臨牀透析 Vol.22 No.4(2)


特集名 透析患者の循環器病変 -- 避けられない宿命か?
題名 透析患者の不整脈とその対応
発刊年月 2006年 04月
著者 石川 康朗 上尾中央総合病院循環器センター
【 要旨 】 透析療法の進歩により透析患者が高齢化し,体液電解質の変動や内在する患者の問題および自律神経の異常などをきたし,各種不整脈を高頻度に認める.透析導入初期,透析後期,時間帯では透析後半から終了後4 - 6時間で不整脈が好発する.定期的な心電図,胸部X線検査や適宜心エコー検査およびホルター心電図検査を施行し,問題となる不整脈の早期発見が重要である.必要時には心臓カテーテル検査や電気生理学的検査などを行い,各種基礎心疾患や重篤な不整脈の有無を評価し薬物治療や非薬物治療の適応を考慮する.抗不整脈薬には,催不整脈作用,陰性変力作用などがあるので安易に用いるべきではない.不整脈治療においては,透析患者のQOL・生命予後の改善を目指し最適な治療を選択する必要がある.
Theme Cardiovascular Complications in Chronic Dialysis Patients -- Are They Inevitable?
Title Management of dialysis patients with arrhythmia
Author Yasuro Ishikawa Cardiovascular Center, Ageo Central General Hospital
[ Summary ] Because of the increased life span of dialysis patients through advancements in dialytic treatment, age related problems such as changes in body fluids and electrolytes, autonomic abnormalities, etc. frequently cause various forms of arrhythmia. Arrhythmia often occurs at the introduction of dialysis and in the late stages of the dialytic patient's lives. Italso occurs four to six hours after dialysis treatment and in the latter portion of dialytic treatment. It is important that the early stages of malignant arrhythmia be detected by regular electrocardiographic and chest X-ray examinations and by the proper Holter ambulatory monitoring, as well as echocardiography. It is also important that heart catheter examination and electrophysiologic examinations also be planned when necessary. Thereafter, the appropriate choice, whether drug therapy or non-drug therapy should be considerd.
Because anti-arrhythmic drugs usually have pro-arrhythmic actions and negative inotropic actions, they should not be used without serious consideration. In the management of arrhythmia, it is necessary to select the best treatment for the improvement of dialysis patient's QOL and overall life prognosis.
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