臨牀透析 Vol.23 No.5(5)


特集名 透析液清浄化技術の最前線
題名 血液浄化器の機能と水質管理の関係
発刊年月 2007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 】 ダイアライザの性能が向上するにつれ,内部濾過現象が次第に顕著になってきている.逆濾過量増大はエンドトキシンサブクラス侵入のリスクが高まることを意味しており,厳格な透析液清浄化対策が不可欠である.具体的には限外濾過率と圧測定を基本とする簡便法にて推定された内部濾過流量がダイアライザごとに明示され,施設の水質管理レベルに合ったダイアライザの使用が望まれる.
Theme The Front of Dialysate Purification Technologies in Hemodialysis Therapy
Title Relationship between dialyzer performance and quality control for dlialysates
Author Michio Mineshima Department of Clinical Engineering, Tokyo Women's Medical University
[ Summary ] Internal filtration flow rates (QIF) in dialyzers have increased with dialyzer performance improvements in recent years. Increasing backfiltration means increasing the risk of invasion of endotoxin fragments in the dialysate into the patient's blood. Strict management of quality control for dialysates is required especially with internal filtration enhanced hemodialysis (IFEHD), defined as a form of HD therapy. This therapy employs a dialyzer designed for enhanced internal filtration / backfiltration (IF / BF). This dialyzer was introduced to have a higher solute removal efficiency than that in conventional HD since enhanced IF / BF flow rates have increased the convective transport of solutes in addition to diffusive transport. The QIF value of all dialyzers should be evaluated by a simple estimation method based on an ultrafiltration coefficient, UFRP, and transmembrane pressure. Dialyzers for each patient should be selected, taking into consideration the level of quality control for dialysates in that dialysis unit.
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