臨牀透析 Vol.19 No.6(2-1)


特集名 透析患者における心疾患への対応
題名 心疾患を有する透析患者のマネージメント (1) 血液透析
発刊年月 2003年 06月
著者 藤元 昭一 宮崎医科大学第一内科
【 要旨 】 心疾患患者の血液透析(HD)施行中は,血圧低下や不整脈などが起こりやすい.除水困難のためにドライウエイトの設定が難しく,肺水腫にも注意が必要である.透析間の体重増加を3%以下に抑え,個々の症例ごとに適切なドライウエイト設定が重要である.血圧低下の著明な例では緩徐な除水と溶質除去が原則であり,そのためのHD法の工夫が大事である.プログラム除水,限外濾過法,血液濾過法,血液透析濾過法なども考慮される.HDでは循環動態が保持できない重症心不全例では,持続的血液浄化療法も必要かもしれない.HD施行中の不整脈の出現には,適切な薬物治療とともに,水・電解質の自己管理の重要性も忘れてはいけない.
Theme Cardioascular Diseases in Dialysis Patients -- Understanding, Treatment and Management
Title Hemodialysis treatment for patients with cardiac disease
Author Shouichi Fujimoto First Department of Internal Medicine, Miyazaki Medical College
[ Summary ] Patients with cardiac disease often experience intradialytic hypotension and arrhythmia.On the other hand, we must pay attention to the occurrence of pulmonary edema on these patients, because their dry weight may not be correctly fixed due to insufficient ultrafiltration. Interdialytic weight gains need to be kept below 3%, and then dry weight may be appropriately set for each patient. Both ultrafiltration and removal of materials should be done slowly in patients with severe intradialytic hypotension. We also need to consider additional hemodialytic methods and other strategies, such as linear decreasing ultrafiltration,extracorporeal ultrafiltration, hemofiltration and hemodiafiltration. Continuous dialysis treatment may be tried for patients with severe cardiac failure, who are not able to maintain hemodynamic stability during intermittent dialysis treatment regimens. In case of the occurence of intradialytic arrhythmia occurs, an appropriate drug prescription and the control of volume and electrolyte disturbances are important aspects of hemodialysis treatment.
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