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血液透析療法における向流操作と並流操作の中分子量尿毒症性物質の除去性能に関する比較検討　―シトクロムcを指標とした水系実験による研究― Comparison of counter and parallel flows on middle molecular weight uremic substance removal performance in hemodialysis therapy -An aqueous experiment on removal of cytochrome c as an indicator of that of middle molecular weight uremic substances- 樫野, 真 カシノ, マコト 向流操作 並流操作 尿毒症性物質除去率 counter flow parallel flow uremic substances reduction rate 血液透析療法は血液と透析液を反対方向に灌流する向流操作で行われる．カプラとダイアライザーを誤接続し並流操作となった場合，尿毒症性物質除去の程度が明確でないままに対応されている．そこで，中分子量尿毒症性物質に着目しシトクロムc除去率（Cyt c RR）を水系実験で向流操作時と並流操作時において比較・検討した．Cyt c RRは時間とともに指数関数的に変化し，60minでは向流操作時96.4±0.6%，並流操作時94.4±0.4％で，時定数はそれぞれ13.2min，17.1minであった．相対Cyt c除去率は5min以降80%を超えていた．これらから，並流操作で血液透析療法が行われた場合でもβ2-ミクログロブリン（β2-M）は向流操作時の80%以上が除去できていると推測でき，低血清β2-M濃度の患者では時間延長の必要性は低く，高血清β2-M濃度の患者でも，並流操作時の時定数が向流操作時の1.3倍であることから最大で30%時間を延長すれば同等の除去効果が期待できる． Hemodialysis is performed in a counter flow operation in where blood and dialysate are perfused in opposite directions. If the coupler and the dialyzer are not properly connected, it becomes a parallel flow operation. In this case, it is unknown how much the uremic substances have been removed. Therefore, focusing on middle molecular weight uremic substances, the cytochrome c reduction rate operations. In the counter and parallel flow operations Cyt c RR varied exponentially with time constants of 13.2 min and 17.1 min, and reached 96.4 ± 0.6%　and 94.4 ± 0.4% at 60 min, respectively. After 5 min from the start of the experiment, the relative Cyt c RR of the parallel flow operation to the counter flow operation Cyt c RR exceeded 80%. These result suggests that more than 80% of the amount of β2-microglobulin (β2-M) that can be eliminated by hemodialysis treatment in the counter flow operation is removed by that in the parallel flow operation. Therefore, the need for time extension is low in patients who are not high in serum β2-M concentration. For patients with high serum β2-M concentration, if the treatment is extended by 30%, β2-M is considered to be eliminated to the same extent as in the counter flow operation, because the time in the parallel flow operation is 1.3 times that in the counter flow operation. 広島国際大学大学院医療・福祉科学研究科 2018-03 jpn departmental bulletin paper VoR https://doi.org/10.60172/00000336 https://hirokoku-u.repo.nii.ac.jp/records/342 10.60172/00000336 18819265 医療工学雑誌 Journal of Medical Engineering 12 1 8 https://hirokoku-u.repo.nii.ac.jp/record/342/files/jme12_001.pdf application/pdf 3.9 MB 2023-03-11