| 特集名 | 糖尿病性腎症の最前線 | |
|---|---|---|
| 題名 | 糖尿病性腎不全患者の血液浄化法 | |
| 発刊年月 | 2001年 01月 | |
| 著者 | 三浦 國男 | 玄々堂君津病院臨床工学科 |
| 著者 | 大崎 慎一 | 玄々堂君津病院外科 |
| 【 要旨 】 | 近年，糖尿病性腎症による透析導入が増加している．糖尿病性腎不全患者(DM患者)は種々の合併症を抱えているため問題点が多く，血液浄化法においては，他の原疾患患者よりも注意深い技術的対応が必要である． 当施設のDM患者の血液浄化法としては，緊急導入時にはECUMと血液透析(HD)を併用し，さらに状態悪化例では血液濾過法(HF)や持続的血液濾過法(CHF)，持続的血液透析(CHD)を選択している．難治性低血圧症に対してはクリットライン装置を用いて循環動態を監視しながらNa-gradient透析液，gradient除水，低温透析液などの方法を組み合わせている．インスリン使用患者や頻回に低血糖発作を起こす患者の低血糖予防は，ブドウ糖濃度150 mg/dlの透析液を使用するか，静脈側血液回路よりブドウ糖を3～5g/hr持続注入するなどで対応している．DM患者は感染に弱いため，ブラッドアクセスは穿刺・止血・消毒を確実にしかも慎重に行うことでトラブル防止をはかることが重要である．以上のほかにも多くの問題点があるが，個々に対策を重ね検討する必要がある． |
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| Theme | Forefront of Diabetic Nephropathy | |
|---|---|---|
| Title | Methods of blood purification for CRF (chronic renal failure) patients with diabetes | |
| Author | Kunio Miura | Department of Clinical engineering, Gen-gen Doh Kimitsu Hospital |
| Author | Shinichi Oosaki | Department of Surgery, Gen-gen Doh Kimitsu Hospital |
| [ Summary ] | Recently, the number of dialysis treatment for patients with diabetes has increased. As is generally known, the CRF patient who has diabetes is inclined to have several complications. Therefore, it is necessary for CRF patients to receive more controlled, technical than that given to those patients who comes to dialysis for other reasons. At our facility, in cases of urgent introduction of dialysis treatment, we select both ECUM and HD. If the patient's condition is worse, we choose HF, CHF or CHD treatment. In cases where the patient has hypotention, there are some particular treatment methods, but mainly we change the concentration of sodium and UF amounts, gradually, during dialysis treatment, or use low-temperature dialysate. Occasionally, we combine other methods with this method. As for the prevention of hypoglycemia, we will use insulin. In the case of a patient who is likely to have an attack of hypoglysemia, we frequently use dialysate, containing 150mg/dl of glucose, or we continuously infuse glucose 3 to 5g/hr into the venous blood tubing line. Regarding the blood access for the patient, we are careful to prevent of trouble by taking care of sticking AV needles, to prevent bleeding and with positive disinfection. Though there are other problems in regard to dialysis treatment, as mentioned above, we must continue to considering countermeasurs for each individual problem. |
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