9. 腎不全合併症例と周術期管理―透析患者の心臓大血管手術，その現状と管理

Hemodialysis Patients in Cardiovascular Surgery；Current Status and Management

心臓大血管手術を受ける患者群の中で，透析症例はそれだけでハイリスクである．糖尿病性腎不全の増加に伴い，透析患者の心臓血管外科手術も増加傾向にある．本稿では透析患者の心臓血管外科手術に関する本邦での現状と管理に関して述べてみたい．

Cardiovascular surgery for renal failure patients with dialysis is challenging. According to the nationwide cardiovascular surgery database in Japan （Japan Cardiovascular Surgery Database；JCVSD）, dialysis patients have occupied about 10％ of whole surgery of coronary artery bypass grafting （CABG）. In CABG, ratio of off-pump surgery did not change between non-dialysis （63％） and dialysis （64％） patients. Operative mortality of dialysis patients （7.8％） was 3 times higher than non-dialysis patients （2.1％）. In aortic valve replacement （AVR） dialysis patients occupied about 9％ of whole AVR in Japan. In dialysis patients the percentage of bioprostheses was 65％ and the choice of bioprostheses steeply increased when the age was over 70, which was similar to the non-dialysis patients. For dialysis before cardiovascular surgery, it is important not to dehydrate too much in order to maintain stable hemodynamics during the surgery. It is also important not to dehydrate too much after surgery in order to prevent non-occlusive mesenteric ischemia （NOMI）.