循環とは何か? 虜になる循環の生理学

出版社: 三輪書店
著者:
発行日: 2020-10-30
分野: 臨床医学:内科  >  循環器一般
ISBN: 9784895907026
電子書籍版: 2020-10-30 (第1版第1刷)
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楽しく ! わかりやすく ! 役に立つ ! 誰もが惹き込まれる循環生理学の本 !
~循環とは何か?~
この普遍的ともいえる問いに自信をもって答えられる医療従事者は少ないのではないでしょうか。循環が大事とわかっていても何をもって循環となすのか、循環生理には生化学、解剖学、物理学などさまざまな学問が関わっています。
本書はその難解な循環の生理学をいまだかつてないほどに深くかつわかりやすく解説し、実臨床に必要となる循環の知識を楽しく勉強できるようにしたものです。経験豊富な救急集中治療医である著者が織りなす循環管理や循環作動薬の深淵もふんだんに盛り込まれ、循環の捉え方や考え方が変わります。循環に興味のあるすべての人に贈る極上の1冊 !

目次

  • 序 章 循環を極めよう
    1-1 循環とは何か
    1 そもそも「循環」って何?
    2 循環とは酸素運搬oxygen deliveryと組織灌流perfusionである
    3 酸素だけで循環による運搬を代表させてよいのか?

    第1章 循環の2要素を極める
    1-1 酸素運搬oxygen delivery
    1 酸素の絶対量CaO2を考える
    2 酸素運搬(oxygen delivery)を考える
    1-2 組織灌流perfusion
    1 組織灌流(perfusion)を考える
    2 臓器血流量と血圧の関係
    3 各臓器のperfusion
    4 カテコラミンを使うと血流が悪くなる?
    5 血圧はどれくらいにすればよいのか?
    6 Perfusionの指標は何か? →尿量
    7 SvO2はoxygen deliveryの指標ではあるがperfusionの指標ではない
    1-3 循環を読み解く
    1 Oxygen delivery とperfusionを見る循環管理
    2 もっとも大事なのは血圧
    3 実際にoxygen deliveryとperfusionを見て考えよう!
    4 どのようなときにショック→循環破綻を疑うのか
    5 ショックへの具体的対応
    6 Cryptic shockに循環の2要素から迫る

    第2章 循環に関わる因子を極める
    2-1 心拍出量と前負荷/後負荷
    1 はじめに
    2 前負荷と後負荷
    3 前負荷と心拍出量―スターリングの法則
    4 後負荷と心拍出量
    2-2 静脈系の圧と循環を極める
    1 静脈系の圧と循環
    2 スターリングの式で考える肺水腫
    3 Critical PCWP の変化
    4 スターリングの法則で考える循環管理戦略
    5 臓器うっ血とCVP
    6 心不全管理ではさらに心仕事量を加味する
    7 最終的に心拍出量はどれくらいあればよいか?
    2-3 改訂スターリングの法則とグリコカリクス理論
    1 膠質浸透圧COPをつめる
    2 血管内皮細胞輸送のメカニズム
    3 グリコカリクスとglycocalyx-junction-break model
    4 改訂スターリングの法則
    2-4 静脈還流venous return
    1 静脈還流(venous return)
    2 心臓が悪いと肺水腫を起こしやすいのはなぜ?
    3 Unstressed volumeとstressed volume
    2-5 血液と粘稠度
    1 はじめに
    2 粘稠度(viscosity)とは何か
    3 血液の粘稠度の規定因子
    4 粘稠度の測定?
    5 毛細血管における赤血球の流れ方
    6 血流における血管径と血液粘稠度
    7 グリコカリクスの粘稠度に対する役割
    8 粘稠度の循環への影響
    9 輸血とoxygen delivery
    10 結局ヘモグロビンはいくらで管理すればよいか
    11 真に輸血すべきか否かはどのように見極めればよいか

    第3章 循環作動薬を極める
    3-1 昇圧薬(血管収縮薬と強心薬)
    1 はじめに
    2 昇圧薬
    3 カテコラミンの作用機序
    4 各昇圧薬の特性と使い方
    3-2 降圧薬
    1 降圧薬の基本
    2 静注降圧薬
    3 降圧薬のエビデンスとパラダイム
    3-3 利尿薬
    1 はじめに
    2 循環作動薬としての利尿薬の位置づけ
    3 各利尿薬の作用機序
    4 静注利尿薬のレパートリー
    5 利尿薬のエビデンス
    6 浸透圧利尿薬のエビデンス
    3-4 抗不整脈薬
    1 抗不整脈薬
    2 心臓の電気生理から考える不整脈診療
    3 Vaughan Williams分類とSicilian Gambit分類
    4 静注抗不整脈薬のレパートリー
    5 抗不整脈薬のエビデンス
    6 心房細動の治療戦略

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[序章] 循環を極めよう

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[第1章] 循環の 2 要素を極める

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[第2章] 循環に関わる因子を極める

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[第3章] 循環作動薬を極める

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