Cruz Dinna, Bellomo Rinaldo, Kellum John A, de Cal Massimo, Ronco Claudio
Department of Nephrology, Ospedale San Bortolo, and International Renal Research Institute Vicenza, Vicenza, Italy.
Crit Care Med. 2008 Apr;36(4 Suppl):S243-52. doi: 10.1097/CCM.0b013e318168e4f6.
Extracorporeal therapy has expanded significantly over the past few decades from solely artificial renal replacement therapy. In patients with multiple organ dysfunction syndrome, it becomes necessary to provide multiple organ support therapy. Technological advances have opened the door to a multifaceted intervention directed at supporting the function of multiple organs through the treatment of blood. Indications for "old" therapies such as hemofiltration and adsorption have been expanded, and using these therapies in combination further enhances blood detoxification capabilities. Furthermore, new devices are constantly in development. Nanotechnology allows us to refine membrane characteristics and design innovative monitoring/biofeedback devices. Miniaturization is leading down the path of wearable/implantable devices. With the incorporation of viable cells within medical devices, these instruments become capable not only of detoxification but synthetic functions as well, bringing us closer to the holy grail of complete replacement of organ function. This article provides a brief overview of current and future direction in extracorporeal support in the critical care setting.
在过去几十年里，体外治疗已从单纯的人工肾替代治疗大幅扩展。对于多器官功能障碍综合征患者，提供多器官支持治疗变得必要。技术进步为通过血液治疗来支持多器官功能的多方面干预打开了大门。诸如血液滤过和吸附等“传统”疗法的适应症已扩大，联合使用这些疗法可进一步增强血液解毒能力。此外，新设备也在不断研发中。纳米技术使我们能够优化膜特性并设计创新的监测/生物反馈设备。小型化正引领着可穿戴/植入式设备的发展方向。随着在医疗设备中纳入活细胞，这些仪器不仅能够解毒，还具备合成功能，使我们更接近完全替代器官功能这一圣杯。本文简要概述了重症监护环境下体外支持的现状和未来发展方向。
