重症急性膵炎に対するアフェレシス(<特集>急性期アフェレシスのup-to-date～各種臓器障害への対応～)

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  • 中永,士師明
    秋田大学大学院医学系研究科医学専攻病態制御医学系救急・集中治療医学講座

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  • Plasmapheresis in Patients with Severe Acute Pancreatitis

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The severity of acute pancreatitis is related to the magnitude of endothelial hyperpermeability caused by excessive humoral mediators. Therefore, the therapeutic approach for severe acute pancreatitis is to control the excessive humoral mediators. Apheresis is considered to be one of the approaches. Continuous hemodiafiltration using a cytokine-adsorbing hemofilter, such as polymethyl-methacrylate or acrylonitrile/sodium methallylsulfonate is recommended as a first choice. Plasma exchange is more efficient to remove albumin-bound mediators aggressively. Selective plasma exchange is performed using a selective membrane plasma separator (pore size of 0.01 in EvacurePlus EC-2A and 0.03μm in EC-4A). These membranes can selectively remove low- or intermediate-molecular-weight albumin-bound substances. In addition, coagulation factors are preserved. Furthermore, we devised a method of plasma filtration with dialysis (PDF), in which selective plasma exchange is performed using EC-2A or EC-4A while the dialysate flows outside the hollow fibers. In short, PDF therapy is a feasible modality for the treatment of severe acute pancreatitis.

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