透析ってどんな治療？どんなことをするの
透析という治療について、あなたはご存じですか？言葉を聞いたことがある方や、ご家族が治療を受けている場合もあるかもしれませんね。この記事では、透析について、全く知識がない方にも、どのような治療なのか理解できるよう、まとめています。
目次
さっそくですが、透析とは…?
透析はどのような方が必要とする治療なのでしょうか。透析の治療の目的は、腎臓の働きを助けることです。透析は、腎臓が障害を負っている状態の場合に行います。とは言っても、多くは慢性的に腎臓の機能が障害された状態である「慢性腎不全」を患っている方が、透析を必要とするケースがほとんどです（*1）
腎臓には次のような働きがあります。
・水分、塩分の調整
・ビタミンDを活性化する
・血液を作る
・酸や電解質の調整
・老輩物の排泄
しかし、腎不全となり腎臓の役割が果たせなくなると
・浮腫みが起こる
・高血圧になる
・息苦しさを感じる
・貧血
・高カリウム血症/高リン血症/低カルシウム血症.
・尿毒症（意識障害、気分深い等）
・肺に水が溜まる
・身体に酸が溜まる
・骨が弱くなる
といった症状を引き起こす場合があります。慢性腎不全による、ここで紹介した症状を放置しておくと、命に関わってくる危険な状態になります。腎臓の全ての機能を回復させるためには、腎臓を移植する「腎移植」しか存在しません。しかし、移植を行うのはなかなか困難なケースが多くなってしまいます。そのため、完全な腎臓の代替とはいいませんが、腎臓の大切な機能の中でも、大切だと言われている「老廃物・水分の排泄」を行うことで、生命維持は可能になると言われています。老廃物・水分の排泄は「透析」で行うことができます。
透析の治療内容を詳しく知りたいのですが….
では、透析についての概要をご説明したところで、透析の治療内容と種類についてご紹介します。透析は、医療用語で「透析療法」と呼ばれ、「血液透析」と「腹膜透析」の2種類が存在します。慢性腎不全の場合、この透析の治療を導入し始めると、一生涯行わなければなりません。次にこの2種類の透析のそれぞれの違いを紹介します。
「血液透析」
腎臓と同じような働きをする、「ダイアライザー」と呼ばれる、人工の腎臓となるフィルタを使用し、血液から、老廃物や過剰な水分を除去していきます。細かい治療内容は患者さんにより異なりますが、標準的には一回4時間程度の治療で、週3回行っていきます。
血液透析は、医療機関での治療になります。そのことから、時間的な拘束がでてきてしまいすが、医療従事者のもとで、治療を受けることができることはメリットと言えます。治療自体は、患者さんが自己にて手技を取得する必要はありません。治療中は血液を血管から、一定量の取り、ダイアライザーに通すことが必要になります。そのため、治療を導入する前に、血管に手術を行うことが必須です。
「腹膜透析」
お腹の中に透析液を入れ、腹膜という自身のお腹を包む膜を使い、透析を行う方法です。お腹の中に1.5-2Ｌ程度の透析液を入れ、時間をかけゆっくりと透析を行います。そのため身体への負担がかかりづらく、血液変動も比較的少ない傾向にあります。夜間寝ている間に透析液を貯めておく方法、１日に4回程度透析液の出し入れを行う方法があります。腹膜透析の、血液透析と最も異なる点は、自宅で治療が行えるという点で、通院も月1回程度です。自己にて手技を行う必要がありますが、時間的な拘束は少ないと言えます。そのため、日常生活における行動範囲の制約も減り、治療導入前の生活スタイルにあわせやすいのがポイントです。治療導入前には、腹膜内に透析を行うためのカテーテルを外科的手術により、入れておく必要がでてきます。
まとめ
腎臓には、老廃物を排泄したり、体内の電解質を調整するなど大切な働きがありますが、この機能が果たせないことで、生命維持の危機に関わってきます。
そこで、腎臓の機能が慢性的に障害されてしまっている方に行われる治療が透析です。場合によっては一時的に透析の治療を必要とするケースもあります。透析は「血液透析」と「腹膜透析」の２種類が存在し、それぞれ医療施設で行うか自宅でできるかという大きな違いがあります。いずれも、治療導入前に手術が必要となります。透析が必要になった場合に自身の生活に合っているのはどちらの治療法であるか、主治医に充分相談する必要があります。
(*1)大量の出血を伴う交通事故や、手術を行ったあと、または全身の火傷により、一時的に腎機能障害が発生することで、一次的に透析を必要とする場合があります。この場合は、腎臓の機能が回復さえすれば、透析は終了するため、「腎臓の機能を助ける」透析の導入目的は同じですが、永久に続くことはありません。
「今後の生活環境が変わる事への不安」や「介護を使って生活をどうデザインをしていったら良いか」など介護は協力体制で成り立っております。 ちょっとでも解決できる、ストレス軽減できる記事を目指し、一つの相談場所のメディアを目指しております。
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