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使用血液透析设备进行血浆置换

Author
Andre A Kaplan, MD
Section Editor
Steve J Schwab, MD
Deputy Editor
Alice M Sheridan, MD
Translators
万建新, 主任医师，教授

引言

传统上，治疗性血浆置换(therapeutic plasma exchange, TPE/plasmapheresis)是使用在血库处理操作中所用的离心设备进行的。 (参见“治疗性血浆置换的处方与技术”)

这些装置可进行选择性细胞移除(细胞单采术)，但与治疗后血小板减少有关[1]，而且需专用的离心设备。一种越来越受到欢迎且经常更有效的替代选择是通过膜式血浆分离(membrane plasma separation, MPS)进行血浆置换[2-5]。

MPS使用一种高渗透性膜和一台标准的透析机，通过其超滤模式、透析旁路模式(与血液灌流中的技术相似)进行。使用NxStage透析机和Prismaflex连续性肾脏替代疗法(Continuous Renal Replacement Therapy, CRRT)机也可能进行TPE。 (参见“每日短时家庭血液透析：低透析液容量法”和“连续性静静脉血液透析：技术问题”)

多年来，在美国最常用的膜是Plasmaflo AP-05H。目前该滤器已被渗透性稍强的OP-05W所替代[6]。该滤器可在多数透析机上使用，但Cobe3和Hospal机与该滤器的管道不匹配。

虽然在美国每年可进行数千次的血浆置换治疗，但目前已发表的MPS使用经验十分有限[7,8]。在某些国家，如德国与日本，90%的血浆置换治疗均是通过MPS进行的[5,9]。

     

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Literature review current through: 2017-06 . | This topic last updated: 2016-07-01.
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References
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