慢性腎不全時の血脈管機能 : 血液透析を中心に
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概要
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Cardiovascular function in chronic renal failure and during hemodialysis was studied, since chronic or periodically repeated dialysis has been performed recently in clinical bases. Subjects were 52 cases of chronic renal failure and 7 cases on whom hemodialysis was repeated 110 times. Anemia was a major factor inducing cardiomegaly, and it was remarkable when Hb was less than 30%. Not only anemia but hypertension and metabolic depletion should be considered as factors inducing cardiomegaly. Blood pressure was correlated with ST-T change and left ventriuclar hypertrophy on E C G. In highly anemic cases, incidence of ST-T change was increased. Hyperkalemic pattern on E C G and real plasma potassium level showed gross correlation. Considering direction of K-shift and digitalis administration would make interpretation of E C G more precise and accurate. During hemodialysis, plasma potassium decreased within normal range, and it seemed to cause shortening PQ, interval, ST depression, flatten T wave, high U wave and elongation of QTc. From these results, K-shift is an important finding. QTc was shortend in the latter stage of dialysis. QII interval was always shortend also and Hegglin's symptom was observed sometimes. In hemodynamic study by Wezler-Boger method, compensatory increase of cardiac output in anemic patients was remarkably reduced and pressure loading reaction was induced by hemodialysis. Hence, importance of cardiovascular control during hemodialysis was stressed in this paper. Findings at autopsy showed cardiac hypertrophy and perivascular edema〜fibrosis in all cases, and lamellar dispersion of perivascular fibers was found in 2 cases. Considering cardiovascular function, initiation of hemodialysis in earlier stage and selection of appropriate dialysing method would secure longer prognosis.
- 千葉大学の論文