血液净化技术新进展与发展设想

State-of-the-art technocology in blood purification at present

目的综述国内外血液净化技术的最新进展及研究动态,为研究我军今后血液净化技术的发展方向提供依据。方法分别通过PubMed及CHKD进行近5年来英文及中文文献检索,限定于血液净化领域,进行分析、归纳及总结。结果近5年来国际上血液净化技术的新进展主要包括维持性透析(血液透析、腹膜透析)及连续性肾脏替代治疗(CRRT)两个方面。新的血液透析滤器的问世提高了对尿毒症毒素的清除能力,而血液透析联机监测功能的完善则保障了透析的效率及安全性。在腹膜透析方面,对影响患者生活质量和长期预后的危险因素以及干预措施有了新的认识,新型腹透液的应用则有利于改善透析效率。CRRT救治危重病患者的时机及剂量、高容量血液滤过(HVHF)应用在近5年也有了显著进展。吸附技术是血液净化发展的另一重要方向。我军血液净化技术在战时卫勤保障中的应用取得了较大成绩,包括危重症患者体外循环干预治疗的临床及基础研究,战创伤患者体外循环抗凝问题,化学剂中毒的血液净化救治,吸附技术的基础研究及临床应用等。结论近年血液净化技术的发展更多着眼于危重症患者的救治,重点包括透析、滤过、吸附及血浆置换等一系列技术的联合应用,我军今后应紧跟最新前沿动态,发展最新技术,同时需将这些技术向卫勤保障及战时应用转化。

Objective To review the recent advancement in clinical practices and studies on blood purification techniques,and to provide a guide for further studies on its application in military medicine.Methods Literature published in recent five years limited to blood purification field either in English or Chinese were retrieved by searching PubMed and CHKD.Analysis and summary were performed based on the literature.Results The advancements in blood purification in recent five years could be categorized into four fields,i.e.hemodialysis（HD）,peritoneal dialysis（PD）,continuous renal replacement therapy（CRRT）,and adsorption therapy.The development in HD was aimed at promoting the ability of removal of toxic elements producing uremia and online monitor techniques,and PD was aimed at improvement of patients’ general condition and intervention to reduce the risk factors affecting long-term outcomes,and preparation of new PD solutions to improve the efficacy of PD.In regard to CRRT,the current progress had been focused on initiation time,dose and proposal of new hypothesis for high-volume hemofiltration（HVHF） application.Adsorption therapy was another choice of blood purification.Domestic military medicine progress in blood purification in our armed forces was focused on techniques that could be used in treatment of casualties in war,including the basic and clinical study of extracorporeal circuit intervention（ECI） for treatment of critically ill patients,problems arising from anticoagulation in ECI for patients with trauma,chemical agents poisoning,and adsorption technique.Conclusions Recently,the main advancement of blood purification technique is combined application of series techniques such as dialysis,hemofiltration,adsorption,and plasma exchange in treatment of critically ill patients.Studies on blood purification in domestic military medicine should be updated continuously to follow closely to the latest achievement in world,and translate these latest techniques into real practical application for treatment of casualty in war.