Department of Nephrology, San Bortolo Hospital, Vicenza, Italy.
Blood Purif. 2011;31(4):227-34. doi: 10.1159/000321073. Epub 2011 Jan 14.
Better solute clearance, particularly of middle-molecular-weight solutes, has been associated with improved patient outcomes. However, blood-membrane interaction during dialysis results in the development of secondary mass transfer resistances on the dialyzer membrane surface. We discuss the potential effects of mechanical vibration on the diffusion, convection and adsorption of uremic solutes during dialysis. For sinusoidal and triangular vibratory motions, we conceptualized the hemodynamic changes inside the membrane and consequent effects on membrane morphology. Longitudinal vibration generates reverse flow by relative membrane motion, and transverse vibration generates a symmetric swirling flow inside the hollow fiber, which enhances wall shear stress and flow mixing. Moreover, the impulse induced by triangle wave vibration could provide higher absorption capacity to middle-molecular-weight solutes. Mechanical vibration could enhance solute removal by minimizing membrane morphology changes resulting from blood-membrane interaction during hemodialysis. These effects of mechanical vibration can be helpful in extracorporeal blood purification therapies including continuous, portable and wearable systems.
更好的溶质清除率，特别是中分子溶质的清除率，与改善患者预后相关。然而，在透析过程中血液与膜的相互作用会导致在透析器膜表面形成继发性传质阻力。我们讨论了机械振动对透析过程中尿毒症溶质的扩散、对流和吸附的潜在影响。对于正弦和三角振动，我们构想了膜内的血液动力学变化以及对膜形态的后续影响。纵向振动通过相对膜运动产生反向流，横向振动在中空纤维内产生对称的旋流，从而增强壁面剪切应力和流动混合。此外，三角波振动产生的脉冲可以为中分子溶质提供更高的吸收能力。机械振动可以通过最小化血液-膜相互作用引起的膜形态变化来增强溶质的清除率。这些机械振动的效果对于体外血液净化治疗，包括连续、便携式和可穿戴系统，可能是有帮助的。
