Kolff型人工腎蔵による血液透析の臨床的研究

Abstract

The report deals with clinical experiences on blood dialysis performed at 78 times in 47 cases using the Kolff's twin coil kidney during the period of recent 6 years. 1) Analysis was made on the results obtained from 64 times of blood d ialysis performed in 35 cases in which clinical and laboratory findings were clarified. 2) Products of nitrogen metabolism in serum, such as NPN, creatinine, uric acid, BUN and amino-N were determined before, during and following dialysis. None of them showed separate and specific reduction. 3) In order to evaluate t h e effect of dialysis, dialysance was measured on serum NPN, creatinine and uric acid. At the mean blood flow rate of 200 cc/min., the mean dialysances for NPN, creatinine and uric acid were 120 cc/min., 100 cc/min. and 80 cc/min. respectively, indicating excellent dialytic efficiencies. 4) The dialysance relate d not only to blood flow rate but also to blood concentration of the substances, so that it reduced with lowering their blood levels. With long term blood dialysis, each substance was able to be decreased down to the normal range. 5) Determination of serum electrolites, such as Na, K, Ca, Cl and P disclosed that their levels normalized after blood dialysis for 4 hours. 6) Before and after blood dialysis, venous C O 2-combining power was measured which showed excellent effect on metabolic acidosis. 7) In all cases, increases in h e matocrit and decreases in serum protein level were demonstrated after blood dialysis. 8) For cases with ma r ked edema and anemia, use of high osmotic dialysate to remove excess water along with administration of blood transfusions resulted in readily correction of circulating blood volume and red cell volume. 9) Anemia in renal insufficiency wa s closely related to renal functions. Immoderate correction of anemia might results in acceleration of red cell destruction with marked azotemia. 10) The proper level of red cell count in anuric state was found to be around 2 to 2.5 milion per cubic milimeter. 11) Effect of low-K dialysate for hyperpotassemia appeared within a short period of dialysis with dramatic clinical improvements. However, in cases on digitalis it was necessary to remove the serum potassium rather slowly. 12) Intense and prolonged dialysis, such as with 200 cc/min. of blood flow rate for 10 hours, was feasible to perform. Appearance of myocard ischemic pattern in ECG during dialysis disappeared in about 30 minutes after discontinuation of dialysis. 13) For dialysis disequilibrium, use of high osmotic dialys a te was proved to have preventive effect. 14) An A-V shunt of our own made of siliconized polyethylen tube could be used for a long period up to 5 months, if it kept maintained good condition. 15) Using two apparatuses of infusion pump, the re g ional heparinization was performed. A prolonged blood dialysis was able to perform with small amount of hepa r in, 1, 000 units per hour, and amount of protamin sulfate. 16) The survival rate of our series o f 47 patients showed 25 % for the first half of 20 cases and 41 % for the latter half of 27 cases. It was confirmed that the earlier performance of blood dialysis is necessary to obtain the better prognosis.