臨牀透析 Vol.17 No.10(2-3)


特集名 透析患者における心・血管系合併症と対策
題名 透析者における心・血管系合併症 (3) 虚血性心疾患
発刊年月 2001年 09月
著者 今田 聰雄 近畿大学医学部堺病院内科
【 要旨 】 虚血性心疾患の最大の危険因子は冠動脈硬化で,透析者は内在性の動脈硬化の危険因子を多数もっている.加齢とともに増加する虚血性心疾患の発症頻度も高齢化の著しい透析者に影響が大きい.加えて,貧血や内シャントなどによる心抽出量の増加,透析時の除水による急激な循環血漿量の減少,血圧降下などの冠動脈血流量を減少させる要因が多いので,透析者は虚血性心疾患を誘発しやすい.透析者の高齢化や糖尿病性腎不全者の増加を考えると,虚血性心疾患の発症は今後さらに増加すると予測できる.透祈者に特有な動脈硬化はないが,冠動脈硬化を基盤として発症する虚血性心疾患は透析者に特有なものもある.その特徴と透析の現場における診断と治療をまとめた.
Theme Management of Cardio-vascular Complication in Hemodialysis Patient
Title Ischemic heart disease
Author
[ Summary ] Though the highest risk factor for ischemic heart disease is coronary sclerosis, a great number of dialysis patients have the additional risk factor of endogenous arteriosclerosis as a cause of coronary sclerosis. Because the frequency of ischemic heart disease increases with aging, the effect on dialysis patients of advanced age can not be disregarded. In addition, ischemic heart disease in dialysis patients may be easily induced by an increase in cardiac output, due to internal shunts or renal anemia, or the decrease in rapidly circulating blood volume, due to removal of fluid and decreased coronary artery blood flow due to hypotension crises when undergoing dialysis. Since there as been an increase in the number of aged and diabetic renal failure patients, we can be predict that the number of ischemic heart disease patients will increase in the future. Although there is nothing unusual about seeing arteriosclerosis in dialysis patients, there is a peculiar ischemic heart disease which is connected with coronary sclerosis, as seen in dialysis patients. We described those features of, diagnosis and therapy for ischemic heart disease in the dialysis field.
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