| 特集名 | 内部濾過促進型血液透析 | |
|---|---|---|
| 題名 | 充てん率を高くした内部濾過促進型ダイアライザの性能と臨床評価 | |
| 発刊年月 | 2002年 04月 | |
| 著者 | 柴田 猛 | 虎の門病院腎センター血液浄化療法部・臨床工学技士 |
| 著者 | 原 茂子 | 虎の門病院腎センター内科 |
| 著者 | 三村 信英 | 虎の門病院腎センター内科 |
| 【 要旨 】 | 血液透析において，内部濾過促進型ダイアライザを使用することにより，簡便に血液透析濾過(HDF)が実施できる． この内部濾過促進型ダイアライザには，血液系の圧力損失を高めるタイプと，透析液系の圧力損失を高めるタイプがある．いずれのタイプにおいても，透析膜面積が約2.Om2で，血液流量250ml/min，透析液流量500ml/minの透析条件下では，2.5 - 3.5l/hrの逆濾過が発生し，10 - 15lHDFと同等のbeta2ミクログロブリン(beta2-MG)の除去が可能である． しかし，透析液系の圧力損失を高めるタイプは，低血液流量で血液過濃縮が発生し，低透析液流量で透析効率の低下率が大きく，問題がある．今後，ダイアライザの中空糸の充てん率を約70％に維持し，透析膜性能と中空糸の内径および有効長の諸因子を考慮すれば，抗血栓性や操作性に優れた，小型で高性能な内部濾過促進型ダイアライザを至適設計できる． |
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| Theme | Internal Filtration Enhanced Hemodialysis | |
|---|---|---|
| Title | Performance and clinical evaluation of the internal filtration enhanced dialyzer with high filling factor | |
| Author | Takeru Shibata | Kidney Center Toranomon Hospital / Clinical Engineer |
| Author | Shigeko Hara | Department of Blood Purification, Toranomon Hospital |
| Author | Nobuhide Mimura | Department of Blood Purification, Toranomon Hospital |
| [ Summary ] | In the area of hemodialysis, hemodiafiltration is easily performed by using an internal filtration enhanced dialyzer. These internal filtration enhanced dialyzers can be categorized as to the type that raises pressure lost in the circulatory system or the type that raises pressure lost in the dialysate system. With either type, reverse filtration of 2.5-3.5L/hr occurs under dialysis conditions in which the dialysis membrane area is about 2.0m2, the blood flow rate is 250mL/min. and there is a dialysate flow rate of 500mL/min, permitting the elimination of beta2-MG equivalent to 10-15L HDF. However, the type that increases pressure in the dialysate system has a problem, in that it causes hypercoagulation with a low blood flow volumes or produces a remarkable decrease in dialysis efficiency with a low dialysate flow volumes. In the future, it will be possible to produce an optimum design for small and high-performance internal filtration enhanced dialyzers with excellent antithrombotic action and operability by maintaining the ratio of hollow fiber filling at about 70% in the dialyzer, and taking into consideration various factors, such as dialysis membrane efficiency, inner diameters and the effective length of hollow fibers. |
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