臨牀透析 Vol.19 No.6(2-5)


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 (5) 臨床工学技士のかかわり―周術期と心臓カテーテル検査
発刊年月 2003年 06月
著者 武田 正則 三井記念病院MEサービス部・臨床工学技士
【 要旨 】 心臓カテーテル検査において臨床工学技士は,検査中の胸部誘導と四肢誘導をモニターし,心電図変化の監視,心内圧,心拍出量の測定などの業務を行う.また,検査中の心機能の悪化に対してはペースメーカー,動脈内バルーンポンプ(IABP),除細動器などを操作する.開心術を施行する場合,臨床工学技士は,術前の血液透析(HD)回数を増加し,ドライウエイトの維持に努める.また,術中は,血液浄化回路を人工心肺回路に組み込み,人工心肺装置を操作しながらHDか血液濾過透析(HDF)などで除水し,カリウム値を3.5mEq/l以下にする.術後24時間は,出血を考慮し透析は施行しないが,肺水腫,高カリウム血症などが認められたらHDを施行する.
Theme Cardioascular Diseases in Dialysis Patients -- Understanding, Treatment and Management
Title The service of ME technicians for hemodialized patients with heart disease-During perioperative period and cardiac catheterization
Author Masanori Takeda Department of Medical Engineering Service, Mitsui Memorial Hospital
[ Summary ] During cardiac catheterization, ME technicians are responsible for monitoring chest and limb leads, observing changes in EKG output, and measuring intracardiac pressure and cardiac output. If problems in heart function arise during testing, the technicians also operate devices such as pacemakers, IABPs, and defibrillators. For open-heart surgery, ME technicians increase the number of preoperative hemodialysis procedures and maintain dry weight. A heart-lung machine, incorporating a hemocatharsis circuit, is used during surgery to eliminate water, while the level of potassium is reduced below 3.5mEq/l by hemodialysis (HD) or hemodiafiltration (HDF). During the twenty four hour period after surgery, dialysis is generally not performed, due to the risk of hemorrhage; however, dialysis may be required if conditions such as pulmonary edema or hyperpotassemia are con firmed.
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