臨牀透析 Vol.21 No.4(5)


特集名 末期腎不全患者の悪性腫瘍
題名 担癌患者の透析導入
発刊年月 2005年 04月
著者 室谷 典義 千葉社会保険病院外科・透析
【 要旨 】 2003年におけるわが国の一般住民と透析患者の粗死亡率を比較すると,透析患者では11.6倍と高い.悪性新生物による透析患者の死亡率は一般住民の3.22倍と報告されている.このような状況のなかで,担癌患者が透析導入を余儀なくされたときのストレスはきわめて大きなものである.当院で透析導入期に「癌」が併存していた5症例を提示し,担癌患者の透析導入について考察した.伊藤は「担癌患者の病態は複雑であり,導入方法がマニュアル化できない.患者のQOL維持を第一義とすべきである」と報告しているが,まさにそのとおりである.担癌患者の透析導入に当たってはサイコネフロロジストを含めた全職種によるチーム医療を推し進めることで,「納得のいく死」を迎えさせることが透析医療従事者にとって大切なことである.
Theme Malignant Tumors in Patients with End-Stage Renal Failures
Title Dialysis introduction for cancer patients
Author Noriyoshi Murotani Chiba Social Insurance Hospital
[ Summary ] When the rough mortality rate of the general population of our country and dialysis patients in 2003 is compared, the rate for dialysis patients, is as much as 11.6 times higher. It is reported that the mortality rate for dialysis patients from neoplasms is 3.22 times higher than the general population. Stress levels when cancer patients are obliged to begin dialysis are very high. In our hospital, five cases in which “cancer” was present at the introduction of dialysis were seen, and the patients' cancer and dialysis were both considered. Ito has stated “the state of diseases for patients with cancer is complicated and we cannot carry out set introductory methods. It has been reported that one should provide QOL maintenance for patients and our first priority to do so”. It is important for dialysis medical workers to take a “satisfactory death” approach in promoting team medical treatments by employing all specialists, including psycho-nephrologists, for cancer patients at dialysis introduction.
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