長期透析患者の血行動態と心血管系異常に関する研究

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  • 大森 伯
    新潟大学医学部第二内科教室 信楽園病院内科

書誌事項

タイトル別名
  • Studies on Hemodynamics and Cardiovascular Disease in LONG-TERM Hemodialysis Patients
  • チョウキ トウセキ カンジャ ノ ケッコウ ドウタイ ト ココロ ケッカンケイ
  • 2. Clinical Studies on Cardiovascular Disease in Long-Term Hemodialysis Patients
  • 第2報　長期生存例の心血管系異常の臨床的検討

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説明

The following conclusions concern about the chronological changes of cardiovascular abnormalities in seventy-two patients on long-term hemodialysis (H.D.). The clinical observations included here were on blood pressure, ECG abnormalities, cardiothoracic ratio (CTR) and aortic calcification seen on chest film, vascular calcification of the peripheral blood vessels and pulse wave velocity of the aorta.<BR>1. Blood pressure was well controlled by H.D. and was stabilized in longer dialysis period, resulted in decreased incidence of hypertensive patients.<BR>2. CTR was decreased and stabilized in longer dialysis period, with no tendency of its increase except age group over 60 years old. The incidence of patients with CTR above 50% on H.D. lasting more than six years was 17 % of the patients, although these patients showed large CTR before the institution of H.D.<BR>3. Sv1+Rv5 on electrocardiogram (ECG) showed 34.8±12.7mm at the onset of dialysis treatment, and temporary increase in the length of one or two years and then the same value as in the onset of H.D.. Incidence of patients with Sv1+Rv5 on ECG above 35mm was 47.5% at the institution of H.D. followed by no increase after the above period. These results suggest left ventricular hypertrophy (LVH) may not progress in the course of H.D.. ECG abnormalities with LVH were seen in half of the patients at the onset of dialysis treatment, which suggest that blood pressure control is of great importance before the institution of H.D..<BR>4. ECG abnormalities with ST and T changes were seen in 41.7% of patients at the onset of dialysis treatment, which showes subsequent decrease in one year, and increase again thereafter. The appearance of patients with myocardial infarction, anginal episode and arrhythmia in the course of dialysis treatment suggest coronary atherosclerosis may progress insidiously.<BR>5. Pulse wave velocity of the orta showed no significant changes suggestive of the advancing atherosclerosis, and the radiographic findings of the aortic calcification and vascular calcification of the peripheral vessels showed gradual increase of the incidence in the course of dialysis treatment, which may reflect the rapid progress of the vascular lesions.<BR>6. The characteric features of the above items by age groups and chronological changes were that the aged patients manifest the high incidence in all of them with its increase in the course of dialysis treatment. It should be stressed the aged patients may develope and deteriorate the cardiovascular abnormalities.

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