今日の治療 浮腫 成因・診断・治療

出版社： 永井書店
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発行日： 1979-08-20
分野： 臨床医学：一般  >  臨床医学一般
電子書籍版： 1979-08-20
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浮腫の病態生理、用いる利尿剤その他の手段の作用機序、予想される副作用などをよく理解しておく必要がある。医師が実際に診療するにあたり、浮腫性疾患の病態生理、利尿剤の作用機序、実際の治療方針に疑問を生じた時にそれぞれの部分を読んで参考にできるように心掛けた。（序文より）

目次

  • 表紙
  • 序
  • 目次
  • I. 総論
  • A. 浮腫の考え方
  • B. 浮腫性疾患の病態生理と成因
  • 1. 全身の水分量と電解質量
  • 2. 循環血液量および有効循環血液量
  • 3. escape現象
  • 4. 細胞外液量増加に対する生体の反応
  • 5. volume receptor
  • 6. ナトリウム排泄調節因子
  • 1) 糸球体濾過値
  • 2) アルドステロン
  • 3) アンジオテンシン
  • 4) レニン・アンジオテンシン系のvolum ereceptor
  • 5) 腎の血行動態
  • 6) ネフロンの多様性
  • 7) 交感神経
  • 8) ナトリウム利尿ホルモン
  • 9) ホルモンのナトリウム代謝におよぼす影響
  • 10) プロスタグランジン
  • 11) カリクレイン・キニン系
  • 7. 浮腫性疾患のネフロンにおけるナトリウム再吸収亢進部位
  • 8. 水代謝調節機構と浮腫
  • 1) 口渇
  • 2) 抗利尿ホルモン
  • 3) 浮腫性疾患における低ナトリウム血症
  • i) 血清ナトリウム濃度
  • ii) 低ナトリウム血症の成因
  • 9. 浮腫におけるカリウム代謝および酸塩基平衡
  • 10. 浮腫の局所性因子
  • 1) 組織間液と浮腫
  • 2) 組織間液生成機序
  • i) 毛細血管の機能
  • ii) Starling forces
  • iii) リンパ管の機能
  • iii) 組織圧
  • iv) 膠質浸透圧
  • C. 浮腫の診断と検査法
  • 1. 浮腫の存在を証明するために行う検査
  • 1) 皮下浮腫の証明
  • 2) 体重の測定
  • 3) 胸腔内水分貯留の証明
  • 4) 心膜液貯留の証明
  • 5) 肺内液体貯留の証明(左心不全)
  • 6) 腹水の証明
  • 2. むくみを主訴とする患者に行う検査と診断法
  • 1) Problem oriented system
  • 2) 問診
  • 3) ベッドサイドにおける診察の要点
  • 4) 臨床検査
  • D. 浮腫の治療
  • 1. 安静
  • 2. 食事療法および輸液療法
  • 1) 熱量
  • 2) 糖質・蛋白・脂質の必要量
  • 3) 食塩制限
  • 4) 水制限
  • 5) カリウムの摂取量
  • 3. 利尿剤による治療
  • 4. そのほかの治療法
  • 文献
  • II. 腎生理学と利尿薬の薬理
  • A. 尿細管における水・電解質の輸送
  • 1. 糸球体・尿細管バランス
  • 1) renin-angiotensin説
  • 2) 尿細管容積説
  • 3) 尿細管流速説
  • 4) 物理的因子説
  • 2. 尿細管での水, NaClの輸送
  • 1) 近位尿細管
  • i) 等張性再吸収
  • ii) 重炭酸イオンとNa+輸送
  • iii) ブドウ糖とNa+輸送
  • iv) アミノ酸とNa+輸送
  • 2) Henleのループ
  • i) 下行脚
  • ii) 細い上行脚
  • iii) 太い上行脚
  • 3) 遠位尿細管
  • 4) 集合尿細管
  • 3. 尿細管でのK+の輸送
  • 1) 近位尿細管心
  • 2) 遠位尿細管
  • 3) 集合尿細管
  • 4. 尿の濃縮機序
  • 1) 腎髄質の役割
  • 2) 対向流系とその意義
  • 3) 腎髄質の対向流系
  • 4) NaClの能動輸送による対向流増幅理論
  • 5) 受動輸送を加味した対向流増幅理論
  • i) 受動輸送モデルの基礎(Kuhn, Ryffelのモデル)
  • ii) Stephensonのモデル
  • iii) Kokko&Rectorのモデル
  • 5. 尿細管でのCa++の輸送
  • 1) 近位尿細管
  • 2) Henleループ
  • 3) 遠位尿細管と集合尿細管
  • 6. 尿細管でのPの輸送
  • 1) 近位尿細管
  • 2) 遠位尿細管
  • 7. 尿細管での酸-塩基平衡の調節
  • 1) 重炭酸イオンの吸収とH+の排泄
  • 2) 滴定酸の形成
  • 3) アンモニアの形成と排泄
  • B. 利尿薬の定義
  • C. 利尿作用の研究方法
  • 1. 尿量, 尿組成の分析
  • 2. 浸透圧クリアランス法
  • 3. ストップフロー法
  • 4. マイクロパンクチャー法
  • 1) フリーフロー法
  • i) 再吸収機能の指標
  • ii) ランダム採取と再採取
  • 2) ストップフロー法
  • 5. マイクロパーフュージョン法
  • 1) in situマイクロパーフュージョン
  • 2) in vitroマイクロパーフュージョン(単離尿細管灌流法)
  • D. 利尿薬の分類
  • 1. 最大効果と尿中電解質パターン
  • 2. 作用部位からみた分類
  • E. 利尿薬の作用機序
  • 1. 能動輸送の抑制
  • 2. 炭酸脱水酵素の抑制
  • 3. 受動的膜透過性の抑制
  • 4. ホルモン作用の修飾
  • 1) 抗アルドステロン作用
  • 2) 抗ADH作用
  • F. 利尿薬の副作用
  • 1. 水, Naバランス
  • 1) 急性Na欠乏
  • 2) 慢性Na欠乏
  • 2. K+欠乏
  • 3. ブドウ糖耐容能の低下
  • 4. 高尿酸血症
  • 5. Ca++代謝
  • G. 効力の高い利尿薬
  • 1. フロセミド
  • 1) 化学
  • 2) 吸収と運命
  • 3) 腎臓に対する作用
  • i) 尿中溶質排泄パターン
  • ii) 尿濃縮力と稀釈力
  • iii) 血行動態
  • iv) 作用部位
  • v) 作用機序
  • 4) 腎外作用
  • i) 血圧
  • ii) 糖代謝
  • 5) 毒性と副作用
  • i) 急性毒性
  • ii) 慢性毒性
  • iii) 副作用
  • 2. エタクリン酸
  • 1) 化学
  • 2) 吸収と運命
  • 3) 腎臓に対する作用
  • i) 尿中溶質排泄パターン
  • ii) 尿濃縮力と稀釈力
  • iii) 血行動態
  • iv) 作用部位
  • v) 作用機序
  • 4) 腎外作用
  • i) 血圧
  • ii) 糖代謝
  • 5) 毒性と副作用
  • i) 急性毒性
  • ii) 慢性毒性
  • iii) 副作用
  • 3. ブメタニド
  • 1) 化学
  • 2) 吸収と運命
  • 3) 腎臓に対する作用
  • i) 尿中溶質排泄パターン
  • ii) 尿濃縮力と稀釈力
  • iii) 血行動態
  • iv) 作用部位
  • v) 作用機序
  • 4) 腎外作用
  • i) 血圧
  • ii) 糖代謝
  • 5) 毒性と副作用
  • i) 急性毒性
  • ii) 慢性毒性
  • iii) 副作用
  • 4. 有機水銀利尿薬
  • 1) 化学
  • 2) 吸収と運命
  • 3) 腎臓に対する作用
  • i) 尿中溶質排泄パターン
  • ii) 作用部位
  • iii) 作用機序
  • 4) 副作用
  • H. 中等度効力の利尿薬
  • 1. サイアザイド系
  • 1) 化学
  • 2) 吸収と運命
  • 3) 腎臓に対する作用
  • i) 尿中溶質排泄パターン
  • ii) 濃縮力と稀釈力
  • iii) 血行動態
  • iv) 作用部位
  • v) 作用機序
  • 4) 腎外作用
  • i) 血圧
  • ii) 血糖上昇作用
  • 5) 毒性と副作用
  • i)急性毒性
  • ii) 慢性毒性
  • iii)副作用
  • 2. サイアザイド類似薬
  • I. 効力の低い利尿薬
  • 1. 炭酸脱水酵素阻害薬
  • 1) 化学
  • 2) 吸収と運命
  • 3) 腎臓に対する作用
  • i) 尿中溶質排泄パターン
  • ii) 尿濃縮力と稀釈力
  • iii) 作用部位
  • iv) 作用機序
  • 4) 腎外作用
  • i) 眼圧低下作用
  • ii) 胃液, 膵液に対する作用
  • iii) 中枢神経に対する作用
  • 5) 毒性と副作用
  • i) 急性毒性
  • ii) 慢性毒性
  • iii) 副作用
  • 2. スピロノラクトン
  • 1) 化学
  • 2) 吸収と運命
  • 3) 腎に対する作用
  • i) 尿中溶質排泄パターン
  • ii) 尿濃縮力と稀釈力
  • iii) 作用部位
  • iv) 作用機序
  • 4) 毒性と副作用
  • 3. トリアムテレンとアミロライド
  • 1) 化学
  • 2) 利尿作用
  • i) 作用部位
  • ii) 作用機序
  • 3) 副作用
  • 4. 浸透圧利尿薬
  • 1) 利尿効果
  • 2) 作用部位と作用機序
  • 3) 副作用
  • 文献
  • III. 各種疾患による浮腫の病態と治療
  • A. 心性浮腫
  • 1. 心不全と浮腫
  • 2. 心性浮腫の発生機序
  • 1) 前方障害説と後方障害説
  • 2) 心性浮腫の成因
  • i) NaCl, 水の貯留
  • ii) 静脈圧の上昇
  • iii) 膠質浸透圧の低下
  • iv) 組織圧
  • v) リンパ流
  • vi) 毛細管透過性
  • vii) ホルモン
  • 3) 心性浮腫と腎
  • 4) 心性浮腫と肝
  • 3. 心性浮腫の診断
  • 4. 心性浮腫の治療
  • 1) 安静およびNa制限
  • 2) digitalis薬
  • 3) 利尿薬
  • 4) 末梢血管拡張薬
  • 5) catecholamine類
  • 6) glucagon
  • 7) 人工透析, 腹水再静注法
  • i) 心性浮腫治療に用いられる利尿薬
  • ii) 心性浮腫における利尿薬の使い方
  • B. 腎性浮腫
  • 1. 腎炎性浮腫
  • 1) 急性腎炎
  • i) 急性腎炎における浮腫の発生機序
  • ii) 急性腎炎浮腫の治療
  • 2) 慢性腎炎
  • 3) 慢性腎不全
  • 4) 人工透析法
  • 2. ネフローゼ性浮腫
  • 1) ネフローゼ症候群における浮腫の頻度
  • 2) 臨床検査所見と浮腫
  • 3) ネフローゼ症候群における浮腫の発生機序
  • 4) ネフローゼ症候群における浮腫の治療法
  • i) 蛋白漏出の抑制
  • ii) 血漿膠質浸透圧増加療法
  • iii) 利尿薬
  • C. 肝性浮腫
  • 1. 肝硬変症における浮腫および腹水の発生機序
  • 1) 一次性因子
  • i) 低albumin血症
  • ii) 門脈圧亢進
  • iii) 肝リンパの漏出
  • 2) 二次性因子
  • i) 二次性aldosterone症
  • ii) 尿細管におけるNa再吸収の亢進
  • 2. 肝性浮腫および腹水の治療
  • 1) 一般療法
  • i) 安静
  • ii) Na制限食
  • iii) 高蛋白, 高カロリー食
  • 2) 利尿薬による治療
  • i) 肝性浮腫ないし腹水に用いられる利尿薬の種類と特徴
  • i) 利尿薬の投与法
  • 3) 腹水穿刺法
  • 4) 血漿膠質浸透圧増加法
  • i) albuminの補給
  • ii) 腹水再静注法
  • D. 内分泌性浮腫
  • 1. 甲状腺機能亢進症
  • 2. 甲状腺機能低下症
  • 3. steroidホルモンによる浮腫
  • 1) 外因性副腎皮質steroidホルモンによる浮腫
  • 2) 内因性副腎皮質steroidホルモンによる浮腫
  • 3) 性ホルモンによると思われる浮腫
  • E. 欠乏性浮腫
  • 1. 低蛋白血症
  • 1) 蛋白質の摂取不足によるもの
  • 2) 蛋白質の吸収障害によるもの
  • 3) 蛋白質の異常喪失による浮腫
  • 2. vitamin B1欠乏症
  • 3. K欠乏症性浮腫
  • F. 局所性浮腫
  • 1. 静脈性浮腫
  • 1) 静脈性浮腫の発生機序
  • 2) 静脈性浮腫の診断
  • 3) 静脈性浮腫の原因
  • i) 静脈血栓および血栓性静脈炎
  • ii) 静脈瘤
  • iii) 静脈弁不全
  • 4) 静脈性浮腫の治療
  • 2. リンパ浮腫
  • 1) 一次性リンパ浮腫
  • 2) 二次性リンパ浮腫
  • 3) リンパ浮腫の症状
  • 4) リンパ浮腫の治療
  • 3. 血管神経性浮腫
  • 4. allergy性浮腫
  • 5. 炎症性浮腫
  • 1) 血管透過性亢進
  • 2) 血管透過性亢進物質
  • i) histamine
  • ii) leucotaxine
  • iii) kinin
  • iv) prostaglandin
  • v) その他の物質
  • 3) 炎症性浮腫の治療
  • G. 妊娠浮腫
  • 1. 妊娠中毒症と浮腫
  • 2. 妊娠浮腫の頻度
  • 3. 妊娠中の水分貯留守
  • 4. 妊娠浮腫の成因
  • 1) 全身性因子
  • 2) 局所性因子
  • 5. 妊娠浮腫の治療
  • 1) 一般的療法
  • 2) 薬物療法
  • H. 医原性浮腫
  • 1. 医薬原性浮腫
  • 1) 解熱鎮痛薬
  • 2) phenylbutazoneその他非steroid性消炎薬
  • 3) 抗糖尿病薬
  • 4) ACTH, 副腎皮質steroidホルモン
  • 5) 蛋白同化ホルモン
  • 6) glycyrrhizin製剤
  • 7) 化学療法薬
  • 8) 利尿薬以外の抗高血圧薬
  • 2. その他の医原性浮腫
  • I. 特発性浮腫
  • 1. 特発性浮腫の臨床的特徴
  • 2. 特発性浮腫の原因
  • 1) 体位に対する反応
  • 2) 毛細血管透過性
  • 3) 蛋白代謝
  • 4) 内分泌異常
  • i) aldosterone
  • ii) ADH(抗利尿ホルモン)
  • iii) 性ホルモン
  • 5) dopamine
  • 3. 特発性浮腫の診断
  • 4. 特発性浮腫の治療
  • 1) 精神療法
  • 2) 食事
  • 3) 利尿薬
  • 4) l-DOPA
  • 文献
  • 常用利尿剤一覧表
  • 索引
  • 奥付

この書籍の参考文献

参考文献のリンクは、リンク先の都合等により正しく表示されない場合がありますので、あらかじめご了承下さい。

本参考文献は電子書籍掲載内容を元にしております。

I. 総論

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II. 腎生理学と利尿薬の薬理

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III. 各種疾患による浮腫の病態と治療

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