The use of an artificial kidney. II. Clinical experience.
The use of an artificial kidney. II. Clinical experience.
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使用人工肾。
DOI：
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发表时间：
1950
影响因子：
15.9
通讯作者：
G. W. Thorn
中科院分区：
文献类型：
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作者：
J. Merrill;S. Smith;E. Callahan;G. W. Thorn
根据Kolff(1)的基本设计改进的人工肾的构造和使用技术已在其他地方描述(2)。本文介绍了我们的临床经验，其中60例，其中已采用该程序的治疗43名患者(表I)。目前还不可能就这种方法在治疗肾脏疾病方面的效果得出明确的结论，但我们的结果似乎表明：(1)使用人工肾是去除循环血液中特定可扩散物质的可行方法；(2)可以在不对患者造成额外危险的情况下完成；(3)如果必要，可以重复使用；(4)不应推迟使用，以便在其他治疗方法失败的情况下将其作为最后手段提供给患者；以及(5)除氮代谢物外，还有可能去除其他高浓度有毒的可扩散物质，如巴比妥酸盐和磺胺类。也可以选择性地去除钠、钾、钙和水。在特定矿物质耗竭的患者中，这些物质可以在不添加其他电解质或水的情况下恢复。对于无尿、钠耗竭的患者，这最后一个功能可能是非常有价值的。从本质上讲，人工肾的应用原理如下：通过嵌入的玻璃插管，通过旋转的联轴器将血液从桡动脉引流到旋转的金属鼓表面。在这里，它通过缠绕在滚筒周围的一段玻璃纸管子，通过滚筒的运动被带到远端。在其过程中，充满血液的管子通过清洗液(2)
The technique of construction and use of an artificial kidney modified from the basic design of Kolff (1) has been described elsewhere (2). This paper describes our clinical experience in 60 instances in which this procedure has been employed in the treatment of 43 patients (Table I). It is not possible at the present time to draw definite conclusions as to the efficacy of such a procedure in the general treatment of renal disease, but our results seem to indicate: (1) that the use of an artificial kidney is a feasible method for the removal of specific diffusible substances from the circulating blood; (2) that it can be accomplished without excess hazard to the patient; (3) that it can be repeated if necessary; (4) that its use should not be postponed so that it is offered to the patient as a last resort because other methods of treatment have failed; and (5) that in addition to nitrogen metabolites it is possible to remove other diffusible substances which may be toxic in high concentrations, such as the barbiturates and sulfonamides. It is also possible selectively to remove sodium, potassium, calcium, and water. In patients with specific mineral depletion these substances may be restored without the addition of other electrolyte or water. In anuric, sodium-depleted patients this last function may be extremely valuable. In essence the principle of application of the artificial kidney is as follows: Blood is led from the radial artery by means of an inlying glass cannula through a rotating coupling to the surface of a revolving metal drum. Here it passes through a length of cellophane tubing wound spirally around the drum, and is carried by the motion of the drum to the distal end. During its course, the bloodfilled tubing is passed through a rinsing fluid (2)