TECHNOLOGY ASSESSMENT OFBLOOD PURIFICATION FOR THE ELDERLY

作为项目的最后一年，我们专注于三个主题，即(1)持续非卧床腹膜透析，(2)作为预防性治疗的分离，以及(3)通过物理原理处理细胞和蛋白质。第五届世界腹膜透析国际会议(1994年3月，休斯敦)1.老年CAPD的技术评估正如一般所提到的，导管出口感染、腹膜恶化、透析中和营养不良也是老年患者需要克服的主要问题。根据我们对Nisenson博士(加州大学洛杉矶分校，美国)、Kharna博士(美国大学)的采访。美国小姐)，Shreiber博士(Clev.克莱恩。美国发现)，将高超声剂从葡萄糖替代为氨基酸或多肽可以改善营养不良并维持腹膜的功能。为了克服一些患者在透析状态下的问题，如果每个患者都知道腹膜腔内的物质传输，那么可以使用可编程的机器来自动控制透析液的注入和丢弃。感染似乎不是技术问题，而更有可能是教育问题。血液净化作为一种预防模式一些血液净化程序有可能防止器官功能的完全丧失，这可能会减少患者数量。清除低密度脂蛋白已被证明可以降低心力衰竭的风险因素。体外免疫调节可激活患者自身免疫反应。这一类别的关键问题是有选择地处理或刺激免疫反应细胞。

As a final year of the project, we focused on three subjects, namely (1) continuousambulatory peritoneal dialysis, (2) apheresis as a preventive therapy and (3) handling cells and proteins by physical principle. A part of the survey was presented at 5th International Conference of World Apheresis (symposium : New separation and apheresis technologies, Houston, March, 1994)1. Technology assessment of CAPD for the elderlyAs mentioned generally, catheter exit infection, deterioration of the peritoneal membrane, under dialysis and malnutrition are main issues to be overcome for the elderly patients, too. Based on our interviews with Dr.Nissenson (UCLA, USA), Dr.Kharna (Univ. of Miss, USA), Dr.Shreiber (Clev. Clin. Found., USA), substitution of hypersonic agent from glucose to amino acid or polypeptide may improve malnutrition and maintain a function of the peritoneal membrane. To overcome under dialysis status in some patients, programmable machine, which can controlinjection and discard of dialysate automatically, could be effective if mass transport in the peritoneal cavity is well known in each patient. Infection seems to be not technologicalissue but more likely educational one.2. Blood purification as a preventive modalitySome blood purification procedures have possibility to prevent total loss of the organ function that may be promising to decrease the patient population. Removal of LDL has been proved to decrease risk factors of heart failure. Extracorporeal immuno-modulation may activate patient's own immune response. The key issue in this category is to handle or stimulate immune response cells selectively.