Nalesso F
Deparment of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Vicenza, Italy.
Int J Artif Organs. 2005 Jul;28(7):731-8. doi: 10.1177/039139880502800712.
Severe sepsis is one of the most significant challenges in critical care. Despite all the developments achieved in infectious diseases and critical care, along with numerous attempts to develop treatments, the mortality rate of severe sepsis and septic shock remains unacceptably high. The pathophysiology of severe sepsis and septic shock is only partially understood. Circulating pro- inflammatory and anti-inflammatory mediators appear to participate in the complex cascade of events which leads to deranged microcirculatory function, as we know from the peak concentration hypothesis. Therapeutic trials targeting single pro-inflammatory and anti-inflammatory mediators failed to demonstrate any benefit, suggesting that the unselective removal of different mediators may be a more appropriate approach. In severe sepsis several blood purification techniques, such as continuous hemofiltration (CVVH), high volume hemofiltration (HVHF), pulse high volume hemofiltration (HVHF), plasma filtration, plasma dsorption, coupled plasma filtration adsorption (CPFA), have been proposed but such techniques appear to have both theorical as well as practical limitations. Plasma Filtration Adsorption Dialysis (PFAD) is a new extracorporeal treatment which combines different principles of blood purification in a single device. The core of this technique is a new dialyzer composed by three suitable compartments that provide specific functions. The association of multiple principles permits specific removal of molecules implicated in the pathophysiology of patient's disease and re-establishment of hydro-electrolyte, acid-base equilibrium, if renal dysfunction-failure is present. The final target of PFAD is to obtain complete purification by combining principles of physics and chemistry to remove hydrophilic and hydrophobic molecules with a very wide range of weights.
严重脓毒症是重症监护中最严峻的挑战之一。尽管在传染病和重症监护领域取得了诸多进展，并且进行了大量开发治疗方法的尝试，但严重脓毒症和脓毒性休克的死亡率仍然高得令人无法接受。严重脓毒症和脓毒性休克的病理生理学仅得到部分理解。正如我们从峰值浓度假说中所知，循环中的促炎和抗炎介质似乎参与了导致微循环功能紊乱的复杂事件级联反应。针对单一促炎和抗炎介质的治疗试验未能显示出任何益处，这表明非选择性地清除不同介质可能是一种更合适的方法。在严重脓毒症中，已经提出了几种血液净化技术，如连续性血液滤过（CVVH）、高容量血液滤过（HVHF）、脉冲高容量血液滤过（HVHF）、血浆滤过、血浆吸附、耦合血浆滤过吸附（CPFA），但这些技术似乎都存在理论和实际的局限性。血浆滤过吸附透析（PFAD）是一种新的体外治疗方法，它在单个设备中结合了不同的血液净化原理。该技术的核心是一种由三个具有特定功能的合适隔室组成的新型透析器。多种原理的结合允许特异性清除与患者疾病病理生理学相关的分子，并在存在肾功能障碍或衰竭时重新建立水电解质和酸碱平衡。PFAD的最终目标是通过结合物理和化学原理来清除各种分子量的亲水性和疏水性分子，从而实现完全净化。
