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1.
滤器复用方式对溶质清除率的影响   总被引:1,自引:0,他引:1  
目的 :探讨不同透析器复用方式对各种连续性肾脏替代疗法 (CRRT)模式溶质清除率的影响。  方法 :采用体外试验 ,聚砜膜F60透析器共分三组 ,A组为首次使用的透析器 ,B组为用次氯酸钠加甲醛复用的透析器 ,C组为单用甲醛复用的透析器 ,分别行连续性静脉 静脉血液滤过 (CVVH) ,连续性静脉 静脉血液透析 (CVVHD)及连续性静脉 静脉血液透析滤过 (CVVHDF) ,并同时测定尿素、肌酐、VitB1 2 、菊粉的清除率。  结果 :不同CRRT方式对小分子物质的清除率在三组间无显著差异 ,对中、大分子物质的清除率 ,CVVH ,CVVHDF方式下C组较A组显著下降 (P <0 0 5) ,CVVHD方式下 ,三组间无显著差异。  结论 :CRRT时透析器复用要加入漂白剂成份才能确保中、大分子清除率不变  相似文献   

2.
血液净化技术对尿毒症患者血浆瘦素、神经肽Y的影响   总被引:1,自引:0,他引:1  
目的 研究血液净化技术对血浆瘦素、神经肽 Y(NPY)的影响 ,探讨改善尿毒症营养不良的有效措施。方法 本文尿毒症患者 6 9例 ,根据所采用的血液净化技术分为 3组 :低通量纤维素膜透析组 (A组 ) 32例 ,低通量血仿膜 F6透析组 (B组 ) 2 1例 ,F6 0高通量血滤器透析滤过并血液透析组 (C组 ) 16例。另选择 18例健康查体者作为对照组。利用放射免疫法测定患者透析前、后及对照组空腹静脉血的瘦素及 NPY水平。结果 三组瘦素与 NPY水平透析前明显高于对照组 (P<0 .0 1) ;透析后 A、B组瘦素、NPY水平未降低 ,C组瘦素水平明显降低 (P<0 .0 5 ) ,但 NPY无显著变化。结论 尿毒症患者存在高瘦素及 NPY血症 ,二者无相关性 ,都不能通过单纯血液透析清除。利用高通量血滤器进行血液滤过有助于增加瘦素的清除率 ,改善患者营养状态。  相似文献   

3.
目的:以费森尤斯空心纤维透析器(F60S)为对照,验证国产高通量“HF12、HF16聚砜膜空心纤维透析器”对慢性肾衰竭维持性血液透析(MHD)患者的临床疗效和安全性. 方法:采用随机平行对照试验设计,将2011年3月至6月在南京军区南京总医院全军肾脏病研究所血液净化中心行MHD治疗的135例患者分为HF12试验组、HF16试验组和F60S对照组,每组45例,使用相应透析器行血液透析治疗一次(4h/次),计算患者尿素氮、肌酐、磷酸盐、β2微球蛋白(β2-MG)的清除率和下降率,并检测试验前后外周血红蛋白、白细胞、血小板、血清白蛋白、补体C3等实验室指标变化,观察并记录不良反应和不良事件. 结果:(1)135例患者均完成试验,无一例失访.其中男性85例,女性50例,年龄19~ 62岁,平均年龄(39±11)岁.(2)试验组患者的尿素氮、肌酐、磷酸盐及β2-MG清除率和下降率与对照组相比均无统计学差异.HF12、HF16试验组患者的尿素氮清除率略低于对照组,分别为(184.0±62.8)ml/min、(196.0±37.9)ml/min和(200.6±23.2) ml/min,三者间无统计学差异.试验组和对照组患者的尿素氮下降率均>60%(P>0.05).HF12试验组患者的β2-MG下降率略低于对照组[(41.3±15.6)% vs(44.0±16.8)%,P>0.05],HF16试验组患者的β2-MG下降率略高于对照组[(47.0±15.0)% vs(44.0±16.8)%,P>0.05].(3)试验组和对照组患者在试验前后外周血红蛋白、白细胞、血小板、血清白蛋白、补体C3均无明显变化.(4)试验组和对照组均未发生不良反应及不良事件. 结论:国产高通量HF12、HF16聚砜膜透析器与进口F60S透析器具有相同的小分子毒素和中分子物质清除作用,生物相容性较好,未发生不良反应和不良事件.  相似文献   

4.
目的 探讨不同透析膜对维持性血液透析(MHD)患者血清C反应蛋白(CRP)、白细胞介素( IL)-6、白细胞介素-8和白蛋白(ALB)水平的影响.方法 选取维持性血液透析患者54例,随机分为纤维素膜组、聚砜膜F6组和聚砜膜F60组3组,每组18例.监测3组患者治疗前后C反应蛋白、白细胞介素-6、白细胞介素-8和白蛋白水平的变化,30例健康体检者作为对照组.结果 维持性血液透析患者透析前C-反应蛋白、白细胞介素-6及白细胞介素-8水平均高于对照组(P<0.01),白蛋白水平低于对照组(P<0.01).纤维素膜组单次透析后C反应蛋白、白细胞介素-6及白细胞介素-8水平上升(P<0.01),聚砜膜F6组及聚砜膜F60组单次透析后C反应蛋白、白细胞介素-6及白细胞介素-8水平无明显变化(P>0.05);聚砜膜F60组治疗8个月后C反应蛋白、白细胞介素-6及白细胞介素-8水平下降(P<0.01),白蛋白水平上升(P<0.05),纤维素膜组及聚砜膜F6组治疗8个月后C反应蛋白、白细胞介素-6、白细胞介素-8及白蛋白水平无明显变化(P>0.05).结论 维持性血液透析患者存在微炎症状态,这种炎症状态与透析膜的生物相容性有关,高通量合成膜能改善维持性血液透析患者的微炎症状态.  相似文献   

5.
目的:探讨不同透析膜对维持性血液透析患者血清C反应蛋白(CRP)、白介素-6(IL-6)及肿瘤坏死因子(TNF-α)水平的影响。方法:选取维持性血液透析患者60例,随机分成铜仿膜(CUP)组、血仿膜(HE)组、聚砜膜(F6)组,各20例。另选取尿毒症非透析患者20例作为非透析组,20例健康体检者为正常对照组,监测透析前、后血炎症因子CRP、IL-6、TNF-α的水平。结果:非透析组及透析组透析前患者血CRP、IL-6、TNF-α水平均高于正常对照组(P0.01),CUP组透析后CRP、IL-6、TNF-α水平较透析前明显上升(P0.05或P0.01),HE组及F6组透析后CRP、IL-6、TNF-α水平与透析前比较,差异无统计学意义(P0.05)。结论:尿毒症患者体内存在微炎症状态,血液透析会进一步加重炎症反应,与透析膜的生物相容性直接有关。  相似文献   

6.
目的:评价不同透析膜血液透析的生物相容性。方法:定量反转录多聚酶链反应、细胞原位杂交技术和酶联免疫吸附方法。结果:在分组设计与拉丁交叉设计中,IL-1β、TNF-α及IL-6血浆水平无论铜仿膜、聚甲基丙烯酸甲酯膜(PMMA)或聚砜膜血透时各组间差异不明显(P值均>0.05);IL-1β、TNF-α与IL-6mRNA在正常人外周血单个核细胞中无表达,而尿毒症未透析患者和血透患者外周血单个核细胞中均有表达,其中血透者的表达水平明显高于尿毒症未透析患者。反转录多聚酶链反应和细胞原位杂交检测发现铜仿膜血透时各细胞因子基因表达水平均显著高于PMMA与聚砜膜(P<0.001),而PMMA与聚砜膜间无差异(P>0.05)。结论:尿毒症(未透析)及血透均可激活外周血单个核细胞。从细胞因子基因表达水平看,铜仿膜生物相容性较PMMA与聚砜膜差。作者认为这一方法在评价透析膜的生物相容性上优于血浆水平测定。  相似文献   

7.
高通量透析器重复使用对清除低分子蛋白的影响   总被引:12,自引:1,他引:11  
随着透析时间的延长 ,透析患者开始出现许多与透析相关的远期并发症 ,使人们认识到常规低通量透析的局限性。高通量透析一定程度上可缓解透析相关的远期并发症。NIHHEMO研究小组对高通量透析器的定义为 :透析器超滤系数 (KUF) >14ml/(h·mmHg) ,首次使用 β2 微球蛋白 (β2 M)清除率 >2 0ml/min[1] 。与低通量透析器不同的是 ,它对中大分子物质的清除显著增加 ,包括低分子蛋白 ,清除方式也从单纯弥散方式增加为弥散、对流及吸附三者结合。高通量透析器用于临床后 ,因经济因素复用现象很普遍。研究表明 ,复用时常用…  相似文献   

8.
高通量透析器的临床应用   总被引:22,自引:2,他引:20  
目的 :观察高通量透析器BLS 814G用于常规血液透析时对几种尿毒症毒素的清除能力。  方法 :选择 30例常规血液透析患者 ,随机分为A、B两组。A组患者 (n =15 )继续使用其原来的低通量透析器ME15H(Kawasumi,膜面积 1 5m2 ,超滤系数 7 7ml/mmHg.h) ;B组患者改用高通量透析器DIAPESBLS 814G (Bellcos.p .a ,膜面积 1 4m2 ,超滤系数 6 1ml/mmHg .h)。所有患者均采用动静脉内瘘及碳酸氢盐透析 ,透析液流量 5 0 0ml/min ,血流量 2 5 0ml/min ,透析时间 4 5h。透析器第一次使用时监测尿素氮 (BUN)、肌酐 (SCr)、尿酸 (UA)、磷及 β2 微球蛋白(β2 M)的清除率 ,以及透析前、后BUN、KT/V及磷、β2 M的下降率。 结果 :A组患者BUN、SCr、尿酸清除率及KT/V分别为 (190 1± 2 7 6 )ml/min、(172 5± 16 9)ml/min、(173 1± 2 1 4 )ml/min和 1 5 4± 0 34;B组患者BUN、SCr、UA清除率及KT/V分别为 (2 10 2± 14 5 )ml/min、(176 4± 2 4 2 )ml/min、(174 8± 2 2 8)ml/min和 1 70± 0 4 0 ,两组之间无显著差异 (P >0 0 5 )。A、B两组对磷的清除率分别为 (15 6 1± 14 3)ml/min、(178 7± 2 3 4 )ml/min ,透析前、后磷的下降率分别为 (5 0 4± 13 3) %、(6 2 7± 11 4 ) % ,两组之间差异显著 (P =0  相似文献   

9.
目的 :研究维持性血液透析患者外周血T细胞AnnexinⅤ和FasL的表达。  方法 :应用流式细胞术分别检测未透析肾衰 (ND)患者、醋酸纤维膜透析 (CA)患者、聚砜膜透析 (PS)患者及健康自愿者 (C)各 10名的外周血T细胞培养 2 4h后AnnexinⅤ和FasL的表达。  结果 :ND组和CA组外周血T细胞计数显著低于C组 ,而PS组与C组间差异不显著 ,ND组和CA组T细胞上AnnexinⅤ和FasL表达显著高于C组和PS组 ,各组AnnexinⅤ和FasL呈显著正相关 (P <0 0 5 )  结论 :终末期肾衰 (ESRF)患者的低T淋巴细胞血症可能与T细胞凋亡增加有关。  相似文献   

10.
腹膜透析已广泛用于治疗慢性肾衰竭 (CRF)尿毒症。随着腹膜透析的进行 ,透析患者的生活质量较治疗前明显改善 ,尿毒症的所有临床症状可相应缓解。但随着透析时间的推移 ,患者的内生肌酐清除率 (Ccr)均有不同程度下降 ,尿量亦逐渐减少。Ccr和尿量是评价透析患者残余肾功能的可靠指标。我们对透析患者随访 8~ 10个月 ,认为影响残余肾功能的因素与患者血压 (BP)、血糖 (GLU)及血脂 (TC)的高低相关。对象与方法1.对象 :我院 1997年 9月~ 2 0 0 1年 2月住院患者 60例 ,年龄 3 2~ 85岁 ,平均年龄 45 .6岁 ,男性 45例 ,女性 15例 ,3 0例患…  相似文献   

11.
A method for determining local transmembrane fluid movement in a commercial hemodialyzer at low dialysate flow rates by measuring changes along the dialyzer length in the local concentration of a marker macromolecule added to the dialysis solution has been developed. The method was evaluated in vitro at zero net ultrafiltration using dialyzers containing polysulfone (n = 4) and cuprophane (n = 3) membranes. The local concentration of the marker macromolecule along the dialyzer length was higher than the input dialysate concentration only during experiments with dialyzers containing polysulfone membranes. These observations provide direct empirical evidence that fluid movement in the dialysate to blood direction, i.e., backfiltration, occurs during hemodialysis with this highly permeable membrane. Net rates of backfiltration for the dialyzer containing polysulfone membrane were also calculated from changes in the local concentration of the marker macromolecule and mass balance considerations. The calculated backfiltration rates increased with increasing blood flow rate and trended upward with increasing dialysate flow rate. The described methodology provides a novel approach for the further characterization of fluid and solute transport during hemodialysis with highly permeable membranes.  相似文献   

12.
Advanced glycation end-products (AGEs) are found in excess during diabetes mellitus, uremia and aging. Non enzymatique glycation, glycoxidation with glucose auto-oxidation and the polyol pathway are involved in the production of AGEs. Tissue accumulation of AGEs and their binding to cell receptors are critical steps in the deleterious consequences of AGE excess. AGE-receptor interaction altered endothelial cells, macrophages, mesangial and mesothelial cell functions. AGEs appear to be involved in the genesis of diabetic micro but also macro-angiopathy. Reduction of AGE clearance and permanent oxidative stress are responsible for AGE excess during uremia. High-flux hemodialysis and peritoneal dialysis reduce AGE level but kidney transplantation is the best treatment to restore homeostasis. New drugs are tested to reduce AGEs or AGE deleterious effects but the best treatment remains the prevention of AGE formation by a strict glycemic control.  相似文献   

13.
Elimination of uremic solutes with molecular weights up to 60 kD, without significant loss of albumin is an important therapeutic goal to optimize outcomes in chronic hemodialysis patients. To characterize a newly developed polysulfone dialyzer (APS-650) a comparative analysis was performed with a highly advanced polysulfone dialyzer (F-60S) including 22 stable chronic hemodialysis patients. Diffusive clearances were determined, and albumin loss was calculated. The elimination profile of uremic solutes up to 32.0 kD was assessed in vivo by sieving coefficients, clearances, and reduction ratios of beta(2)-microglobulin (11.8 kD), myoglobin (17.2 kD), prolactin (23.0 kD), and alpha(1)-microglobulin (32.0 kD). Hemocompatibility was tested in serial measurements of total white blood cell count, platelet count, C3a, and neutrophil elastase. No significant albumin loss was detected. Significantly higher sieving coefficients, clearances, and reduction ratios for proteins with molecular weight up to 32.0 kD were demonstrated with the newly developed polysulfone membrane. Both polysulfone membranes were equal concerning hemocompatibility parameters. The APS-650 dialyzer allowed optimized hemodialysis treatment with respect to clearance of medium-sized uraemic solutes by high-flux dialysis.  相似文献   

14.
15.
BACKGROUND: Protein-calorie malnutrition is present in 30-50% of dialysis patients. The lack of biocompatibility of the dialysis membrane, which results in low-grade inflammation, could be responsible for this malnutrition. We investigated whether protein-energy malnutrition could be partly due to incompatibility of the dialyzer during the dialysis session. METHODS: Five patients were dialyzed during 2 periods of 3 weeks (cross-over) with either a single-use low-flux polysulfone or cellulose triacetate (biocompatible) or a single-use cuprophan (bio-incompatible) membrane. As a measure of whole body protein metabolism, a primed constant infusion of L-[1-(13)C]-valine was used during a 4-hour dialysis session. RESULTS: Cuprophan was a more powerful activator of the complement system than other membranes. Protein metabolism parameters during both study protocols were not different and resulted in the same protein balance during polysulfone/cellulose triacetate (-15 +/- 3) and cuprophan (-13 +/- 2 micromol/kg/h) dialysis. CONCLUSION: In stable hemodialysis patients with no apparent complications, protein metabolism during dialysis is not affected by the compatibility of the dialysis membrane.  相似文献   

16.
目的 评价国产一次性使用空心纤维血液透析器LST140与进口一次性使用空心纤维血液透析器F7HPS是否具有同样的安全性和有效性.方法 本试验采用开放性交叉对比设计.选择满足入选/排除标准并自愿参加本试验的维持血液透析患者57例,采用国产透析器LST140组(试验组)与进口透析器F7HPS组(对照组)目标值法进行对照,观察对患者透析前后血尿素、肌酐下降率的影响以及不良反应.结果 试验组与对照组透析后血尿素、肌酐均明显下降,两组间透析前后血尿素、肌酐下降值比较差异无统计学意义(P>0.05).试验组与对照组透析前后肌酐下降率比较差异无统计学意义(P>0.05).患者血液透析期间至下次透析自我感觉良好,无低血压、热原反应、过敏反应、透析器凝血、心律失常、恶心、呕吐等不良事件发生.结论 国产透析器LST140与进口透析器F7HPS对血液透析患者具有相当的疗效和安全性.  相似文献   

17.
In patients on peritoneal dialysis, peritoneal membrane alterations with inadequate peritoneal membrane function may be induced during long-term therapy. Chronic inflammation triggers malnutrition and atherosclerotic cardiovascular disease contributing to high mortality. The role of catheter, peritonitis and peritoneal dialysis fluids is argued. A neutral pH, a lesser presence of glucose degradation products generated during heat sterilization and accelerating the production of advanced glycosylation end-products (AGEs) could be reduced with better biocompatibility of peritoneal dialysis fluids.  相似文献   

18.
Pore models of peritoneal fluid and solute transport are reviewed and critiqued. Although several pore models of the peritoneal membrane have been previously formulated, a model containing three distinct pore sizes is required to accurately simulate both the molecular size dependence of solute transport and the time dependence of fluid transport during peritoneal dialysis in man. Nevertheless, certain observations from peritoneal dialysis experiments using animals do not agree with predictions from the three-pore model. These discrepancies suggest that the three-pore model of peritoneal transport based exclusively on capillary physiology is incomplete. Moreover, our inability to accurately estimate peritoneal reflection coefficients for small osmotic solutes questions whether lymph flow rates from the peritoneal cavity calculated using the three-pore model are reliable. Further experimental and theoretical studies are needed to obtain a better understanding of peritoneal transport physiology.  相似文献   

19.
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