臨牀透析 Vol.35 No.5(2-6)


特集名 透析医工学の最前線
題名 透析関連技術の進歩 (6) 体内水分組成モニタを利用した水分管理
発刊年月 2019年 05月
著者 長尾 尋智 (医)知邑舎メディカルサテライト岩倉・臨床工学技士
著者 神崎 将克 (医)知邑舎メディカルサテライト岩倉・臨床工学技士
著者 武安 美希子 (医)知邑舎メディカルサテライト岩倉・臨床工学技士
著者 高田 幹彦 (医)知邑舎岩倉病院外科
【 要旨 】 透析患者の適正な体液管理は,生命予後改善において重要な管理項目である.しかし,現在の高齢化と低栄養の進んだ患者構成と循環器疾患を抱える患者では,従来の指標では管理に向かない状況がみられ,また,体内水分量と栄養状態が深く関連することから,その評価は難しくなりつつある.
多周波数生体電気インピーダンス法(multi frequency bioelectrical impedance analysis;MFBIA)が体内水分管理や栄養管理に臨床応用されるが,近年MFBIAで得られる栄養指標として,高齢透析患者のサルコペニア,フレイルをいち早く推定できる可能性から「位相角(phase angle;PhA)」が注目される.総体液量比率(TBW/FFM)とPhAおよび透析中の血圧状況を組み合わせた検討は,患者の臨床症状を反映でき,透析患者の適正体液量管理と安定透析に有用と思われる.
Theme Current topics in medical engineering technologies for dialysis therapy
Title Body water management using body composition monitor
Author Hirotomo Nagao Medical Satellite Iwakura
Author Masakatsu Kanzaki Medical Satellite Iwakura
Author Mikiko Takeyasu Medical Satellite Iwakura
Author Mikihiko Takada Medical Satellite Iwakura
[ Summary ] Adequate fluid management is important in improving prognosis in patients undergoing dialysis. However, in the current era, conventional indicators for fluid management are not applicable to a rapidly increasing aging population that includes a large percentage of undernourished patients with a high prevalence of cardiovascular diseases. Body fluid volume is closely associated with a patient's nutritional status; thus, it is difficult to assess fluid balance in patients undergoing dialysis. Multi-frequency bioelectrical impedance analysis (MFBIA) is a clinical method of fluid and nutritional management. Among the nutritional indicators that can be evaluated using MFBIA, the phase angle (PhA) has been drawing attention because it may potentially suggest the presence of sarcopenia and frailty at an early stage in elderly patients undergoing dialysis. The ratio of total body water to fat-free mass combined with the PhA and blood pressure status during dialysis can reflect the patient's clinical symptoms. Thus, these parameters are considered useful indicators to ensure adequate fluid management in patients undergoing dialysis and stable dialysis.
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