もう一つの治療の選択肢〜オーバーナイト透析・在宅血液透析について〜

by hobashira-clinic

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΋͏Ұͭͷ࣏ྍͷબ୒ࢶ ʙΦʔόʔφΠτಁੳɾࡏ୐݂ӷಁੳʹ͍ͭͯʙ ҩྍ๏ਓ΍·ͼ͜ձɹ෱Ԭ౦΄͹͠ΒΫϦχοΫ Ϛωʔδϟʔྟচ޻ֶٕ࢜ɹਿຊ౽ण ɹୈճ݂ӷড়Խ4UFQ6Qηϛφʔ

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೥݄೔ɹ෱Ԭݝதؒࢢੜ·Ε ೥ɹ๺۝भ޻ۀߴ౳ઐ໳ֶߍɹଔۀ ೥ɹ෱ԬҩՊࣃՊٕज़ઐ໳ֶߍɹଔۀ ೥ɹἙ԰ࡔҪྤ࣮ΫϦχοΫɹೖ৬ ɹ೥ɹຊࢁࡔҪྤ࣮ΫϦχοΫɹసଐ ೥ɹ஑ాόεΩϡϥʔΞΫηεಁੳɾ಺Պɹೖ৬ ೥ɹҩྍ๏ਓ΍·ͼ͜ձɹೖ৬ ೥ɹ݄೔ɹ෱Ԭ౦΄͹͠ΒΫϦχοΫ։Ӄ

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ΦʔόʔφΠτಁੳ ࡏ୐ಁੳ ໿ྫ ࡏ୐ಁੳ ྫ 7"؅ཧ Ϛωδϝϯτ ΦʔόʔφΠτಁੳ ࡏ୐ಁੳ ྫ ௕࣌ؒɾසճಁੳ ΦʔόʔφΠτಁੳࡏ୐݂ӷಁੳ ೥݄೔ɹ෱Ԭݝதؒࢢੜ·Ε ೥ɹ๺۝भ޻ۀߴ౳ઐ໳ֶߍɹଔۀ ೥ɹ෱ԬҩՊࣃՊٕज़ઐ໳ֶߍɹଔۀ ೥ɹἙ԰ࡔҪྤ࣮ΫϦχοΫɹೖ৬ ɹ೥ɹຊࢁࡔҪྤ࣮ΫϦχοΫɹసଐ ೥ɹ஑ాόεΩϡϥʔΞΫηεಁੳɾ಺Պɹೖ৬ ೥ɹҩྍ๏ਓ΍·ͼ͜ձɹೖ৬ ೥ɹ݄೔ɹ෱Ԭ౦΄͹͠ΒΫϦχοΫ։Ӄ

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͋ͳ͕ͨɺ໌೔͔Βಁੳͩͱͨ͠Β ͲΜͳ࣏ྍΛߦ͍͍ͨͰ͔͢ʁ

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Կ࣌ؒʁ Կճʁ Ͳ͜Ͱʁ

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Կ࣌ؒʁ Կճʁ Ͳ͜Ͱʁ ͲΜͳੜ׆Λ ૹΓ͍ͨͰ͔͢ʁ

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Ұൠతͳࢪઃಁੳ ճʙ࣌ؒ िճʢ݄ճʣ

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Ұൠతͳࢪઃಁੳ ճʙ࣌ؒ िճʢ݄ճʣ

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Ұൠతͳࢪઃಁੳ ճʙ࣌ؒ िճʢ݄ճʣ ຊ౰ʹըҰతͳ࣏ྍͰྑ͍ͷʁ

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ಁੳෆ଍ͷ߹ซ঱ Կͱ͔͍ͨ͠ʂʂ ೋ࣍ੑ ෭ߕঢ়થ ػೳဏਐ঱ ಁੳΞϛϩΠυ঱ ߴ݂ѹ ૡᙱײ ϨετϨεϨοά ঱ީ܈ ෆ຾ ൽෘͷ৭ૉ௜ண ߴ1ɾ,݂঱

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೔ۭ͖Ͱࢁ΄Ͳ૿͑ͯ͘Δ͠ɺ ͨ͘͞Μ৯΂ͯσʔλ͸ΠϚΠν ಁੳத͸଍͕ͭΔɺ݂ѹԼ͕Δɺ ٸมରԠ͕ࢲͨͪͷ࢓ࣄʁ

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ױऀ͞Μ͕ ࣗ෼ͷਓੜΛ Ͳ͏ੜ͖͍͖͍͔ͯͨ ಁੳத৺ͷੜ׆͔Β ੜ׆ͷதͷಁੳ΁

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ࠓ೔ͷ͓࿩ ಁੳ࣏ྍͷબ୒ࢶ ΋ͬͱ͋ͬͯ΋͍͍Μ͡Όͳ͍ʁ

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ΦʔόʔφΠτಁੳ ࡏ୐݂ӷಁੳ

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ΦʔόʔφΠτಁੳ ࡏ୐݂ӷಁੳ

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ΦʔόʔφΠτಁੳ ໷৸͍ͯΔؒʹ΍Δಁੳ ਓؒ୭Ͱ΋৸Δ ͦͷ৸Δ࣌ؒΛ׆༻ ਭ຾࣌ؒʹಁੳΛߦ͏ͷͰ ௕࣌ؒಁੳ͕࣮ݱͰ͖Δ ʢʙ࣌ؒʣ ମײ࣌ؒΛ୹͘Ͱ͖Δ ೔தͷ࣌ؒΛ ϑϧ׆༻Ͱ͖Δ

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౰ӃͷΦʔόʔφΠτಁੳ ʙ ·Ͱʹ ಁੳ։࢝ ಁੳऴྃ w࣌ʹ࢝ΊΕ͹࣌ؒ෼ಁੳՄೳ wʮʓ࣌ؒಁੳʯΑΓʮʓ࣌·Ͱಁੳʯͱ͍͏ߟ͑ํ ˞ຖճͷಁੳ͕࣌ؒҟͳΔํ΋͍Δ wऴΘͬͨํ͸ͦͷ··࢓ࣄɹPSɹ͍ͬͨΜ͓Ո΁ w࣌ؒ͋ͨΓͷআਫ଎౓͕গͳ͘ͳΔ

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ΦʔόʔφΠτಁੳͷ҆શੑ͸ʁ w ໨͕ಧ͖ʹ͍͘؀ڥ w ৸ฦΓͳͲͷମಈ w ೔தΑΓগͳ͍ελοϑ Χϝϥ؂ࢹ ग़݂ηϯα

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౰ӃͷΦʔόʔφΠτಁੳ͸ࣗݾճऩ ࡂ֐ରࡦΛ໨తͱͯ͠ ΦʔόʔφΠτಁੳ࣮ࢪ৚݅ͷҰͭͱ͍ͯ͠Δ ೥݄೔ɹ࣌෼ େࡕ෎๺෦஍਒ൃੜ ࠷େ਒౓ऑ

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ൈ਑ํ๏ ਑݀ʹࢭ݂༻λϒϨο τΛషΓ෇͚Δ λϒϨοτͷ্ʹɺ ΫογϣϯͱͳΔΨʔ θΛ৐ͤΔ Ψʔθͷ্͔Βςʔϓ Ͱѹഭ͢Δ ਑Λൈ͘

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ൈ਑ํ๏ ਑݀ʹࢭ݂༻λϒϨο τΛషΓ෇͚Δ λϒϨοτΛϕϧτͰ కΊΔ ਑Λൈ͘

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ࣗݾճऩɹ̦ˍ̖ ̦ɽ౤ༀʢ஫ࣹʣ͸Ͳ͏ͯ͠Δʁ ̦ɽճऩதελοϑͷ࢓ࣄ͸ʁ ̦ɽࣄނ΍τϥϒϧ͸ͳ͍ʁ

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ࣗݾճऩɹ̦ˍ̖ ̦ɽ౤ༀʢ஫ࣹʣ͸Ͳ͏ͯ͠Δʁ ̖ɽճऩ࣌ɺελοϑ͕๚চͯ͠౤ༀ͠·͢ ̦ɽճऩதελοϑͷ࢓ࣄ͸ʁ ̖ɽױऀ͞ΜͷݟकΓ΍८ճͰ͢ ̦ɽࣄނ΍τϥϒϧ͸ͳ͍ʁ ̖ɽͨ·ʹࢭ݂ࣦഊ͢Δ͜ͱ͸͋Γ·͢

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ΦʔόʔφΠτಁੳ আਫ͕؇΍͔ʹͳΔ͜ͱ͕ɺ ԿΑΓͷϝϦοτɽ ೔தͷ࣌ؒΛ༗ޮ׆༻͠ɺ ࣾձ෮ؼ͠΍͍͢ɽ ಠډͷױऀ͞Μ΋໰୊ͳ͍ɽ

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ΦʔόʔφΠτಁੳ ࡏ୐݂ӷಁੳ

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ΦʔόʔφΠτಁੳ ࡏ୐݂ӷಁੳ

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ࡏ୐݂ӷಁੳ ױऀ͕ɺࣗ਎ͷډ୐Ͱɺ ࣗݾ؅ཧͷ΋ͱߦ͏݂ӷಁੳ ἥࢗ͸ࣗݾἥ͕ࢗجຊ ಁੳՄೳ࣌ؒ͸ ࢪઃʹΑͬͯҟͳΔ ࣗ୐ʹϓϥΠϕʔτ؀ڥ ௨Ӄ͕࣌ؒෆཁ ͚ͩ͡Όͳ͍ʂ

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))%ͷಛ௃

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ճ਺੍ݶͳ͠ ݄ճͷ੍ݶͳ͘ ಁੳΛߦ͑Δ

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ճ਺੍ݶͳ͠ ࣌ؒ΋ࣗ༝ ճͷಁੳ࣌ؒ΋ࣗ෼ͷ ੜ׆ʹ߹ΘͤͯܭըͰ͖Δ

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ճ਺੍ݶͳ͠ ࣌ؒ΋ࣗ༝ ಁੳεέδϡʔϧ΋ ࣗ༝ʹܾΊΒΕΔ ޷͖ͳ࣌ʹͰ͖Δ

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ࢪઃಁੳͷݶքΛ௒͑ͨ ΑΓࣗ༝ͳಁੳੜ׆ ճ਺੍ݶͳ͠ ࣌ؒ΋ࣗ༝ ޷͖ͳ࣌ʹͰ͖Δ

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ճ਺ ࣌ؒ ͍ͭʁ σʔλ ମௐ ߹ซ঱

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ճ਺ ࣌ؒ ͍ͭʁ σʔλ ମௐ ߹ซ঱ ࢪઃಁੳͷࠔ͍ͬͯΔ͜ͱ ))%ͳΒղܾͰ͖Δ͔΋͠Ε·ͤΜ

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ಁੳྔͷࢦඪ ೥%S4DSJCOFSɼ%S0SFPQPVMPT )%1 )FNPEJBMZTJT1SPEVDU ಁੳճ਺ि ɹ ಁੳ࣌ؒճ × 2 Ҏ্͕ྑ͍ͱఏএɹ౰ӃͰ͸Ҏ্Λਪ঑ ɹ ࣌ؒ ɹ ɹ ɹ ɹ ɹ ճि ɹ ɹ ɹ ɹ ɹ ɹ ɹ

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HDP Alb BUN Cr Ca P K β2-MG Hb #1 392 4.2 26.0 4.1 9.5 4.7 4.1 15.0 12.0 #2 188 4.5 34.4 7.7 10.3 3.3 4.2 16.5 12.4 #3 182 4.8 40.9 8.6 9.7 3.8 4.4 18.0 12.3 #4 172 4.3 32.7 6.3 9.1 4.8 5.0 18.6 11.1 #5 147 4.3 48.9 7.8 8.5 4.7 4.9 17.5 9.6 #6 147 4.1 41.9 6.1 9.2 4.4 5.0 21.7 9.1 #7 126 4.4 47.1 8.6 8.9 4.6 6.0 23.0 12.9 #8 123 4.0 26.3 7.5 8.9 4.1 5.0 16.0 12.2 #9 108 4.3 35.4 7.5 8.9 3.8 4.8 20.2 11.8 #10 108 4.6 49.2 6.7 9.8 3.8 4.4 14.0 10.0 #11 100 4.1 42.4 7.4 8.7 5.5 5.0 25.9 11.8 #12 100 4.4 32.0 8.1 9.2 3.9 5.1 23.2 11.4 #13 100 4.1 33.0 6.1 9.3 4.5 4.3 14.1 9.7 #14 100 4.4 30.0 5.5 9.3 3.4 4.8 16.4 10.0 #15 96 4.1 47.2 7.2 9.2 3.5 5.4 22.7 10.7 #16 96 4.2 47.3 9.8 8.2 5.1 5.1 20.4 12.3 #17 88 4.0 34.0 7.0 9.3 4.3 4.0 15.6 12.3 #18 88 4.3 40.2 9.6 9.1 3.1 4.2 20.2 12.0 #19 64 3.8 36.1 10.4 9.7 4.4 4.8 25.3 10.0 #20 61 4.4 46.8 10.0 9.9 6.6 4.2 21.7 11.0 #21 54 4.0 49.0 10.1 9.2 3.1 5.0 23.1 10.6 HDP Alb BUN Cr Ca P K β2-MG Hb Ќ.(͕ ҎԼ΋ "MC͸ ΄΅Ҏ্ ,͸ ʙ୆ $B͸ ಁੳӷ͕ॏཁ 1ͷԼ͕Γ ͗͢ʹ஫ҙ ˞ಁੳӷͰͷิਖ਼͕ඞཁ

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))%ױऀ਺ ਓ ೥຤ɹ೔ຊಁੳҩֶձʮΘ͕ࠃͷຫੑಁੳྍ๏ͷݱگʯΑΓ શಁੳױऀɹ໿ສਓͱͯ͠ 0 150 300 450 600 1975 1976 1977 1978.6 1979.6 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

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ͳͥ૿͑ͳ͍ʁ))%ױऀ਺

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ҩྍऀ͕ѹ౗తʹ ))%Λ஌Βͳ͍

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೥ɹਓ޻ਛଁר ೥ɹྟচಁੳ݄߸

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Α͋͘Δޡղ wಁੳ૷ஔΛࣗ෼ͰങΘͳ͍ͱ͍͚ͳ͍ʁ w௞ିॅ୐Ͱ͸Ͱ͖ͳ͍ʁ wࣗݾἥࢗ͸೉͍͠ʁ wຖ݄ߴֹͳࣗݾෛ୲͕͋Δʁ

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Α͋͘Δޡղ wಁੳ૷ஔΛࣗ෼ͰങΘͳ͍ͱ͍͚ͳ͍ʁ w௞ିॅ୐Ͱ͸Ͱ͖ͳ͍ʁ wࣗݾἥࢗ͸೉͍͠ʁ wຖ݄ߴֹͳࣗݾෛ୲͕͋Δʁ /0

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ͪΐͬͱ͚͓ͩۚͷ࿩΋ ))%ͷอݥ఺਺͸ɺ ࢪઃಁੳΑΓ௿͍Ͱ͢ ʲࡏ୐݂ӷಁੳࢦಋ؅ཧྉʳɹ఺ ˞ࡐྉඅͷ੥ٻ͸Մೳ ʲසճࢦಋ؅ཧྉʳɹɹɹɹɹ఺ ˞ॳճࢉఆ݄͔Β͔݄ؒɺճ݄·Ͱ ʲಁੳӷڙڅ૷ஔՃࢉʳɹɹɹ఺ ʲ࠶਍ྉʳɹɹɹɹɹɹɹɹɹ఺ճ ͓͓Αͦɺ݄ʹ਺ສԁ ଟ͍ʁ গͳ͍ʁ

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Ոʹಁੳ૷ஔͷ ͋Δ෩ܠ ૝૾Ͱ͖·͔͢

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΍ͬͯΈΑ͏ ४උ͸ͭ̕

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ࢦಋܭը ױऀ༻ ϚχϡΞϧ ୲౰ऀ ۈ຿ௐ੔

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ࢦಋܭը ױऀ༻ ϚχϡΞϧ ୲౰ऀ ۈ຿ௐ੔ Φϯίʔϧ ମ੍ ෺඼ͷ ड͚౉͠ ఆظड਍ ؅ཧ߲໨

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ࢦಋܭը ױऀ༻ ϚχϡΞϧ ୲౰ऀ ۈ຿ௐ੔ Φϯίʔϧ ମ੍ ෺඼ͷ ड͚౉͠ ఆظड਍ ؅ཧ߲໨ ૷ஔܖ໿ ʢରϝʔΧʔʣ ױऀ༻ ൃ஫ॻ ಉҙॻ ঝ୚ॻ

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ҡ࣋؅ཧͷίπ ఆظड਍ ҆શରࡦ σʔλͷ؅ཧ ۓٸి࿩ରԠ ఆظ఺ݕ ഇغ෺ ɾ ɾ ɾ

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透析⽤抜針・漏液検知器と連動。⾒針絆Ⓡ検知器との連動針抜け⾎液漏れ ग़݂ײ஌͢Δͱ ಁੳ૷ஔͷϙϯϓ͕ࢭ·Δ ಁੳ૷ஔ͔Βܯใ͕໐Δ

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WebΧϝϥΛ׆༻ͨ͠ ి࿩ରԠ WebΧϝϥͰಁੳ૷ஔͷը໘ΛϦΞ ϧλΠϜʹϞχλϦϯάͰ͖Δ ΋͠΋͠ʁ ͳΜ͔ɺ੩຺ѹͷܯใ͕Կ ճ΋໐ΓΑΔΜ΍͚Ͳʁ ΧϝϥͰݟͯΈ·͢Ͷɺ ͪΐͬͱ଴͍ͬͯͩ͘͞ ͱΓ͋͑ͣɺ͜ͷը໘Έ ͯ΋Β͑ͨΒɺͲΜͳঢ় گ͔Θ͔Δ΍Ζ ը໘ʹग़ͯΔܯใͷछྨ ͸ʁͦͷ΄͔ͷ਺஋͸Ͳ͏ ͳͬͯΔ͔ͳʁ

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ͳʹΑΓେ੾ͳ͜ͱʂ ҡ࣋؅ཧͷίπ ఆظड਍ ҆શରࡦ σʔλͷ؅ཧ ۓٸి࿩ରԠ ఆظ఺ݕ ഇغ෺

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Կ͔͋ͬͨΒ ऴྃ͢Δ ͜ͷ͚ͭͩΛ ઈରʹकͬͯ΋Β͏

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ਓ໨ͷଔۀ ࢝·ͬͯ͠·͑͹ɺ ҙ֎ͱΧϯλϯʹଓ͖·͢ʂ ·ͣɺ

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ΦʔόʔφΠτಁੳ ࡏ୐݂ӷಁੳ

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ҩྍ๏ਓ΍·ͼ͜ձ ෱Ԭ౦΄͹͠ΒΫϦχοΫ ೥݄೔։Ӄ ಺Պɾਛଁ಺Պɾ౶೘ප಺Պ ਓ޻ಁੳ಺Պ ಁੳࣨݸࣨʢ׬શݸࣨԽʣ ΦʔόʔφΠτಁੳ ࡏ୐݂ӷಁੳ ௕࣌ؒɾසճɾ೔༵ಁੳ

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চɹ׬શݸࣨͷಁੳࣨ ୆ಋೖʢݱࡏ͸୆ʣ w ը໘͕ԼΛ޲͘ w ϝϯςφϯε෦඼͕গͳ͍ w ૢ࡞ը໘͕େ͖͍ w λονόΠϒػೳ

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ΦʔόʔφΠτಁੳத͸ υΞΛดΊ͍ͯΔͷͰ ܯใ౮͕Έ͑ͳ͍ ෦԰ͷ֎ʹܯใ౮Λ ֎෦ग़ྗͯ͠ Ͳͷ෦԰͔֬ೝ

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ݸࣨ಺ʹ͸؂ࢹΧϝϥΛઃஔ ױऀͷಉҙΛಘ্ͨͰɺ ಁੳதͷঢ়ଶΛϞχλϦϯά φʔεεςʔγϣϯ಺Ͱɺ શݸࣨͷΧϝϥΛ֬ೝՄೳ ফ౮ޙ͸҉ࢹରԠ

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ΦʔόʔφΠτಁੳɺࡏ୐݂ӷಁੳ͸ ਛ୅ସྍ๏ͷ৽ͨͳબ୒ࢶ બ୒ࢶΛ૿΍͢͜ͱ͸ɺ୭ͷͨΊʁԿͷͨΊʁ