REXEEDTM系列透析器在高通量透析中的溶质清除特性

目的 研究REXEEDTM系列透析器的溶质清除特性，讨论护理特点。方法 规律性血液透析患者18例，采用随机化交叉和3×3拉丁方实验设计，每例患者分别运用REXEEDTM-15AC、15UC和对照透析器APS-15U进行血液透析治疗。于透析器血液入、出口处采血测定尿素氮、肌酐、磷、β₂-微球蛋白，计算溶质清除率；在每使用一种透析器的第3次透析前后，采血测定患者血尿素氮和肌酐水平，计算下降比率。严密观察患者生命体征，监测透析机的静脉压和跨膜压数值。结果 REXEEDTM-15AC和REXEEDTM-15UC透析器的尿素氮清除率显著大于APS-15U透析器（P<0.05）；REXEEDTM-15AC透析器肌酐清除率显著大于APS-15U透析器（P<0.05）。同一患者使用不同透析器的血尿素氮下降比率比较差异无统计学意义（均>65%）。血液透析过程中，患者生命体征稳定，无不良反应发生；实验室安全性指标监测未见异常。结论 REXEEDTM系列透析器临床使用安全、有效。透析护理过程中，必须加强观察并重视患者的不适主诉；对于超滤量少的患者，可在适当补充液体的同时增加超滤量，以提高跨膜压，防止反超。

Solute clearance characteristics of REXEEDTM series dialyzer during high-flux dialysis

Objective To evaluate the solute clearance characteristics of REXEEDTM series dialyzers during high-flux dialysis, and explore the care characteristics. Methods A randomized crossover study of 3×3 Latin square was designed based on different dialyzers. Eighteen patients with regular hemodialysis underwent dialysis with REXEEDTM-15AC dialyzer, REXEEDTM-15UC dialyzer and controlled APS-15U dialyzer, respectively. Blood samples were obtained from the blood flow entrance and exit of dialyzers, levels of urea nitrogen, creatinine, phosphate and β2-microglobulin were detected, and solute clearance rates were calculated. Before and after the third dialysis with each dialyzer, blood samples were obtained to measure the levels of urea nitrogen and creatinine, and the rates of decrease were calculated. The vital signs of each patient were intensively observed, and the venous pressure and transmembrane pressure were monitored from the dialyzers. Results The urea nitrogen clearance rates of REXEEDTM-15AC dialyzer and REXEEDTM-15UC dialyzer were significantly higher than that of APS-15U dialyzer (P<0.05). The creatinine clearance rate of REXEEDTM-15AC dialyzer was significantly higher than that of APS-15U dialyzer(P<0.05). There was no significant difference in the rate of decrease in blood urea nitrogen among different dialyzers of the same patient(>65 % for all patients). The vital signs were stable with no adverse events during dialysis, and there was no abnormal findings in laboratory security parameters. Conclusion REXEEDTM series dialyzers are effective and safe for clinical application. Great importance should be attached to the complaints from patients during dialysis. For those with less ultrafiltration, fluid as well as uhrafiltration should be supplemented to increase the transmembrane pressure.