臨牀透析 Vol.16 No.1(3-6)


特集名 腎不全患者の血液浄化療法の選択
題名 日常遭遇する病態と血液浄化療法の選択 (6) 消化器疾患
発刊年月 2000年 01月
著者 宮崎 滋 信楽園病院腎センター
著者 酒井 信治 信楽園病院腎センター
【 要旨 】 透析患者に肝硬変,肝癌,虚血性腸炎を合併した際にも,非透析患者と同様の治療が適用可能である.肝硬変,肝癌合併例の透析療法は血液透析,腹膜透析(CAPD)ともに可能であるが,大量の腹水を有する患者でCAPD療法を伴う際には,食道静脈瘤をあらかじめ治療しておくことがすすめられる.虚血性腸炎はしばしば透析患者に合併し,開腹術を行ってもその生命予後は不良である.透析中,透析後あるいは,低血圧を伴う場合の高度の腹痛,下血,下痢を呈する例では十分な観察が必須である.血液透析は,必要な際(高カリウム血症,代謝性アシドーシス,低蛋白血症の補正など)には,メシル酸ナファモスタット(フサン(R))を抗凝固薬として用い術中に行うことも可能である.
Theme The Choice of Blood Purification for the Patients with Renal Failure
Title Common complication and selection of dialysis therapy for gastrointestinal diseases
Author Sigeru Miyazaki Kidney Center, Shinraku-en Hospital
Author Shinji Sakai Kidney Center, Shinraku-en Hospital
[ Summary ] Dialysis patients with liver cirrhosis (LC), hepatic cell carcinoma (HCC) and ischemic colitis (IC) were treated in our hospital for 25 years.
Complications of LC, including hepatic coma, esophageal varices, ascites, hepatic failure and HCC of hemodialysis patients, was managed the same as that of non-dialysis patients. Both hemodialysis and peritoneal dialysis (CAPD) were suitable for patients with LC and HCC, however CAPD therapy in LC patients with massive ascites may be recommended after treatment of esophageal varices. IC was a frequent comolication and its prognosis was very poor, even after the emergent laparotomies for dialysis patients. Careful examination is required in dialysis patients when they have severe abdominal pain, melena or diarrhea after dialysis therapy or hypotensive episodes. To correct hyperkalemia, metabolic acidosis and hyporoteinemia, hemodialysis therapy during laparotomic operations can be safety performed by employing Futhan(R) as an anticoagulant.
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