臨牀透析 Vol.22 No.5(2)


特集名 透析関連モニタリング技術の最前線
題名 ダイアライザ内部濾過流量の動脈側TMP値からの簡便な推定法
発刊年月 2006年 05月
著者 峰島 三千男 東京女子医科大学臨床工学科
【 要旨 】 HDモードでHDFに近い溶質除去効果が期待できる内部濾過促進型血液透析が注目されている,しかし,ダイアライザ内部はブラックボックスであり,実際に内部濾過現象がどの程度生じているか,評価することは難しい.超音波ドップラー法によるベッドサイドモニタリングも試みられているが,実用性には疑問が残る.本稿では,ダイアライザ動脈側膜間圧力差 (TMP) 値から簡便に内部濾過流量を推定する方法を紹介する.厳密な内部濾過流量の測定には限界はあるが,内部濾過流量の経時的な変化率はかなり精度よく評価が可能である.
Theme Current Topics in Monitoring Technologies for Dialysis Therapy
Title Simple estimation of internal filtration flow rate in a dilalyzer using arterial TMP value
Author Michio Mineshima Department of Clinical Engineering, Tokyo Women's Medical University
[ Summary ] Internal filtration enhanced hemodialysis (IFEHD), defined as a type of HD therapy using a dialyzer designed for enhanced internal filtration / backfiltration (IF / BF), is expected to have a higher solute removal efficiency than that with conventional HD. This is because enhanced IF flow rate increased convective transport of the solute in addition to diffusive transport. Several kinds of monitoring techniques, such as Doppler ultrasonography, have been introduced to measure internal filtration flow rates (QIF). This is, however, a bit complicated because an ultrasonic instrument and a probe slider in the water bath are required as special equipments. A simple estimation of maximum QIF value, based on analytical study, was introduced in this paper. We assume that the value of mean transmembrane pressure (TMP) is about one-fourth the value of that on the arterial side, TMP (0), because the mean positive TMP region has half-length of the dialyzer and half of the height of the TMP profile. The QIF value could be estimated as UF x TMP (0) where UF indicates the ultrafiltration coefficient. The time decay ratio for the QIF value seemed to be precisely estimated with this method.
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