Mineshima M, Eguchi K, Horibe K, Yokoi R, Kaneko I, Kimata N, Sanaka T, Nihei H, Agishi T
Kidney Center, Tokyo Women's Medical College, Japan.
ASAIO J. 1998 Sep-Oct;44(5):M465-9. doi: 10.1097/00002480-199809000-00029.
A continuous hematocrit (HCT) monitor, Crit-Line, was introduced to examine the change in patients' blood volume (BV) due to albumin loss during double filtration plasmapheresis (DFPP) treatments. Nine patients with autoimmune diseases or ABO incompatible renal transplantation received 15 DFPP treatments under Crit-Line monitoring. In these patients, plasma albumin concentration (C(P)) changed from 3.7 +/- 0.6 g/dl to 3.5 +/- 0.5 g/dl and HCT from 28.7% +/- 3.3% to 31.3% +/- 4.3% (change ratio [CR] of BV = -8.1%) during treatment with albumin concentrations (C(S)) of 9.5 +/- 1.0 g/dl and 500 ml volumes (V(S)) of supplementation fluid. Although the apparent CR value of C(P) was -5.3%, on average, the CR of albumin in the patients' plasma (M(P)) was -16.1%, which means a corrected CR value of C(P) by the HCT value to eliminate the influence of the patient's blood volume contraction during treatment. Albumin loss usually occurred in DFPP treatments. The decrease in BV was induced by an oncotic pressure drop due to albumin loss, and often resulted in a blood pressure drop. The amount of albumin loss during DFPP treatments strongly depends on sieving coefficients of the plasma separator (SC(PS)) and the plasma fractionator (SC(PF)), the filtration fraction of the plasma fractionator (FF(PF)), pretreatment C(P) value, and C(S) and V(S) values of the supplementation fluid. To determine the optimum C(S) and V(S) values for each patient, the authors introduced a variable blood volume model for albumin transport in DFPP. In this model, changes in C(P), HCT, and BV values could be estimated during treatment. For example, a patient with an HCT of 31.2%, body weight of 61.1 kg, and pretreatment C(P) of 4.4 g/dl received a DFPP treatment using a plasma separator, OP-05 (SC(PS) of 0.99), and a plasma fractionator, Evaflux 2A (SC(PF) of 0.40), under FF(PF) of 0.8 with a V(S) of 500 ml. A value for C(S) of about 10 g/dl is required for the patient to maintain a normal C(P) level during treatment by an estimation from the model. As a result of the treatment with a C(S) of 10 g/dl, the patient had no adverse reactions, such as a blood pressure decrease, during treatment under these conditions.
一种连续血细胞比容（HCT）监测仪Crit-Line被用于检测患者在双重滤过血浆置换（DFPP）治疗过程中由于白蛋白丢失导致的血容量（BV）变化。9例自身免疫性疾病患者或ABO血型不相容肾移植患者在Crit-Line监测下接受了15次DFPP治疗。在这些患者中，血浆白蛋白浓度（C(P)）从3.7±0.6 g/dl变为3.5±0.5 g/dl，血细胞比容从28.7%±3.3%变为31.3%±4.3%（血容量变化率[CR]= -8.1%），治疗时白蛋白浓度（C(S)）为9.5±1.0 g/dl，补充液体积（V(S)）为500 ml。尽管C(P)的表观CR值平均为-5.3%，但患者血浆中白蛋白的CR为-16.1%，这意味着通过血细胞比容值校正C(P)的CR值以消除治疗期间患者血容量收缩的影响。白蛋白丢失通常发生在DFPP治疗中。血容量的减少是由白蛋白丢失导致的胶体渗透压下降引起的，并且常常导致血压下降。DFPP治疗期间白蛋白的丢失量强烈取决于血浆分离器的筛系数（SC(PS)）和血浆成分分离器的筛系数（SC(PF)）、血浆成分分离器的滤过分数（FF(PF)）、预处理C(P)值以及补充液的C(S)和V(S)值。为了确定每位患者的最佳C(S)和V(S)值，作者引入了DFPP中白蛋白转运的可变血容量模型。在该模型中，可以估计治疗期间C(P)、血细胞比容和血容量值的变化。例如，一名血细胞比容为31.2%、体重为61.1 kg且预处理C(P)为4.4 g/dl的患者使用血浆分离器OP-05（SC(PS)为0.99）和血浆成分分离器Evaflux 2A（SC(PF)为0.40），在滤过分数（FF(PF)）为0.8且V(S)为500 ml的情况下接受了DFPP治疗。根据模型估计，该患者在治疗期间需要约10 g/dl的C(S)值以维持正常的C(P)水平。在这些条件下，使用10 g/dl的C(S)进行治疗的结果是，该患者在治疗期间没有出现诸如血压下降等不良反应。
