A haemodialysis system for the treatment of acute renal failure and metabolic disorders in neonates
A haemodialysis system for the treatment of acute renal failure and metabolic disorders in neonates
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DOI：
10.1016/j.medengphy.2006.06.007
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发表时间：
2007-05-01
影响因子：
2.2
通讯作者：
Everdell, N. L.
中科院分区：
文献类型：
--
作者：
Everdell, N. L.
一个用于治疗早产儿的原型透析系统已经设计、建造并成功测试。它可用于治疗患有肾衰竭或代谢紊乱的婴儿。这些患者很难或不可能进行常规治疗，因为他们的总血量非常小（通常为40 ml），并且他们对捐献的血液不耐受。有一个强有力的理由来开发一种专门为治疗这类患者而设计的透析系统。该系统基于以前开发的手动操作设备。该方法在几个方面不同于传统的透析。血液通过单一静脉导管进入患者体内。仅需要非常少量的血液来预充体外循环-对于最小的患者，这可以少至6.8 ml。这与常规回路中所需的体积（在15-40 ml的范围内）相比非常有利。这种小的预充体积意味着不需要捐献的血液来预充回路，这降低了治疗的风险和复杂性。由于相同的血液在透析器中来回流动多次，因此可以实现的清除率和超滤率与患者血液的获取率无关。体外测试涵盖了多个操作区域。确定了超滤工艺的准确度。确定了可能达到的清除率。新系统通过实验获得的清除率始终高于通过系统的平均血液流速的40%。可用的最大平均血液流速为5 ml/min，因此最大清除率约为2 ml/min。可获得的最大超滤速率为50 ml/h。发现系统对血液造成的损伤量完全在可接受的临床限值范围内。体内试验确立了使用计算机算法控制从患者体内抽血的可行性。该系统已成功用于治疗七名患者在出版时。(c)2006年IPEM。由爱思唯尔有限公司出版。保留所有权利。
A prototype dialysis system for the treatment of premature babies has been designed, built and successfully tested. It can be used to treat babies who are suffering from renal failure or metabolic disorders. These patients are difficult or impossible to treat conventionally, due to their very small total blood volume (typically 40 ml) and their intolerance to donated blood. There was a strong case for developing a dialysis system specifically designed for the treatment of such patients.The system is based on a manually operated device that had been previously developed. The method differs from conventional dialysis in several ways. Blood access to the patient is via a single venous catheter. Only a very small amount of blood is needed to prime the extracorporeal circuit-this can be as little as 6.8 ml in the smallest patients. This compares very favourably with the volumes needed in conventional circuits, which are in the range of 15-40 ml. This small priming volume means that donated blood is not needed to prime the circuit, which reduces the risks and complexity of the treatment. The clearance and ultrafiltration rates that can be achieved are independent of the rate that blood can be accessed from the patient, since the same blood passes back and forth through the dialyser several times.In vitro testing covered several areas of operation. The accuracy of the ultrafiltration process was established. The clearance rates that could be achieved were determined. The clearances that have been obtained experimentally with the new system are consistently above 40% of the mean blood flow rate through the system. The largest mean blood flow rate available is 5 ml/min, so the maximum clearance is approximately 2 ml/min. The maximum ultrafiltration rate that can be obtained is 50 ml/h. The amount of damage caused to the blood by the system was found to be well within acceptable clinical limits. In vivo testing established the feasibility of using a computer algorithm to control the withdrawal of blood from the patient. The system has been used successfully to treat seven patients at the time of publication. (c) 2006 IPEM. Published by Elsevier Ltd. All rights reserved.