Odamaki So, Hori Yuki, Nakai Sota, Akazawa Mayumi, Sato Kanako, Yamada Asuka, Aoki Kanako, Sato Hiroshi, Miyakawa Hiroyuki, Ishibashi Yoshitaka
Department of Clinical Engineering, Japanese Red Cross Medical Center, Tokyo, Japan.
Department of Nephrology, Japanese Red Cross Medical Center, Tokyo, Japan.
Ther Apher Dial. 2019 Jun;23(3):266-270. doi: 10.1111/1744-9987.12822. Epub 2019 May 26.
At present, conventional plasma exchange (CPE) sets removal rate, replacement fluid volume and replacement fluid albumin (Alb) concentration according to the first-order kinetics of mass balance for removal of pathogenic substances. With the spread of selective plasma exchange (SePE), it has become necessary to set the removal rate and replacement fluid Alb concentration based on the initial concentration for each performance of the plasma separator. Considering the patient as a single reactor we devised a complete mixed reactor model simulating the concentration change in the reactor. Our formula is obtained by adding membrane performance and replacement fluid concentration to formulas currently available and can be used for both CPE and SePE. For the in vitro experiment, fresh frozen plasma stored in a bag was used to simulate a patient's circulating plasma. Plasma was separated by plasma separator Evacure EC-4A10 (EC-4A) (Kawasumi Laboratories Inc., Tokyo, Japan) while a replacement Alb solution was simultaneously entered into the circuit at the same rate as separation. IgG, Alb, total protein (TP), and fibrinogen (Fib) concentrations were measured every 10 min and examined for correlation with the value predicted by the mass balance formula. The concentration of each solute was measured 21 times during the 195 min of the experiment. The rate of change of each solute was IgG 76%, Alb 58%, TP 58%, and Fib 32%. Experimental values and predicted values showed significant correlation (IgG: r = 0.9962; Fib: r = 0.9535; Alb: r = 0.9808; TP: r = 0.9721, all P < 0.05). Since the solute concentration change in SePE can be predicted, this mass balance formula is useful for setting treatment conditions for both CPE and SePE.
目前，传统血浆置换（CPE）根据清除致病物质的质量平衡一级动力学来设定清除率、置换液量和置换液白蛋白（Alb）浓度。随着选择性血浆置换（SePE）的推广，有必要根据血浆分离器每次性能的初始浓度来设定清除率和置换液Alb浓度。将患者视为单个反应器，我们设计了一个完全混合反应器模型来模拟反应器中的浓度变化。我们的公式是通过将膜性能和置换液浓度添加到现有公式中得到的，可用于CPE和SePE。在体外实验中，使用储存在袋中的新鲜冷冻血浆来模拟患者的循环血浆。使用血浆分离器Evacure EC - 4A10（EC - 4A）（日本东京河合药品工业株式会社）分离血浆，同时以与分离相同的速率将置换Alb溶液输入回路。每10分钟测量一次IgG、Alb、总蛋白（TP）和纤维蛋白原（Fib）浓度，并检查其与质量平衡公式预测值的相关性。在实验的195分钟内，每种溶质的浓度测量了21次。每种溶质的变化率分别为IgG 76%、Alb 58%、TP 58%和Fib 32%。实验值与预测值显示出显著相关性（IgG：r = 0.9962；Fib：r = 0.9535；Alb：r = 0.9808；TP：r = 0.9721，所有P < 0.05）。由于SePE中溶质浓度变化可以预测，因此该质量平衡公式对于设定CPE和SePE的治疗条件都很有用。
