Ronco Claudio, Bellomo Rinaldo
Department of Medicine, University of Padova, Padua, Italy.
International Renal Research Institute of Vicenza (IRRV), Vicenza, Italy.
Crit Care. 2022 May 12;26(1):135. doi: 10.1186/s13054-022-04009-w.
Blood purification through the removal of plasma solutes by adsorption to beads of charcoal or resins contained in a cartridge (hemoperfusion) has a long and imperfect history. Developments in production and coating technology, however, have recently increased the biocompatibility of sorbents and have spurred renewed interest in hemoperfusion.
We performed a narrative assessment of the literature with focus on the technology, characteristics, and principles of hemoperfusion. We assessed publications in ex vivo, animal, and human studies. We synthesized such literature in a technical and state-of-the-art summary.
Early hemoperfusion studies were hampered by bioincompatibility. Recent technology, however, has improved its safety. Hemoperfusion has been used with positive effects in chronic dialysis and chronic liver disease. It has also demonstrated extraction of a variety of toxins and drugs during episodes of overdose. Trials with endotoxin binding polymyxin B have shown mixed results in septic shock and are under active investigation. The role of non-selective hemoperfusion in sepsis or inflammation remains. Although new technologies have made sorbents more biocompatible, the research agenda in the field remains vast.
New sorbents markedly differ from those used in the past because of greater biocompatibility and safety. Initial studies of novel sorbent-based hemoperfusion show some promise in specific chronic conditions and some acute states. Systematic studies of novel sorbent-based hemoperfusion are now both necessary and justified.
通过吸附于置于滤器（血液灌流）中的木炭或树脂珠来清除血浆溶质进行血液净化，其历史悠久但并不完善。然而，生产和涂层技术的发展最近提高了吸附剂的生物相容性，并激发了人们对血液灌流的新兴趣。
我们对文献进行了叙述性评估，重点关注血液灌流的技术、特性和原理。我们评估了体外、动物和人体研究中的出版物。我们将这些文献综合成一份技术和最新进展的总结。
早期的血液灌流研究受到生物不相容性的阻碍。然而，最近的技术提高了其安全性。血液灌流已用于慢性透析和慢性肝病并取得了积极效果。它还在药物过量发作期间显示出能清除多种毒素和药物。使用内毒素结合多粘菌素B的试验在感染性休克中的结果不一，仍在积极研究中。非选择性血液灌流在脓毒症或炎症中的作用仍不明确。尽管新技术使吸附剂的生物相容性更高，但该领域的研究议程仍然广泛。
新型吸附剂由于具有更高的生物相容性和安全性，与过去使用的吸附剂有显著不同。基于新型吸附剂的血液灌流的初步研究在特定的慢性疾病和一些急性状态中显示出一些前景。现在有必要且合理对基于新型吸附剂的血液灌流进行系统研究。
