臨牀透析 Vol.15 No.1(6-2)


特集名 血液浄化機器の歴史と今後の発展
題名 透析方法の変法 (2) 持続的療法
発刊年月 1999年 01月
著者 奈倉 勇爾 日本大学医学部第二内科
著者 久野 勉 日本大学医学部第二内科
【 要旨 】 慢性腎不全の維持血液透析が間欠的療法の代表であるのに対し,持続的療法(CRRT)は近年,救急・集中治療領域で不可欠の治療法に発展した.循環動態の安定が特徴であり,歴史的には持続的動脈-静脈血液濾過法(CAVHF)に始まり,カテーテル法の進歩から血液ポンプ,患者監視装置を使用した持続的静脈-静脈血液濾過法(CVVHFまたはCHF)に発展した.さらに最近では,小分子物質の除去能の向上を目指して持続的血液透析濾過法(CHDF)も選択されるようになってきた.これらの進歩は,関連する周辺医療機器の発展に負うところが大きく,とくにヘモフィルタは小型で,高透過性,高生体適合性,かつ適切な吸着能を有する膜が開発されている.高精度除水制御機構が組み込まれたマイコン制御の専用患者監視装置が多数(ACH-10, TR-520, KM-8600, JUN-600など)開発されている.将来的には,より高性能の新素材膜の開発や,透析液および補充液をオンライン化して作製可能とする装置などが登場するものと思われる.
Theme Progress and Future in Blood Purification
Title Continuous renal replacement therapy (CRRT)
Author Yuji Nagura 2nd Department of Internal Medicine, Nihon University School of Medicine
Author Tsutomu Kuno 2nd Department of Internal Medicine, Nihon University School of Medicine
[ Summary ] Continuous renal replacement therapy (CRRT) has been widely accepted over the last decade in the critically ill patients. There are several well established advantages to CRRT, such as hemodynamic stability and optimal fluid balance and others. Continuous arterio-venous hemofiltration (CAVHF) without blood pump is a simple method, however it has been some complications resulted from arterial access. Therefore a veno-venous pump driven technique (CVVHF or CHF) has been developed through improvement of vascular catheter procedure with blood pump and monitoring system for extracorporeal circulation. These hemofilters have a lower priming volume, highly permeable to solute and water, highly adsorbent capacities, longer operating times and biocompatible membranes. Another way continuous hemodiafiltration (CHDF) which has combined the convective diffusive principle was deve1oped, because CHF has limit in small molecules solute clearance by convective transport. Recently, automatic fluid balance technique was improved by newest generation machines with micro-computer assisted devices such as the ACH-10 (Asahi), the TR-520 (Toray), the KM-8600(Kurare)and the JUN-600(Ube Medical). In future, new membrane technology, on-line preparation technique for sterile pyrogen free dialysate and replacement fluid, and new generation equipment might be developed.
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