重症患者管理におけるcontinuous hemodiafiltration(CHDF)の臨床効果

概要

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Continuous hemodiafiltration (CHDF) has been widely accepted to be the most useful modality for the management of critically ill patients with renal failure, because of its effective clearance of waste products and mild influence upon the hemodynamics and fluid balance. Moreover, we found that CHDF could remove causative humoral mediators such as cytokines and other substances which play a key role in the pathophysiology of the disease. Therefore, we applied CHDF with nonrenal indications for patients without renal dysfunction with the expectation that CHDF could be effective through the removal of these substances. We have claimed that CHDF was effective in the management of critical conditions such as sepsis, pancreatitis and acute respiratory distress syndrome (ARDS). We also showed that CHDF decreased the adverse effects of plasma exchange and enhanced the consciousness level of patients with hepatic failure. Thus, it is suggested that CHDF may be applied more widely as an effective therapeutic tool for critically ill patients with those diseases. However, further studies are required to clarify the timings of initiation and weaning, and the precise mechanism of the efficacy of CHDF in the treatment of those diseases without renal dysfunction.
日本アフェレシス学会の論文
1999-02-28