients includes; 1) poor vascular response to vasoactive substances, 2) inappropriate cardiac functional reserve. On the other hand, dialysis-induced-hypotension is caused by; 1) reduced circulating blood volume due to water removal, caused mainly by inappropriate plasma refilling, 2) autonomic nervous dysfunction, 3) acetate intolerance, 4) poor biocompatibility with the dialyzer membrane, 5) hypoglycemia. Sustained-hypotension is usually treated with pharmaceutical agents. To prevent dialysis-induced-hypotension, the dry weight setting should be considered carefully, using echocardiography, In most cases, several dialysis maneuvers, such as ECUM, HDF, hypernatremic dialysis, and low temperature dialysis, can prevent dialysis-induced-hypotension. Patients with autonomic dysfunction are treated with pharmaceutical agents. |
|