血液透析中の血液動力学的管理のためのシャント側esCCOモニタリングの使用は,低血圧の早期発見のための新しいアプローチとして: 2つの症例の報告
Koji Nakai1, Yuichi Hirate2, Takeyuki Hiramatsu2
1College of Life and Health Sciences, Department of Clinical Engineering, Chubu University, 1200 Matsumoto-cho, Kasugai, Aichi, 487-8501, Japan. k_nakai@fsc.chubu.ac.jp.
まとめ
シャント側での推定連続心圧出力 (esCCO) 監視は,従来の血圧 (BP) 監視よりも早期に内静脈低血圧を検出する可能性があります. この非侵襲的な方法は,透析中の血液動力学的管理のための有望なアプローチを提供します.
科学分野:
- 腎臓科
- 心血管の生理学
背景:
- 内透析性低血圧 (IDH) は,透析中の一般的な合併症です.
- 血液動力学的変化の早期発見は,IDHとその悪影響を予防するために不可欠です.
- 従来の血圧モニタリングは,IDHの早期警告を十分に提供しない可能性があります.
研究 の 目的:
- 透析中の低血圧の早期発見のための非侵襲的なシャント側推定連続心電量 (esCCO) の有用性を評価する.
- 透析中の患者の伝統的な血液動力学パラメータとesCCOの傾向を比較する.
主な方法:
- 血液動力学が安定した患者と 低血圧ショックを発症した患者によるケーススタディ
- シャント側ESCCOを用いた非侵襲的連続血液動力学的モニタリング
- 非侵襲的な血圧 (BP),心拍数,ESCCO,推定脳卒中量,全身血管抵抗,および透析前のおよび後の血量変化の年代的評価.
主要な成果:
- 安定した患者 (ケース1) では,esCCOは血量減少とともに一時的な低下を示したが,心拍数と脳卒中の容量の変化によるBPは安定したままでした.
- 低血圧ショック (ケース2) の患者では,esCCOは非侵襲的なBP低下が明らかになる前に急速に低下し,esCCOは30分前に迫り来る低血圧を検出したことを示しました.
- システム血管抵抗補償の限界は,EsCCOの低下前にケース2で達成されました.
結論:
- シャント側ESCCOモニタリングは,透析中の従来のBPモニタリングで見逃された低血圧の早期徴候を特定することができます.
- esCCOモニタリングは,効果的な内分析血液動力学的管理のための潜在的な将来的な方法を示しています.
- esCCOを使用した非侵襲的血液動力学的モニタリングは,透析中の患者の安全性と結果を改善することができます.
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