臨牀透析 Vol.19 No.6(1-1)


特集名 透析患者における心疾患への対応
題名 透析患者の心疾患 (1) 虚血性心疾患
発刊年月 2003年 06月
著者 土井 修 静岡県立総合病院循環器科
【 要旨 】 透析患者の高齢化や糖尿病患者の増加などに伴い,虚血性心疾患の早期発見,治療そして予防がさらに重要となってきている.その冠動脈病変の特徴は,びまん性かつ高度の石灰化である.透析自体の影響もあるが,一般的な動脈硬化の終末像として捉えることもできる.胸痛は非典型的なこともある.透析中の血圧変動時に胸痛が出現したり,息切れや呼吸困難として訴えられることがある.無症候性虚血の存在も忘れてはならない.内科的治療も有効であるが,冠危険因子の調節や生活習慣の改善も重要である.冠血管再建術は予後やQOLの改善に有効であり適応も拡大しつつあるが,経皮的冠動脈インターベンション(PCI)の再狭窄率や冠動脈バイパス手術(CABG)の院内死亡率が高いという限界性がある.腎臓内科,循環器内科,心臓外科医が協力して治療にあたらなければならない.
Theme Cardioascular Diseases in Dialysis Patients -- Understanding, Treatment and Management
Title Coronary artery disease in dialysis patients
Author Osamu Doi Department of Cardiology, Shizuoka Prefectural General Hospital
[ Summary ] The cardiovascular disease (CVD) is the leading cause of death in patients receiring dialysis (ESRD). Among the types of CVD's, coronary artery disease (CAD) has become more prevalent in patients on dialysis because they as a group have become older and more often diabetic. So it is important to find earlier, means of treating and preventing CAD, even starting in the pre-dialysis phase. Coronary atherosclerotic lesions associated with ESRD are diffuse and heavily calcified. These characteristics make interventions more difficult. The symptmatology of CAD in ESRD is also very important. Chest pain is sometimes atypical (dyspnea) or completely absent (silent ischemia). To diagnose CAD and follow up, stress ECGs and scintigraphy are useful. Medical treatment and prevention of CAD are important revasculization with PCI or CABG may improve the prognosis and QOL for ESRD patients. However the limitations of these procedures should be noted: high rates of restenosis in PCI cases and in-hospital mortality for CABG cases. The prognosis for AMI in ESRD is dismal. Early diagnosis and intervention are very important. For treatment of CAD in patients with dialysis, the nephrologist, cardiologist and cardiac surgeon should cooperate and pursue the best means of treatment.
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