Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,12/29/2014,#,高截留分子量超滤膜在临床中的应用,1,11/16/2024,2,基本概念,高截留分子量超滤膜,高截留分子量超滤膜在临床中的应用,内容目录,11/16/2024,3,截留分子量,截留分子量,CO,是指对有孔材料孔径大小的一种描述。在能自由通过某种有孔材料的分子中最大分子的分子量即为该材料的截留分子量。大于截留分子量的分子，被材料截留；小于截留分子量的分子，则可自由通过。一般滤器膜的截留分子量分子的筛选系数为,0.1,，即通过滤器膜能力为,10%,的分子的分子量定义为截留分子量。,DEFINITION:The cut-off point of a solute for any membrane is a sieving coefficient of 0.1.This means that 10%of the molecules will pass and 90%will not pass.,11/16/2024,4,筛选系数,-SC,筛选系数,SC,（,seiving coeffcient),为超滤液中溶质浓度与滤器前血浆溶质浓度比值，是溶质通过滤器膜能力的一个定量指标,SC,越高，表明,CRRT,治疗清除的 溶质越多，,SC,接近,1,，提示溶质近乎可自由通过滤器膜,滤器膜的性质会影响,SC,值,SIEVING COEFFICIENT,1.0,0,5600,inulin,11800,b2-m,21000,RBP,44000,orosomucoide,54000,a1 AT,66500,albumin,MOLECULAR WEIGHT=SOLUTE SIZE,DEFINITION:The cut-off point of a solute for any membrane is a sieving coefficient of 0.1.This means that 10%of the molecules will pass and 90%will not pass.,0.5,60,urea,Cut-off point,O.1,筛选系数与截留分子量,Solute Classes by Molecular Weight,Daltons,Inflammatory,Mediators(1,200-50,000),“small”,“middle”,“large”,高截留分子量超滤膜,RR-AB-34 Jan 2011,New functional membrane with defined larger pore size,HCO membrane,0,01 m,0,02 m,0,09 m,0,30 m,:pore diameter,high flux,high cut-off*,protein separation membrane,plasma separation membrane,Variation of membrane pore size,Electron micrographs of inner membrane surface,sieving coefficient,100,1000,10000,100000,1000000,0,0.2,0.4,0.6,0.8,1,Molecular weight D,Classical Filter,30 kD,human kidney,high cut-off,High Cut-Off Hemofilter,Molecular Weight Da,Standard HighFlux,High Cut-Off,HF,UF=1L/h,t=2h,Median,25th-75th percentiles),ICM(2002)28:651-655,HCO Membrane with increased permeability,for inflammatory mediators,membrane characteristics,高截留分子量超滤膜的临床应用,12,HCO treatment reduces significantly inflammatory mediator plasma levels,高截留分子量超滤膜的临床应用,IL-6 in PROWESS,Non-survivors,Survivors,Kinasewitz et al,Crit Care 2004,PROWESS,（,Recombinant Human Activated Protein C Worldwide,Evaluation in Severe Sepsis)Study,At study entry,evaluated IL-6 was present in 98.5%patents,Limited Effect of,“Standard”CRRT on,Plasma Inflammatory Mediator,Levels,Herring et al,Kidney Blood Press Res 2003,Course of IL-6 plasma level during treatment with septeX/HCO,Intensive Care Med 2003;29:1989-95,N=24 pts,CVVH,Substantial Reduction of Plasma IL-6 Levels,Interleukin-6 plasma values,Crit Care Med.2006;34:2099-04.,N=10 pts CVVH,N=20 pts CVVH,IL-6 Clearance,mL/min,Sieving coefficient:,Morgera S,Bellomo R et al.Crit Care Med.2006;34:2099-04,0.01,0.01,0.00,0.93,0.93,0.84,CVVH,UF-rate 2.5L/h,Recent HPHF Studies in Sepsis:,Clearance rates for IL-6 were significantly higher in the high cutoff,hemofiltration group(p .0001).,Cellular immunomodulation through HCO treatment,高截留分子量超滤膜的临床应用,Muret et alShock 2000,Hoffmann et alKidney Int.1995,Heidecke et alAm J Surg.1999,T-Lymhocyte Proliferation is Reduced in Sepsis,Monocyte phagocytosis is elevated in Sepsis,Spark JI,Scott DJ.Br J Surg.2001;88:1583-9,.,Simms HH,DAmico R.Blood.1994;83:1398-407,Cellular immunomodulation,Human sepsis studies:,HCO treatment restores lymphocyte proliferation in septic patients,NDT,2003;18:2570-6.,N=28 pts CVVH,与,HCO,可以滤除淋巴细胞增殖的阻滞物质有关,HCO treatment reduces monocyte phagocytosis rate of septic patients,Nephron Clin Pract.2003;94:75-80,CVVH,Clinical benefits through HCO treatment,高截留分子量超滤膜的临床应用,Norepinephrine requirement is reduced,with HCO,Crit Care Med.2006;34:2099-04.,N=20 pts CVVH,N=10 pts CVVH,P=0.1103,P=0.5717,MAP mmHg,MAP mmHg,Improvement in Simplified Acute Physiology,Score,(SAPS)II,Crit Care Med.2006;34:2099-04.,N=20 pts CVVH,N=10 pts CVVH,Clearance Rates for HCO Filter:CVVH vs CVVHD,2,Morgera et al,Am J Kidney Dis 2004,clinical safety-data,高截留分子量超滤膜的临床应用,Stable albumin plasma levels during,treatment,N=24 pts,CVVH/CVVHD,Am J Kidney Dis.2004,43:444-53.,Coagulation Status During High Cut-Off Hemofiltration,Intensive Care Med 2003;29:1989-95,N=16 pts CVVH,Days on Norephrinine(10,0 9 vs 11,3 9),Days on Ventilation(13,9 11 vs 16,1 11),Need for RRT(9,1 8 vs 9,5 8),HCO versus standard high flux,Recent HPHF Studies in Sepsis,High-Flux,HCO,Honore PM et al,.,10th Congress of WFSICCM.Florence 2009,N=81 pts CVVHD,HICOSS(High Cut-Off Sepsis Study),Multicenter study with HCO in septic AKI,Reduction of catecholamine requirements by High Cut off-CVVHD:,clinical improvements and Safety(albumin levels),SOFA,Days 28 mortality(31 vs 33%),both groups lower than predicted by APACHE score,Days in ICU(1912 vs 1911),HCO vs standard high flux,Recent HPHF Studies in Sepsis:,HCO,High-Flux,Honore PM et al,.,10th Congress of WFSICCM.Florence 2009,N=81 pts CVVHD,HICOSS(High Cut-Off Sepsis Study),Multicenter study with HCO in septic AKI,Reduction of catecholamine requirements by High Cut off-CVVHD:,clinical improvements and Safety(albumin levels),SOFA,HCO versus standard high flux,Safety:Stable plasma albumin levels,with,HCO,compared to standard high flux-CVVHD,N=81 pts CVVHD,Re