Clark William R, Ferrari Fiorenza, La Manna Gaetano, Ronco Claudio
Contrib Nephrol. 2017;190:43-57. doi: 10.1159/000468911. Epub 2017 May 23.
Limitations imposed by the characteristics of some solutes and the structure of dialysis membranes have spurred new interest in the use of mechanisms beyond diffusion and convection for extracorporeal solute removal. Sorbents have been utilized for more than 50 years in extracorporeal blood treatments for specific purposes, and better understanding of their basic aspects may further expand the potential for their clinical application. In this chapter, the basic principles applying to sorbents are discussed, including composition and structure, along with the fundamental mechanisms of solute removal. The critical importance of sorbent biocompatibility is also highlighted. With these basic principles in mind, the clinical application of sorbents is discussed, with an emphasis on the use of hemoperfusion and coupled plasma filtration-adsorption for sepsis-related disorders. Finally, new sorbent-based clinical approaches for acute conditions and end-stage renal disease are presented, emphasizing that sorbent technologies may assume a larger role for a variety of clinical disorders in the future.
某些溶质的特性和透析膜的结构所带来的限制，激发了人们对利用扩散和对流以外的机制进行体外溶质清除的新兴趣。吸附剂已在体外血液治疗中用于特定目的五十多年了，对其基本方面的更好理解可能会进一步扩大其临床应用潜力。在本章中，将讨论适用于吸附剂的基本原理，包括组成和结构，以及溶质清除的基本机制。还强调了吸附剂生物相容性的至关重要性。牢记这些基本原理，将讨论吸附剂的临床应用，重点是血液灌流和血浆滤过吸附联用在脓毒症相关疾病中的应用。最后，介绍了针对急性病症和终末期肾病基于吸附剂的新临床方法，强调吸附剂技术未来可能在各种临床疾病中发挥更大作用。
