课件：高通量血液透析的临床应用实践.pptVIP

* * * * 更少的材料=高通透性 中空滤丝束的3维结构 * * 透析液侧 血侧 从透析液侧到血侧无内毒素的转移: 透析液侧泡沫状膜，血液侧膜光滑、表面大 吸附能力强 仅有 1/百万单位的内毒素能跨过膜 !!! 高通量聚砜膜: 内毒素截留能力 Solf et al.Nieren und Hochdruckkrht 26:468-469 (1997) 透析时间 (h) 普通透析液 超纯透析液 0 2 4 20 24 28 32 36 40 ?2-m mg/l 0 2 4 2 3 4 5 6 7 8 IL-6 pg/ml 普通透析液 超纯透析液 普通 超纯 普通 20 24 28 32 36 40 ?2-m mg/l 超纯透析液对细胞因子和?2-微球蛋白的影响 提要 高通量透析器历史 为什么应用高通量透析器 高通量透析技术要求 临床实践中的高通量透析 Removal of uremic toxins ** P0.01 Gong Dehua, et al. J Nephrol Dialy Transplant, 2002 Removal of uremic toxins *,P0.05, **, P0.01 Gong Dehua, et al. J Nephrol Dialy Transplant, 2002 Reduction rate post-dialysis(%) Effect of MHD on renal osteopathy in ESRD HFHD(n=54) LFHD(n=37) P value PTH(pg/L) 151.4±200.7 1119.3 ±924.6 0.001 P-pre(mM/L) 1.68 ±0.51 1.75 ±0.54 0.53 P-reduction(%) 57.4 ±9.87 45.7 ±13.3 0.001 Ca-pre(mM/L) 2.49 ±0.22 2.14 ±0.26 0.001 Ca-post(mM/L) 2.84 ±0.18 2.55 ±0.35 0.001 Comparison between HFHD and LFHD in serum PTH, Ca and P Gong Dehua, et al. J Nephrol Dialy Transplant, 2001 Effect of MHD on renal osteopathy in ESRD Serum iPTH levels in patients between HFHD and LFHD **, P0.01 Maitainence time on HD(years) Gong Dehua, et al. J Nephrol Dialy Transplant, 2001 Effect of MHD on renal osteopathy in ESRD HFHD(n=15) LFHD(n=15) P value MHDT(month) 98.6±37.4 117.2 ±41.9 0.211 Serum PTH(pg/L) 179.8 ±185.2 1450.0 ±33.3 0.001 Osteoid area(%) 37.3 ±24.4 84.5 ±49.4 0.003 Osteoblast number(/mm2) 5.83 ±4.88 9.69 ±6.04 0.032 Osteoclast number(/mm2) 3.77 ±4.61 6.21 ±4.26 0.071 Erosion surface(%) 8.45 ±5.10 11.7 ±5.85 0.059 Aj.AR(μm/d) 0.45 ±0.56 0.45 ±0.47 0.998 Mineralization lag time(d) 178.7 ±271.3 83.9 ±99.7 0.245 Clinical and bone biopsy data from patients treated by LFHD and HFHD Gong Dehua, et al. J Nephrol Dialy Transplant, 2001 Effect of reusing of HFHD on the performance Use number of dialyser Solutes clearance changes during reuse of a high flux dialyser(BLS627) Gong Dehua, et al. Bulletin of Medical Postgraduate,2000 Effect of reusing of HFHD on the