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Emboless®静脉腔可有效减少气泡：一项针对慢性血液透析患者的随机研究。

The Emboless® venous chamber efficiently reduces air bubbles: a randomized study of chronic hemodialysis patients.

作者信息

Forsberg Ulf, Jonsson Per, Stegmayr Bernd

机构信息

Department of Public Health and Clinical Medicine, the Skelleftea Unit, Umea University, Umea, Sweden.

Department of Public Health and Clinical Medicine, Unit of Medicine, Umea University, Umea, Sweden.

出版信息

Clin Kidney J. 2024 Oct 24;17(11):sfae323. doi: 10.1093/ckj/sfae323. eCollection 2024 Nov.

DOI:10.1093/ckj/sfae323
PMID:39574541
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11579606/
Abstract

BACKGROUND

When blood passes the extracorporeal circuit, air microbubbles (MBs) contaminate the blood. Some MBs will end up as microemboli in the lung, heart, and brain. MB exposure has no medical purpose and is considered to be bio-incompatible. Selecting venous chambers with a high removal rate of MBs is warranted to reduce the risks of air bio-incompatibility. The primary aim was to compare the Fresenius 5008 (F5008-VC) and the Emboless (Emboless-VC) venous chambers regarding the elimination of MBs in the return bloodline during hemodialysis (HD).

METHODS

Twenty patients underwent 80 sessions of cross-over HD using both the F5008-VC and the Emboless-VC randomized such that half started with the F5008-VC and half with the Emboless-VC. For 32 of the 80 sessions, measurements were also performed during hemodiafiltrations (HDF) after the initial HD. MBs were measured with an ultrasound device (within the size range of 20-500 µm) at the "inlet" and "outlet" bloodline of the venous chambers. The Wilcoxon pairwise test compared the percentage of MB elimination between venous chambers.

RESULTS

During HD, the median reduction of MBs for the outlet was 39% with the F5008-VC and 76% with the Emboless-VC (< .001). During HDF, the reduction was 28% with the F5008-VC and 70% with the Emboless-VC (< .001).

CONCLUSION

Fewer MBs and subsequently fewer microemboli entered the bloodline of the patient using the Emboless-VC compared to the F5008-VC venous chamber during HD and during HDF. Venous chambers with a high removal rate of MBs will reduce the extent of air emboli.

摘要

背景

当血液流经体外循环时，空气微泡（MBs）会污染血液。一些微泡最终会在肺部、心脏和大脑中形成微栓子。接触微泡没有医学目的，被认为具有生物不相容性。选择具有高微泡清除率的静脉腔室有助于降低空气生物不相容性的风险。主要目的是比较费森尤斯5008（F5008-VC）和无栓子（Emboless-VC）静脉腔室在血液透析（HD）期间对回血线路中微泡的清除情况。

方法

20名患者接受了80次交叉血液透析，使用F5008-VC和Emboless-VC随机分组，使得一半患者从F5008-VC开始，另一半从Emboless-VC开始。在80次透析中的32次，在初始血液透析后的血液滤过（HDF）期间也进行了测量。使用超声设备（在20-500微米的尺寸范围内）在静脉腔室的“入口”和“出口”血路中测量微泡。Wilcoxon配对检验比较了静脉腔室之间微泡清除的百分比。

结果

在血液透析期间，F5008-VC的出口微泡中位数减少率为39%，Emboless-VC为76%（<.001）。在血液滤过期间，F5008-VC的减少率为28%，Emboless-VC为70%（<.001）。

结论

与F5008-VC静脉腔室相比，在血液透析和血液滤过期间，使用Emboless-VC静脉腔室进入患者血路的微泡和随后的微栓子更少。具有高微泡清除率的静脉腔室将减少空气栓子的程度。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/094f/11579606/ff81662bada6/sfae323fig6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/094f/11579606/7194b157cb74/sfae323fig1g.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/094f/11579606/4316cb7a8438/sfae323fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/094f/11579606/ada19fdc5ea7/sfae323fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/094f/11579606/6dde0639c244/sfae323fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/094f/11579606/01cd5be23ff4/sfae323fig4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/094f/11579606/50bbb783195b/sfae323fig5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/094f/11579606/ff81662bada6/sfae323fig6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/094f/11579606/7194b157cb74/sfae323fig1g.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/094f/11579606/4316cb7a8438/sfae323fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/094f/11579606/ada19fdc5ea7/sfae323fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/094f/11579606/6dde0639c244/sfae323fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/094f/11579606/01cd5be23ff4/sfae323fig4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/094f/11579606/50bbb783195b/sfae323fig5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/094f/11579606/ff81662bada6/sfae323fig6.jpg

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Microemboli induced by air bubbles may be deposited in organs as a consequence of contamination during medical care.由气泡引起的微栓子可能因医疗过程中的污染而沉积在器官中。
Clin Kidney J. 2022 Oct 6;16(1):159-166. doi: 10.1093/ckj/sfac217. eCollection 2023 Jan.
3
Venous chambers in clinical use for hemodialysis have limited capacity to eliminate microbubbles from entering the return bloodline: An in vitro study.
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Artif Organs. 2023 Jun;47(6):961-970. doi: 10.1111/aor.14495. Epub 2023 Jan 10.
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Air contamination during medical treatment results in deposits of microemboli in the lungs: An autopsy study.医疗过程中的空气污染导致肺部微栓子沉积：一项尸检研究。
Int J Artif Organs. 2019 Sep;42(9):477-481. doi: 10.1177/0391398819840363. Epub 2019 Apr 11.
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Long-Term Survival for Hemodialysis Patients Differ in Japan Versus Europe and the USA. What Might the Reasons Be?日本与欧洲及美国的血液透析患者长期生存率存在差异。原因可能是什么？
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