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抄録
膜型血漿分離器「エバキュアー」(Evacure;EC)を用いた単純血漿交換(Plasma filtration;PF)を持続的に施行して,ECの溶質透過性能の安定性等について検討した.症例は,劇症肝炎,術後肝不全,筋腎代謝症候群の各1例である.ECはEC-2A10(膜面積1.0m^2)を使用した.間歇的なPFにおけるミオグロビン,アルブミン(Alb)の篩係数(S.C.)を測定したところ,いずれの溶質についても経時的に安定した値が得られた.またAlb,ビリルビン(Bil),フィブリノゲンについて長時間のPFにおける経時変化を観察したところ,いずれの溶質についてもS.C.は血漿処理量14.4L時まで安定していた.AlbとBilはほぼ同じS.C.を示した.ECは物質除去性能が安定しており,持続的に用いても有用物質の保持と不要物質の除去のバランスがとれた膜であることが示唆された.今後,肝不全等にも有用な選択肢であると考えた.
We performed intermittent and continuous plasma filtration (PF) using a membrane plasma separator "Evacure" Kuraray Medical Japan, and reviewed its permeation properties. The procedure was conducted on three patients with different diseases (fulminant hepatitis, acute hepatic failure and myonephropathic metabolic syndrome). The name of the product used was EC-2 A 10 (surface area: 1.0m^2). We calculated the sieving coefficient (S.C.) of Myoglobin and Albumin in the case where intermittent PF was performed and found that the S.C. of each substance were almost constant throughout the entire session. We also checked the S.C. of Bilirubin, Fibrinogen and Albumin during continuous PF. As a result, it was found that the S.C. of each substance remained the same value after the filtration of 14.4L of plasma. Meanwhile, the S.C. of Albumin was almost the same as that of Bilirubin. It was suggested that the permeation property of the membrane plasma separator Evacure was relatively stable over time and that Evacure could show a good balance between retaining useful higher molecular weight substances and selectively removing harmful lower molecular weight substances even when continuously used over a long period of time. In this context, we concluded that Evacure might be a useful option for the treatment of hepatic failure.
