计算评估脉动泵对血液净化中毒素清除的影响。

Computational assessment of the effects of a pulsatile pump on toxin removal in blood purification.

机构信息

Department of Mechanical & Biomedical Engineering, Kangwon National University, Chuncheon, Kangwon-do, Republic of Korea.

出版信息

Biomed Eng Online. 2010 Jun 22;9:31. doi: 10.1186/1475-925X-9-31.

DOI:10.1186/1475-925X-9-31

PMID:20569462

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2901332/

Abstract

BACKGROUND

For blood purification systems using a semipermeable membrane, the convective mass transfer by ultrafiltration plays an important role in toxin removal. The increase in the ultrafiltration rate can improve the toxin removal efficiency of the device, ultimately reducing treatment time and cost. In this study, we assessed the effects of pulsatile flow on the efficiency of the convective toxin removal in blood purification systems using theoretical methods.

METHODS

We devised a new mathematical lumped model to assess the toxin removal efficiency of blood purification systems in patients, integrating the mass transfer model for a human body with a dialyser. The human body model consists of a three-compartment model of body fluid dynamics and a two-compartment model of body solute kinetics. We simulated three types of blood purification therapy with the model, hemofiltration, hemodiafiltration, and high-flux dialysis, and compared the simulation results in terms of toxin (urea and beta-2 microglobulin) clearance and the treatment dose delivered under conditions of pulsatile and non-pulsatile pumping. In vivo experiments were also performed to verify the model results.

RESULTS

Simulation results revealed that pulsatile flow improved the convective clearance of the dialyser and delivered treatment dose for all three types of therapy. Compared with the non-pulsatile pumping method, the increases in the clearance of urea and beta-2 microglobulin with pulsatile pumping were highest with hemofiltration treatment (122.7% and 122.7%, respectively), followed by hemodiafiltration (3.6% and 8.3%, respectively), and high-flux dialysis (1.9% and 4.7%, respectively). EKRc and std Kt/V averaged 28% and 23% higher, respectively, in the pulsatile group than in the non-pulsatile group with hemofiltration treatment.

CONCLUSIONS

The pulsatile effect was highly advantageous for all of the toxins in the hemofiltration treatment and for beta2-microglobulin in the hemodiafiltration and high-flux dialysis treatments.

摘要

背景

对于使用半透膜的血液净化系统，超滤的对流质量传递在毒素去除中起着重要作用。增加超滤率可以提高设备的毒素去除效率，最终缩短治疗时间和降低成本。在这项研究中，我们使用理论方法评估了脉动流对血液净化系统对流毒素去除效率的影响。

方法

我们设计了一种新的集中数学模型，通过将人体质量转移模型与透析器相结合，评估患者血液净化系统的毒素去除效率。人体模型由体液动力学的三腔模型和体溶质动力学的两腔模型组成。我们用模型模拟了三种血液净化治疗方法，即血液滤过、血液透析滤过和高通量透析，并比较了在脉动和非脉动泵送条件下毒素（尿素和β2-微球蛋白）清除率和治疗剂量的模拟结果。还进行了体内实验以验证模型结果。

结果

模拟结果表明，脉动流提高了透析器的对流清除率，并为所有三种治疗方法提供了治疗剂量。与非脉动泵送方法相比，脉动泵送时尿素和β2-微球蛋白的清除率增加最高，血液滤过治疗时分别增加了 122.7%和 122.7%，血液透析滤过治疗时分别增加了 3.6%和 8.3%，高通量透析治疗时分别增加了 1.9%和 4.7%。血液滤过治疗时，脉动组的 EKRc 和 std Kt/V 平均值分别比非脉动组高 28%和 23%。