心臓移植後患者の生体腎臓移植術における循環管理

Circulatory Management in Living Donor Renal Transplantation for a Post-heart Transplant Patient

要旨

　心臓移植後患者の麻酔管理では脱神経が問題点となるが，移植後数年の経過で交感神経・副交感神経の順に再支配が起こりうると報告されている。再神経支配の程度により効果が期待できる薬物があるため，移植後期間，移植方法や運動耐容能，運動に対する心拍数や血圧の変化など参考にして事前に麻酔計画を練ることが重要である。

　Denervation is a common problem in patients who have received a heart transplant. Sympathetic reinnervation followed by parasympathetic reinnervation can occur several years after a patient undergoes a heart transplant procedure, and the degree of reinnervation varies with the duration of the post-transplant period and the patient’s individual characteristics. The effectiveness of some drugs may also depend on the length of the post-transplant period. The selection of anesthesia agents and methods in advance of a heart transplant is important in this regard, and the following should also be considered：the post-transplant period, the transplant method, the patient’s exercise tolerance, and changes in the patient’s heart rate and blood pressure in response to exercise.