| 特集名 | 透析患者と血圧異常 | |
|---|---|---|
| 題名 | ［各論］血圧管理の実際 (1) 薬物療法を中心に 3. 低血圧 | |
| 発刊年月 | 2011年 08月 | |
| 著者 | 椿原 美治 | 大阪府立急性期・総合医療センター腎臓・高血圧内科 |
| 【 要旨 】 | 透析関連低血圧は血液透析患者のもっとも頻度が高く，スタッフにとっても厄介な合併症である．また透析中の血圧低下や透析後の起立性低血圧が独立した死亡要因であることも確認され，予防や治療にさまざまな工夫が行われてきた．薬物療法では，生理食塩水を始めとした循環血漿量の減少を補充する薬剤と，血圧低下の大きな要因である交感神経賦活薬や心機能賦活薬などがあげられる．経口交感神経賦活薬が透析関連低血圧に適応が拡大され，有効性が認められる反面，副作用にも十分注意する必要がある． | |
| Theme | Abnormal Blood Pressure in Dialysis Patients | |
|---|---|---|
| Title | Management of dialysis related hypotension | |
| Author | Yoshiharu Tsubakihara | Department of Kidney Disease and Hypertension, Osaka General Medical Center |
| [ Summary ] | Dialysis related hypotension (DRH) is one of the most common complications experienced by hemodialysis (HD) patients. DRH is not only related to intradialytic hypotension (IDH), but sustained hypotension and orthostatic hypotension (OH) experienced by after HD session. Generally, IDH is treated with cumbersome and complicated means during HD sessions. However, for HD patients, treatment for OH after HD sessions is a serious problem, leading to impaired ADL and QOL. Survival rates for IDH patients may also suffer. The primary factor concerning IDH or OH is ultrafiltration rates during HD. Restriction of sodium and fluid intake is the most important prophylactic action. Normal saline infusion is the most useful therapy for DRH. Failure of the sympathetic nervous system is also a major concern for DRH patients. Therefore, refractory cases should be treated with sympathicomimetic drugs such as amezinium metilsulfate or droxidopa. |
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