特集名 | 血液浄化機器の歴史と今後の発展 | |
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題名 | 透析方法の変法 (1) HDF, push & pull HDF, on-line HDF, AFBF | |
発刊年月 | 1999年 01月 | |
著者 | 石田 尚志 | 松江赤十字病院内科 |
著者 | 新井 篤史 | 松江赤十字病院透析センター |
著者 | 倉橋 明男 | 松江赤十字病院内科 |
著者 | 漆谷 義徳 | 松江赤十字病院内科 |
著者 | 並河 整 | 松江赤十字病院内科 |
著者 | 福庭 洋 | 松江赤十字病院内科 |
著者 | 福田 勇司 | 松江赤十字病院透析センター |
著者 | 伊原 恵子 | 松江赤十字病院検査部生理検査 |
著者 | 坂本 祐子 | 松江赤十字病院検査部生理検査 |
著者 | 田中 昭彦 | 重井医学研究所附属病院 |
著者 | 大森 浩之 | 重井医学研究所附属病院 |
【 要旨 】 | 透析治療(広義)にはもちろん,透析方法と使用する透析膜の選定が適切でなくてはならない.一般に血液透析(狭義HD)は小分子量物質の除去に優れ,血液濾過法(HF)はβ2-ミクログロブリン(β2-MG)などの低分子量蛋白の除去に優れている.両者を組み合わせて同時に行う血液透析濾過法(HDF)は,両者の弱点を補いうる血液浄化法として各種の変法が考案されている.ここでは,HDFの各種の概説と松江赤十字病院での10余年の,3時間でのbottle式HDF(3HDF)治療効果を臨床成績に基づき提示した.HDFの短期的な効果は低分子量蛋白の除去に優れること,短時間治療にもかかわらず除水効率が良く,ドライウエイトを下げられることである.長期的効果には低分子量蛋白の維持レベルを降下させること,透析アミロイド症の発生を抑止することである.HDFの変法であるon-line HDF, push and pull HDF, acetate-free biofiltrationでの臨床実践上の利点と問題点を実例をもとに検討し,今後の問題点を考察した. |
Theme | Progress and Future in Blood Purification | |
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Title | HDF, push and pull HDF, on-line HDF, AFBF | |
Author | Hisashi Ishida | Department of Internal Medicine, Matsue Red Cross Hospital |
Author | Atsushi Niii | Dialysis Center, Matsue Red Cross Hospital |
Author | Akio Kurahashi | Department of Internal Medicine, Matsue Red Cross Hospital |
Author | Yoshinori Urushidani | Department of Internal Medicine, Matsue Red Cross Hospital |
Author | Tadashi Nabika | Department of Internal Medicine, Matsue Red Cross Hospital |
Author | Hiroshi Fukuba | Department of Internal Medicine, Matsue Red Cross Hospital |
Author | Yuji Fukuda | Dialysis Center, Matsue Red Cross Hospital |
Author | Keiko Ihara | Clinical laboratory, Matsue Red Cross Hospital |
Author | Yuko Sakamoto | Clinical laboratory, Matsue Red Cross Hospital |
Author | Akihiko Tanaka | Shigei Medical Research Hospital |
Author | Hiroyuki Omori | Shigei Medical Research Hospital |
[ Summary ] | In dialysis therapy, the selection of an HD method and HD membrane is one of the most important matters of consideration. In HD methods solutes are removed through pores in the membrane along with dilution. Small molecular substances are easy to remove, but larger molecular ones are harder to remake. On the other hand, larger molecular solutes such as beta-2-microglobulin are removed morely easily with HF than with HD, because HF purification is based on the conbection of larger amounts of replenished solution. Hemodiafiltration is a combined method, using HD and HF to remove smaller and larger molecular substances. In this paper, we mentioned several kinds of HDF i.e.: bottle/bag, on-line and push&pull methods. We plan to summarize the clinical efficiencies of the bottle/bag type three hour HDF in our more than ten years' of clinical experience and the results of HDF therapy in my hospital. We have achieved lower beta2-MG plasma levels, more frequently with bottle/bag type HDF therapy than with HD or the high performance membrane(HPHD)methods. By achieving lowered plasma beta2-MG levels, we decreased the retardation of the median nerve conduction velocities through the carpal tunnel and the incidence of carpal tunnel syndrome; one of the long term complications of HD. Furthermore, we discussed the efficacy of other HDF methode, i.e.; on-line, push & pull and acetate free biofiltration (AFBF), and concluded that the on-line HDF or AFBF types should be recommended as methods of HDF in the near future. |