臨牀透析 Vol.13 No.13(2-4-1)


特集名 透析と呼吸器
題名 透析における呼吸器合併症 (1) 呼吸器感染症,肺炎
発刊年月 1997年 12月
著者 頼岡 徳在 広島大学医学部第二内科
著者 重本 憲一郎 一陽会原田病院
【 要旨 】 透析患者における呼吸器感染症について,診断と治療を中心に概説する.細菌性肺炎に関して,外来透析患者では,Streptococcus pneumoniae,Haemophilus influenzaeが多く,入院透析患者では,日和見感染の結果,Pseudomonas aeruginosa,Enterobacter,Serratiaなどのグラム陰性桿菌が多い.抗生物質の投与法は,排泄経路の違いによる血中半減期,透析性を考慮して投与量,投与間隔を決定する必要がある.ウイルス性肺炎では,Cytomegalovirus肺炎が重要である.診断にはアンチゲネミア法が有用であり,治療としてganciclovirを透析終了後に投与する.呼吸器真菌症の原因菌として,Candida,Aspergillus,Cryptoccus,Nocardiaなどが挙げられる.診断には(1-3)-β-D-グルカンが有用であり,治療としてamphotericinB(AMPH),flucytosine(5-FC),miconazole(MCZ),fluconazole(FLCZ)などを投与する.Pneumocystis carinii肺炎も透析患者の日和見感染として重要である.乾性咳嗽,急速に進行する呼吸困難,胸部X線における両側性間質性陰影,著明な低酸素血症が特徴である.PCR法によるDNAの検出も診断に有用である.治療としてST合剤,pentamidine isetionateを投与する.透析患者に合併した呼吸器感染症は重症化しやすいため早期の対策が重要である.
Theme Dialysis Therapy and Respiratory Systems
Title Respiratory infection, pneumonia
Author Noriaki Yorioka Second Department of Internal Medicine, Hiroshima University School of Medicine
Author Kenichiro Shigemoto Ichiyokai Harada Hospital
[ Summary ] This study assessed the diagnosis and treatment of various respiratory infections in patients on dialysis. With respect to pneumonia, outpatients on dialysis are commonly infected with Streptococcus pneumoniae or Haemophilus influenzae, while inpatients on dialysis often suffer opportunistic infections with Gram-negative bacilli such as Pseudomonas aeruginosa. Enterobacter, and Serratia. When administering antibiotics, the dose and interval must be determined from the blood half-time and the rate of dialysis (depending on the excretion route). Among the viral pneumonias, cytomegalovirus is important. For diagnosis, detection of circulating antigen is useful, and ganciclovir is administered after dialysis for treatment. Respiratory mycoses include.
Candida, Aspergillus, Cryptococcus, Nocardia and others. For diagnosis, the (1-3)-β-D-glucan level is useful, while amphotericin B, flucytosine, miconazole, or fluconazole are administered for treatment. Pneumocystis carinii pneumonia is also an important opportunistic infection in patients on dialysis. It presents with a dry cough, rapidly progressive dyspnea, bilateral interstitial infiltrates on chest X-ray films, and severe hypoxemia. DNA detection by PCR is useful for making the diagnosis. An ST mixture or pentamidine isetionate is administered as treatment. Respiratory infections in patients on dialysis are prone to become complicated and serious. Thus, it is important to treat them as promptly as possible.
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