血液透析膜的生物相容性

通过比较不同种血液透析膜的材料学特点，探讨了血液透析膜相容性的基本条件，将血液透析膜分为纤维素膜和合成膜两种类型，阐述了血液透析膜生物相容性的研究现状。目前各种新型的膜材料在不断地研发，部分已在临床使用或即将问世，如维生素E 修饰的透析膜、多黏菌素B 修饰的透析膜、甲壳素膜、以及人肾单位透析器和生物活性膜等。研制高通量、高效、生物相容性好的透析膜仍将是今后发展的主要方向。随着高分子材料和纳米技术的不断发展，透析膜的透析效果、生物相容性将逐步提高。     

血液透析膜的生物相容性与透析并发症

血液透析是肾功能衰竭的主要治疗措施，透析膜材料是影响血液透析治疗效果的关键因素。文章探讨了血液透析基本原理、透析膜的种类、常用膜材料及其生物相容性、透析并发症等方面的研究，系统地讨论了透析膜材料的改进及其对血液透析的影响。     

透析膜材料的发展方向及其生物相容性

摘要：血液透析是急、慢性肾功能衰竭的主要治疗措施,透析膜是透析器的主要构成部分,它的理化特性决定透析效果。文章探讨了血液透析膜材料目前的发展方向、常用膜材料及其评价透析膜材料生物相容性的指标,并总结了近年来透析膜材料的改进及其对血液透析的影响。     

不同透析膜材料在维持性血液透析过程中的生物相容性

摘要 目的：对聚砜膜、血仿膜和醋酸纤维膜在维持性血液透析中的应用进行综合评价，以选择适宜的透析膜材料进行血液透析。 方法：电子检索中国期刊全文数据库(CNKI：1990/2008)，以“透析膜，相容性，并发症”为检索词收集关于不同透析膜材料的临床应用文献共50篇，排除综述类文献、实验研究及透析膜清洗等文献，共纳入22篇关于不同透析膜溶质清除率及生物相容性评价的文献，对不同材料的血液透析膜的临床应用情况进行全面总结。 结果：通过对聚砜膜、血仿膜和醋酸纤维膜在维持性血液透析中的溶质清除率的分析得出，聚砜膜、血仿膜对全段甲状旁腺激素、血磷、血钙的清除效果优于醋酸纤维膜，对于B细胞活化的血清CD23清除效果优于醋酸纤维膜，对血小板活化程度的影响弱于醋酸纤维膜。高通透量的聚砜膜不增加炎症反应，醋酸纤维膜透析的P选择素的水平高于聚砜膜和血仿膜，3种透析膜的血清胱抑素C清除率无差异。 结论：聚砜膜、血仿膜和醋酸纤维膜对血清CD23浓度、血小板活化程度、炎症反应、出凝血并发症、血清P选择素水平均的影响与其生物相容性有关:生物相容性越好，对血清CD23浓度水平、血小板活化程度、炎症反应、出凝血并发症、血清P选择素水平的影响越小，反之则大，聚砜膜和血仿膜生物相容性好于醋酸纤维膜，血仿膜的血液透析并发症最少。 关键词：聚砜膜；血仿膜；醋酸纤维膜；血液透析；溶质清除率；生物相容性；并发症 doi:10.3969/j.issn.1673-8225.2010.34.045     

PolyamixTX与F7HPS两种透析膜透析效果的比较

背景：透析膜的生物相容性与否直接关系到维持性血液透析患者的生活质量与生存率。 目的：比较PolyamixTX与F7HPS两种透析膜对尿素氮、肌酐等代谢废物的清除效果。 方法：选择2008-06/2011-03天津市海河医院门诊尿毒症维持性常规血液透析患者40例,随机分为F7HPS膜材料和PolyamixTX膜材料组,每组20例。比较透析前后患者尿素氮、肌酐下降程度,观察不同透析膜治疗后低血压、抽搐发生情况。 结果与结论：PolyamixTX膜材料组和F7HPS膜材料组透析6个月后尿素氮、肌酐与透析前相比均显著下降(P < 0.05),F7HPS膜材料组下降更多。F7HPS膜材料组20例患者中15例并发低血压、抽搐,PolyamixTX膜材料组中7例并发低血压、抽搐,未见其他并发症发生。提示F7HPS具有相对好的溶质清除力,但发生低血压、抽搐等并发症的情况也较多。     

高通量透析膜在血液透析中的应用

背景：高通量膜具有很高的通透性及溶质转运性能，透析中能有更多相对分子质量较大的溶质从血液转运到透析液中，故称之为高通量透析，属于一种高效血液净化治疗方法。 目的：总结近年高通量透析膜在血液透析中的应用现状。 方法：由作者应用计算机检索维普数据库，检索时限2000-02/2008-10。检索关键词：高通量透析膜；血液透析；临床应用。纳入标准：①高通量透析膜在血液透析中的应用。②实验结果叙述与材料有关的临床应用问题。排除标准：重复研究或较陈旧文献。根据纳入排除标准共保留相关文献12篇。 结果与结论：与低通量血液透析相比可清除β2微球蛋白，降低透析患者血脂、血磷及甲状旁腺素水平，减轻炎症反应、氧化应激及血管内皮变化，不影响维持性血液透析患者血浆细胞因子及内毒素水平，对尿素氮、肌酐等小分子的清除也优于常规透析。因此，高通量透析可预防血液透析患者的远期并发症如肾性骨病，动脉硬化，并可改善食欲不振，高血压症状，提高透析的充分性。     

血液透析膜材料在重症胰腺炎领域的应用

背景：透析膜材料是影响血液透析治疗效果的关键因素。 目的：评价血液透析膜材料在重症胰腺炎领域的应用及生物相容性,为其在临床上的应用提供参考依据。 方法：以“血液透析;透析膜材料;组织相容性;血液相容性;聚醚砜”为中文关键词;以“hemodialysis, dialysis membrane materials;histocompatibility;blood compatibility;polyethersulfone”为英文关键词,采用计算机检索1994-06/2011-02相关文章。纳入与有关生物材料与宿主相容性的文章;排除重复研究或Meta分析类文章。以25篇文献为重点进行探讨聚砜膜滤器材料的性能及应用前景。 结果与结论：同时连续性血液净化对多器官功能障碍综合征疗效确切,尤其对出现急性肾功能不全的患者疗效尤为显著,因此可最终改善重症急性胰腺炎患者预后,成为目前治疗重症急性胰腺炎的重要手段。血液透析膜的类型较多,聚砜膜滤器应用广泛,其宿主生物相容性较好,封堵效果也较好,因费用较低,临床广泛应用。     

高分子材料聚砜膜滤器临床应用及相容性评价

摘要 目的：评价高分子材料聚砜膜滤器的性能以及置入体内与宿主的生物相容性,为其在临床上的应用提供参考依据。 方法：以“血液透析;透析膜材料;组织相容性;血液相容性;聚醚砜”为中文关键词;以“hemodialysis, dialysis membrane materials;histocompatibility;blood compatibility;polyethersulfone”为英文关键词,采用计算机检索2006-01/2010-03相关文章。纳入与有关生物材料与宿主相容性的文章;排除重复研究或Meta分析类文章。以22篇文献为重点进行探讨聚砜膜滤器材料的性能及应用前景。 结果：目前各种新型的膜材料在不断地研发,部分已在临床使用或即将问世,如维生素E 修饰的透析膜、多黏菌素B 修饰的透析膜、甲壳素膜、以及人肾单位透析器和生物活性膜等。聚砜膜滤器由于具有较好的生物相容性和封堵效果,在临床广泛应用。 结论：聚砜膜滤器通过高分子材料滤器强大的对流、黏附作用,高效清除组织损伤过程中产生的炎症递质和毒性代谢产物,排除机体内潴留的多余水分,维持水、电解质、酸碱平衡,实现内环境的稳定,改善重要脏器功能,调节免疫系统。聚砜膜滤器目前虽广泛应用,但不可避免存在着相容不良,引发附近组织发炎,产生病变,造成溶血或凝血现象等。理想的膜滤器材料无论材料本身还是其降解产物都不能产生炎症和毒性反应,所以良好生物相容性的封堵器需进一步开发研制。 关键词：血液透析;透析膜材料;组织相容性;血液相容性;聚醚砜 doi:10.3969/j.issn.1673-8225.2010.42.032     

血液透析膜材料的生物相容性

血液透析是急慢性肾功能衰竭主要治疗措施，透析膜材料是影响血液透析治疗效果的关键因素。理想的透析膜应该与血管内皮非常接近，但目前还不能达到这一目标，所以血液和异体的透析膜接触后必然相互作用。文章对透析膜引起补体、白细胞、单核细胞及细胞因子的释放、凝血、血管活性物质、β2 -微球蛋白以及其他方面的变化进行相应探讨。     

维持性血液透析患者实施健康教育的护理体会

终末期肾脏疾病（ESRD）是各种病因导致肾功能损伤的终末期表现，是不可逆转的慢性渐进性疾病，同时在疾病的进展过程中，会出现一系列代谢紊乱的表现。维持性血液透析（MHD）是主要的肾脏替代治疗，随着透析技术的广泛应用，绝大多数患者的生命得到了延长。然而绝大多数病人在接受血液透析治疗时因缺乏专业知识，易产生焦虑、恐惧、     

Longitudinal study of neuropsychological functioning in patients on chronic hemodialysis: A preliminary report

This study is part of a five-year project to investigate the long term effects of chronic hemodialysis on patients with end-stage renal failure. Previous research has associated hemodialysis with progressive dialysis encephalopathy (PDE), which is characterized by speech disturbances, cognitive impairment, myoclonus and behavioral changes. Little is known about the cause or the course of this syndrome except that is begins 14–36 months after treatment onset and usually culminates in death. The purpose of this study was to investigate neuropsychological (cognitive and behavioral) functioning in dialysis patients over a period of years. To date, 34 patients have been studied for 22 months utilizing a cross-sectional method comparing patients at different stages of treatment combined with a longitudinal method of repeated evaluations over time. Current findings show improved cognitive functioning during at least the first year of treatment and no evidence of cognitive deterioration in patients on dialysis for more than one year (M = 4.3). These findings offer strong evidence that PDE is not necessarily a general phenomenon among patients on chronic hemodialysis.     

Cerebrovascular effects of hemodialysis in chronic kidney disease.

Patients with end-stage renal disease (ESRD) undergoing hemodialysis are known to suffer cognitive deficits and stroke of unknown etiology. It has been suspected that the treatment itself may contribute to the syndrome by unknown mechanisms, which we investigated in this study. End-stage renal disease patients on hemodialysis (n=19) or peritoneal dialysis (PD, n=5) were compared with 14 healthy controls. Subjects participated in magnetic resonance imaging (MRI) measurements of cerebral atrophy, cerebral blood flow (CBF) arterial spin labeled-MRI (ASL-MRI), quantitative Doppler blood flow through the internal carotid artery, and cerebral oxymetry. The Doppler and oxymetry procedures were also performed at the beginning and end of a single hemodialysis session. End-stage renal disease patients on hemodialysis showed significant cerebral atrophy, associated with longer hemodialysis duration and cognitive deficits, including focal bilateral lesions in the caudate nucleus and midbrain. Cerebral oxygenation was extremely low before dialysis (rSO(2) 41+/-13, compared with 70+/-2 in controls, P<0.02) and improved only slightly after dialysis. Carotid blood flow was also very low at the start of dialysis (115+/-28 mL/sec, versus 193+/-56 in controls, P<0.005) but normalized at the end of the session (181 mL/sec). The PD patients showed intermediate values, between the hemodialysis and controls. Notably, duration of hemodialysis treatment predicted global gray-matter volume (r=-0.74), change of blood flow during dialysis (r=-0.65), and baseline rSO(2) (r=-0.65). The findings suggest that ESRD patients on hemodialysis suffer low CBF during the interdialytic cycle. Coupled with low cerebral oxygenation levels and atherosclerosis, this may contribute significantly to the etiology of the observed cerebral atrophy, cognitive deficits, and high stroke prevalence.     

Children of dialysis patients and selection of dialysis setting

The authors interviewed hemodialysis patients, their families, and medical staff and found that some patients preferred dialysis at a medical facility, which allowed them to appear more "normal" before their children. Patients with more social support involved their children in dialysis at home. The author suggests that social support is of primary importance to the outcome of home dialysis and should be considered by physicians in the assessment of patient's suitability for home dialysis.     

Overall results of attempts to treat schizophrenia by hemodialysis. Reflections on the placebo effect in a psychosis

A review is made of 325 published cases of schizophrenic patients who underwent series of hemodialysis. In 211 cases the series of dialysis were open studies; 49 of these patients (23%) were markedly improved. In 114 other patients the effects of actual and sham dialysis were compared in a double blind experiment. A marked improvement was found in 24 cases (21%). But results of sham and actual hemodialysis did not differ significantly. Hemopurification is therefore not the cause of improvement. The rate of marked improvement is however clearly higher than what one could expect in chronic schizophrenics from a simple placebo effect. The various possible causes for this special effect are discussed. It is proposed that about 20% of schizophrenic patients could favorably react to the strong healing involvement of the psychiatrist, especially when a magic aspect is implied. This should encourage to approach patients not responding to conventional therapy with more optimism and possibly with new methods.     

The spouse's role in home hemodialysis.

The role of the spouse as a factor in the success or failure of home dialysis becomes increasingly important as expectations rise that hemodialysis patients be home-trained. Home hemodialysis offers advantages to the patient but may add stress to the spouse. We present cases illustrating the types of responses spouses have to home hemodialysis. Present conditions are such that the spouse's ability to participate in home hemodialysis may be less affected by aspects of the patient-partner's chronic renal disease than the potential change in the marital relationship that can derive from home hemodialysis. Success in home dialysis is at risk when the spouse is naturally dependent on the patient-partner. These spouses will often require special supportive measures.     

Different melatonin rhythms and sleep–wake rhythms in patients on peritoneal dialysis,daytime hemodialysis and nocturnal hemodialysis

BackgroundLittle comparative data on sleep–wake rhythms in different dialysis groups exist. The aim of this study was to investigate sleep–wake parameters measured with actigraphy and sleep questionnaires as well as melatonin rhythms in automated peritoneal dialysis, conventional daytime hemodialysis and nocturnal hemodialysis patients.MethodsConventional daytime dialysis (n = 20), nocturnal hemodialysis (n = 13) and automated peritoneal dialysis patients (n = 6) were included in the study. Melatonin in saliva was sampled at 5 time points (21:00, 23:00, 1:00, 7:00 and 9:00 h). Furthermore, actigraphy measurements and sleep questionnaires were performed. All parameters were tested by Kruskall–Wallis test (followed by post hoc Dunn test) to find significant differences (p < 0.05).ResultsAlthough most sleep parameters were impaired in all three groups, conventional daytime dialysis patients had the worst sleep. In nocturnal hemodialysis patients a normal nocturnal melatonin rise was found. In daytime hemodialysis and automated peritoneal dialysis patients this rise was absent.ConclusionsThe study showed impaired sleep parameters in all dialysis patient groups. As automated peritoneal dialysis is also performed during night time, the same effect on normalized melatonin was anticipated as was found in nocturnal hemodialysis. Melatonin seems to play a subordinate role in the sleep–wake rhythm of automated peritoneal dialysis patients.