慢性透析患者のOPCABにおいて術中HDFが有用であった1例  [in Japanese] Hemodiafiltration during Off-Pump Coronary Artery Bypass Grafting for a Chronic Dialysis Patient  [in Japanese]

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Author(s)

    • 福本 淳 Fukumoto Atsushi
    • 京都府立医科大学心臓血管呼吸器機能制御外科学 Department of Cardiovascular and Thoracic Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
    • 夜久 均 Yaku Hitoshi
    • 京都府立医科大学心臓血管呼吸器機能制御外科学 Department of Cardiovascular and Thoracic Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
    • 土井 潔 Doi Kiyoshi
    • 京都府立医科大学心臓血管呼吸器機能制御外科学 Department of Cardiovascular and Thoracic Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
    • 沼田 智 Numata Satoshi
    • 京都府立医科大学心臓血管呼吸器機能制御外科学 Department of Cardiovascular and Thoracic Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
    • 林田 恭子 Hayashida Kyoko
    • 京都府立医科大学心臓血管呼吸器機能制御外科学 Department of Cardiovascular and Thoracic Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
    • 小川 貢 Ogawa Mitsugu
    • 京都府立医科大学心臓血管呼吸器機能制御外科学 Department of Cardiovascular and Thoracic Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
    • 井上 知也 Inoue Tomoya
    • 京都府立医科大学心臓血管呼吸器機能制御外科学 Department of Cardiovascular and Thoracic Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
    • 北村 信夫 Kitamura Nobuo
    • 京都府立医科大学心臓血管呼吸器機能制御外科学 Department of Cardiovascular and Thoracic Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine

Abstract

慢性透析患者の冠動脈バイパス術(CABG)症例においては, その周術期管理のさまざまな問題により, 合併症発症頻度, 早期死亡率とも依然高いのが現状である.そこでわれわれは, 慢性透析患者に対し, 手術リスクを下げ, かつ周術期合併症を予防する目的で, off-pump CABG (OPCAB)の術中に血液濾過透析(HDF)を施行した.手術開始時よりHDFを開始し, OPCAB (LITA-# 8∿# 10)を施行した.吻合中は, 血行動態への影響を軽減するため, 透析装置の血液流量を下げ, 除水を中断した.吻合終了後は, ヘマトクリット30∿35%, 中心静脈圧3∿5 mmHg, 血清K^+濃度3.0∿3.5 mEq/lを目標に, 開胸のまま, 輸血を十分行いながらHDFを続行した.目標達成後, HDFを終了し, 術野の出血がないことを十分確認したのちに閉胸を行い, 手術を終了した.ICU入室後90分で抜管, 翌朝より食事を開始し, 術後2日目に一般病室へ転室した.術後3日目から透析室にて週3回の維持透析を再開し, 合併症もなく術後11日目に退院となった.OPCABの術中にHDFを施行したことにより, 早期抜管, 早期離床が可能となり, 術後経過がきわめて良好であった慢性透析患者の1例を経験した.

Patients on chronic hemodialysis, undergoing coronary artery bypass grafting (CABG) have high perioperative mortality and morbidity. In order to reduce the perioperative risks, we performed intraoperative hemodiafiltration (HDF) during off-pump CABG (OPCAB). A 62 year-old-man, who had been on dialysis for 2 years, was admitted with a sensation of chest compression. A coronary angiography revealed 75% stenosis with severe calcification in the left anterior descending artery and 90% stenosis in the second diagonal branch. During the operation, veno-venous HDF was started, using a double lumen catheter that was introduced into the femoral vein at the same time that a skin incision was made. During the exposure of the diagonal branch by rotating the heart, the blood flow of HDF was decreased and dehydration was halted to avoid hemodynamic deterioration. The patient was extubated 1.5 h after the operation and did not require continuous hemodiafiltration (CHDF) in the intensive care unit (ICU). Routine hemodialysis was restarted on the 3rd postoperative day. The postoperative course was uneventful, and the patient was discharged to home on the 11th postoperative day. HDF during OPCAB for this chronic dialysis patient was observed to be effective and yielded an excellent postoperative recovery without CHDF in the ICU.

Journal

  • Japanese Journal of Cardiovascular Surgery

    Japanese Journal of Cardiovascular Surgery 34(3), 216-219, 2005-05-15

    The Japanese Society for Cardiouascular Surgery

References:  10

Keywords

Codes

  • NII Article ID (NAID)
    10016471994
  • NII NACSIS-CAT ID (NCID)
    AN00193284
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    02851474
  • Data Source
    CJP  NII-ELS 
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