| 特集名 | 透析患者の心臓―心臓病による死亡を減らすために | |
|---|---|---|
| 題名 | 透析患者の心筋症 | |
| 発刊年月 | 2010年 05月 | |
| 著者 | 杉本 徳一郎 | 三井記念病院腎臓内科 |
| 著者 | 三瀬 直文 | 三井記念病院腎臓内科 |
| 著者 | 栗田 宜明 | 三井記念病院腎臓内科 |
| 【 要旨 】 | 透析患者の心筋症（uremic cardiomyopathy）は，多くの原因因子が関係する二次性の心筋症である．おもな病態は拡張型心筋症で，左室の内腔拡張と収縮障害を示す．病理像は心筋の肥大，配列の乱れ，線維化が強く，微小血管の障害などは単なる冠動脈虚血以外の病因が重要である．原因因子の管理と適正な透析の実施が，病を生きる患者の生活の質の維持に欠かせない．血圧管理，カルシウムやリン，脂質，糖などの代謝異常や，貧血の管理が保存期を通じて重要と考えられる．安定した血行動態の維持が困難な場合，透析方法の変更，AVアクセスの血流コントロールなどの検討が必要である．身体活動は心不全患者一般の予後を改善するので，透析心筋症を有する患者においても有用である可能性が考えられる． | |
| Theme | Heart and it's Diseases in Dialysis Patients -- For their better longevity | |
|---|---|---|
| Title | Uremic cardiomyopathy | |
| Author | Tokuichiro Sugimoto | Division of Nephrology, Department of Medicine, Mitsui Memorial Hospital |
| Author | Naobumi Mise | Division of Nephrology, Department of Medicine, Mitsui Memorial Hospital |
| Author | Noriaki Kurita | Division of Nephrology, Department of Medicine, Mitsui Memorial Hospital |
| [ Summary ] | Cardiomyopathy in dialysis patients is different from idiopathic cardiomyopathy in that there are many causes which affect the myocardium in relation to uremic pathology and dialysis for daily living. High blood pressure, repetitive fluid overload, coronary heart disease, and hypotension during hemodialysis are very common factors encountered. Left ventricular dilatation and impaired systolic function occur during various occasions during the course of long term dialysis. In order to maintain a good quality of life for dialysis patients with uremic cardiomyopathy, secondary preventative measures must be taken, including adequate dialysis prescriptions. Blood pressure control at home and during hemodialysis is important. Humoral factors such as control of calcium and phosphate, LDL cholesterol and triglyceride levels may be managed through diet and medication. When stable hemodynamic states are difficult to achieve, modification of dialysis modalities, including intervention for AV access blood flow should be considered. Physical exercise before and after initation of dialysis and even after the occurrence of heart disease appears to be important. The heart does not operate by itself but in concert with adequate lung ventilation, acceptable levels of peripheral circulation and healthy muscle condition including enzyme activities. Daily physical exercise will help to achieve and maintain quality of life for dialysis patients. |
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