课件：ICU中的血液净化治疗：必威体育精装版进展.ppt

* * * * * * * Figure 2B: Clearances of cytokines and albumin in 6L/hr ultrafiltration (ml/min) Cellulose triacetate SHF filter + HVHF Loss of SC Observations观测结果 Polyamide and cellulose triacetate are different. Polyamide is better. 多聚酰胺膜效果较好 Increasing UF rate increases clearance but decreases SC Time effect small 时间对它的影响较少 Albumin losses sustainable 蛋白的丢失是可以忍受的 Highest cytokine removal ever reported! 这是迄今为止所有报道中细胞因子清除得最多的 Can we dialyze cytokines?我们是否真正能够对细胞因子透析？ Hemofiltration requires high blood flows 血滤要求很高的血流速 Without high blood flows, no high UF flow rates 没有高血流速度，就没有高的滤出率 High UF flows increase TMP and decrease functional pore size 高的滤出率增加跨膜压，并减低有效的膜孔径 Replacement fluid expensive 置换液很昂贵 How about diffusing cytokines? 那么是否可以考虑行细胞因子透析？ Figure 2A: Clearances of cytokines and albumin in 1L/hr dialysis (ml/min) Polyamide filter 聚酰胺 Low clearance for MW Uchino, Morimatsu, Bellomo ASAIO J (2002) (in press) Clearances of cytokines and albumin in 9L/hr dialysis (ml/min) Polyamide filter Citrate effect Uchino, Morimatsu, Bellomo ASAIO J (2002) (in press) Conclusions结论 Super high-flux membranes offer new opportunities to explore the usefulness of blood purification in ICU 超高通量膜为ICU血液净化治疗提供了新的治疗契机 Several technical optimizations may allow very high cytokine clearances 由此而生的几项新的优化技术可能大大增加细胞因子的清除率 Cytokine dialysis is possible 细胞因子透析是可行的 This is pretty exciting stuff !!! 这是一个相当令人兴奋的新材料和新技术！！！ Other technology其它技术 Polymixin B hemoperfusion (Nemoto et al. Blood purif 2001; 19: 361-369) 多粘菌素B血液灌流 New sorbents (Betasorb?) for hemoperfusion (Blood Purif 2002; 20: 380-88) 用于血液灌流的新黏附剂 New bioreactors with macrophages 使用巨噬细胞的新型生物反应器 New bioreactors with tubular cells 使用肾小管细胞的新型生物反应器 The future looks very interesting !! 未来充满新奇和希望！！ THANK YOU SUCCESS * * 可编辑 * * * * * * * * * * * * * * * * * * * * * * * * % Change in NorepinephrineDose: HVHF vs CVVH % change over 8 h. Cole, Bellomo et al. Intensive Care Med 2001 ; 27: 978-986 C3a: HVHF (6 L) vs. CVVH (1 L) ng /ml p 0