Hilt H, Keller F
Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Steglitz der Freien Universität Berlin.
Anasth Intensivther Notfallmed. 1987 Dec;22(6):278-82.
The elimination of substances during hemofiltration depends on the special properties of the used wide-porous membranes. High filtration-fractions are achieved and, in practice, all substances with a molecular weight below 10,000 Dalton pass the membrane. Also drugs are filtrated equivalent to their unbound free plasma-fraction. A quantitative elimination of drugs during hemofiltration is to expect, 1. if a sufficient ultrafiltration rate of 10 ml/min or more is reached, which is the upper limit of spontaneous CAVH, 2. if the sieving-coefficient or plasma-protein-binding enables a sufficient passage and 3. if the serum concentration of the drug related to its administered dose is high, i.e. the volume of distribution is small. An adjustment of drugs is partially necessary during hemofiltration. A simple way is to calculate the total creatinine-clearance to derive dosage modifications.
血液滤过过程中物质的清除取决于所用大孔膜的特殊性质。可实现高滤过分数，实际上，所有分子量低于10,000道尔顿的物质都能通过膜。药物的滤过与其未结合的游离血浆分数相当。在血液滤过过程中，预计药物能被定量清除，条件如下：1. 达到足够的超滤率，即10毫升/分钟或更高，这是自发性连续性动静脉血液滤过（CAVH）的上限；2. 筛系数或血浆蛋白结合率能使药物充分通过；3. 与给药剂量相关的药物血清浓度较高，即分布容积较小。血液滤过过程中部分药物调整是必要的。一种简单的方法是计算总肌酐清除率以得出剂量调整。
