透析用水中残余氯的测定

血液透析用水的质量直接影响患者的透析安全和生存质量.透析用水中残余氯超标会损害反渗膜并引起溶血性贫血.本文对透析用水中残余氯的来源、危害、控制标准和常用的检测方法作一综述,希望能为各透析中心改进透析用水检测方法提供更多依据.     

透析用水中游离氯与氯胺的测定

目的透析用水中游离氯和氯胺浓度超标会对人体造成巨大危害,而我国目前大多数透析中心只能检测游离氯,本研究通过检测自来水和透析用水中游离氯和氯胺含量,评估了单独检测游离氯的安全性,并评估了目前常用的TMB目视比色法的准确性.方法以DPD分光光度法为金标准,同时采用DPD分光光度法和TMB目视比色法对北京市9家透析中心的自来水和透析用水中游离氯和氯胺浓度进行检测,每家血液透析中心检测2d,每天检测10次,每次间隔1h;对透析用水中游离氯和氯胺浓度进行相关性分析,P＜0.05认为有统计学意义;对DPD分光光度法和TMB目视比色法的检测结果进行Kappa检验.结果在各个时点,各透析中心的透析用水中游离氯和氯胺浓度均在国家标准范围之内;透析用水中游离氯和氯胺浓度之间不存在线性相关关系(r=0.14,P=0.146):同DPD分光光度法相比,TMB目视比色法所测得游离氯结果的假阴性率为100%,kappa值为0,所测总氯结果的假阴性率10.67%,kappa值为0.88.结论单独检测游离氯是不安全的,必须同时检测总氯浓度;同DPD分光光度法相比,TMB目视比色法测得的游离氯和总氯结果存在一定的假阴性率,建议有条件的单位尽量采用DPD分光光度法.     

北京市血液净化中心10年透析用水化学污染物变化分析

目的 透析用水的质量直接影响透析患者的治疗安全和透析并发症的发生.通过分析北京市属医院透析中心透析用水十年化学污染物检测结果,找出化学污染物不合格的原因,研究解决方法,可以帮助透析中心更好的选择合适的水处理系统,以及设备的正确维护方法.方法 铝、铜、钡、锌、砷、铅、银、锡、镉、铬采用电感耦合等离子体质谱法检测、硒和汞采用氢化物发生-原子吸收分光光度法,氯、氯胺采用分光光度测定法,氟、硝酸盐和硫酸盐应用离子色谱法检测.钙、镁、钠、钾采用电感耦合等离子体原子发射光谱法.结果 从2003年开始,19家透析中心透析用水化学物质超标,第2年4家,随后超标中心逐步减少,直到最后2年,北京全部透析中心透析用水化学物质全部达标.结论 在血液透析质量控制和改进中心的统一管理和指导下,血液透析中心使用高品质的水处理系统,同时,透析设备的常规维护和水质监测是保证透析用水质量的关键.     

透析用水及透析液内毒素含量检测

目的测定透析用水及透析液的细菌内毒素含量,评价现有的限度标准,为透析用液安全提供参考。方法按《中国药典》2015年版四部1143细菌内毒素检查法,通过干扰试验确定样品的稀释倍数,用动态浊度法测定7家医院,涉及7批透析用水、19批透析液的细菌内毒素含量。结果将透析用水稀释2倍、透析液稀释64倍时,干扰消除,回收率在50%~200%之间。透析用水内毒素平均含量为小于0.019 EU/ml,透析液内毒素平均含量为小于0.34 EU/ml。结论透析用水和透析液内毒素含量均低于现有标准,提示现有标准尚需提高,拟定透析用水内毒素限值:应小于0.25EU/ml,拟定透析液内毒素限值:应小于0.50 EU/ml。     

血液透析用水和透析液的微生物学监测与分析

目的了解血液透析用水、透析液污染原因,进行水质控制的持续质量改进。方法15个月间,前瞻性地对某医院血液净化室透析用水、透析液进行微生物学监测。结果前5个月透析用水、透析液合格率为70．59％（24／34）,后10个月的合格率上升为98．04％（50／51）,两者比较,P〈0．001,差异显著。结论血液透析液制备输送过程中多个环节可能造成透析用水、透析液再次污染,水路合理设计、整个系统各部件的维护消毒到位,是避免透析用水再污染的前提,定期开展微生物学监测是必要的监控手段。建议同内尽快制定血液透析用水、透析液质量控制行业标准,使其管理更规范。     

北京市血液透析单位透析用水及透析液质量的持续性质量改进

目的了解近3年来北京市血液透析单位透析用水及透析液质量的状况.方法采用统一的透析登记表对在2002～2004年期间北京市各血液透析单位透析用水和透析液方面的管理状况进行调查,并对2003年和2004年度各单位透析用水的化学污染物的检测结果及2004年透析液的内毒素污染状况进行分析.结果2002年、2003年和2004年度分别有88家、115家和110家透析单位完成了透析登记工作.①透析用水的质量管理:3年来,北京市血液透析单位对透析用水的质量日趋重视,对透析用水硬度、电导度、游离氯以及透析液细菌培养进行检测频率的达标率均有明显的改进.②透析液的质量管理:所有透析单位均使用碳酸盐透析液.2004年直接使用A、B透析液原液的单位比2002年增加约1倍(35.7%vs 18.7%);98.2%单位都能够规范的配置透析液.此外越来越多的单位进行了透析液离子浓度处方个体化的调整.③对透析用水的化学污染物及透析液内毒素的检查及改进:2003年,19/99(18.6%)家透析单位透析用水的化学污染物不合格,主要的不合格项目为:钙、硝酸盐、铝和氯胺;2004年,4家(4%)单位透析用水的化学污染物不合格,主要不合格项目为钙和硝酸盐.经过对水处理设备进行检修及改进后,复检的结果均达标.2004年我们对透析单位进行了现场内毒素检测,其中28%的单位不合格;复检后仍有2家透析液内毒素水平超标.结论3年来,北京市血液透析单位提高了对透析用水和透析液重要性的认识,加强了管理.但是,仍要警惕透析用水的污染问题.为了保证患者透析治疗的安全,各透析单位应该对透析用水及透析液进行严格管理,定期进行检测.     

基于调整消毒周期制备可持续使用超纯透析用水的研究

目的用现有的水处理系统制备出可持续使用的超纯透析用水。方法通过研究陕西省中医医院血液透析室透析用水中细菌、内毒素含量与消毒时间的关系,寻找细菌、内毒素达到超纯透析用水标准的时间节点,制定合理的水处理系统消毒周期。结果将水处理设备的消毒周期调整为1个月可使透析用水中细菌、内毒素含量持续符合超纯水标准。结论通过优化消毒周期能够制备出可持续使用的超纯透析用水。     

1 094例孕妇全血微量元素缺乏的调查

目的了解孕妇不同孕期血液铁、钙、锌、镁、铜5种微量元素的缺乏状况,为孕妇保健提出依据。方法采用原子吸收光谱法测定血液5种微量元素,分早孕组、中孕组、晚孕组进行统计分析。结果5种微量元素测定,铁、钙、锌、镁、铜缺乏分别为42．60％、35．23％、14．26％、1．56％、0．31％。不同孕期5种微量元素缺乏各有特点。结论不同孕期5种微量元素缺乏各有特点。早孕以缺铁为主,中、晚孕期以缺乏铁、钙、锌3种微量元素为主,孕妇应及时补充缺乏的微量元素。     

透析用水内毒素含量检测数据调查研究分析

目的 符合透析治疗安全的透析用水是血液透析日常治疗开展的基本保障,根据统计分析内毒素含量的变化规律,探索控制透析用水内毒素含量的管理方式.方法 对上海市21家血液净化中心(室)2019年3月至2020年2月期间透析用水的内毒素(endotoxin,ET)含量数据进行汇总与统计分析.结果 透析用水内毒素含量在全年的春季与...     

透析用水的细菌培养方法

随着血液透析技术的广泛开展,透析用水的质量安全越来越受到重视。很多国家和地区为透析用水制定了安全标准和细菌培养方法,目前尚未达成一致意见。国外很多学者针对透析用水细菌培养方法的敏感性进行了比较,国内目前没有相关方面报道。本文就透析用水的细菌培养方法比较做出综述。1透析用水质量控制的重要性     

Aluminum, iron, lead, cadmium, copper, zinc, chromium, magnesium, strontium, and calcium content in bone of end-stage renal failure patients.

BACKGROUND: Little is known about trace metal alterations in the bones of dialysis patients or whether particular types of renal osteodystrophy are associated with either increased or decreased skeletal concentrations of trace elements. Because these patients are at risk for alterations of trace elements as well as for morbidity from skeletal disorders, we measured trace elements in bone of patients with end-stage renal disease. METHODS: We analyzed bone biopsies of 100 end-stage renal failure patients enrolled in a hemodialysis program. The trace metal contents of bone biopsies with histological features of either osteomalacia, adynamic bone disease, mixed lesion, normal histology, or hyperparathyroidism were compared with each other and with the trace metal contents of bone of subjects with normal renal function. Trace metals were measured by atomic absorption spectrometry. RESULTS: The concentrations of aluminum, chromium, and cadmium were increased in bone of end-stage renal failure patients. Comparing the trace metal/calcium ratio, significantly higher values were found for the bone chromium/calcium, aluminum/calcium, zinc/calcium, magnesium/calcium, and strontium/calcium ratios. Among types of renal osteodystrophy, increased bone aluminum, lead, and strontium concentrations and strontium/calcium and aluminum/calcium ratios were found in dialysis patients with osteomalacia vs the other types of renal osteodystrophy considered as one group. Moreover, the concentrations of several trace elements in bone were significantly correlated with each other. Bone aluminum was correlated with the time on dialysis, whereas bone iron, aluminum, magnesium, and strontium tended to be associated with patient age. Bone trace metal concentrations did not depend on vitamin D intake nor on the patients' gender. CONCLUSIONS: The concentration of several trace elements in bone of end-stage renal failure patients is disturbed, and some of the trace metals under study might share pathways of absorption, distribution, and accumulation. The clinical significance of the increased/decreased concentrations of several trace elements other than aluminum in bone of dialysis patients deserves further investigation.     

Determination of trace elements and calcium in bone of the human iliac crest by atomic absorption spectrometry

A rapid and reliable analytical method for the determination of trace elements in human bone by atomic absorption spectrometry is reported. Calcium was determined to estimate the homogeneity of samples. Human bone from the iliac crest was obtained at autopsy of adult subjects. Before analysis samples were decomposed by microwave digestion and acid digestion in a Parr bomb. Zinc, rubidium, strontium, calcium and iron were determined by flame atomic absorption spectrometry (FAAS) and aluminium, copper and lead by electrothermal atomic absorption spectrometry (ETAAS) at optimum measurement conditions. The results for the two digestion procedures agreed for zinc, rubidium and calcium within +/-5%, for copper within +/-7% and for strontium, iron, aluminium and lead within +/-10%. The repeatability of measurement (R.S.D.) for determination of calcium and trace elements after microwave digestion and acid digestion in a Parr bomb was tested in one representative autopsy bone sample by six parallel determinations. It was found to be better than +/-5% either for microwave digested samples or samples digested in a Parr bomb, for all elements determined by FAAS and ETAAS techniques. The accuracy of the applied digestion procedures was checked by analysis of trace elements in NIST SRM 1486 Bone Meal reference material. Good agreement of the results with certified values was obtained for both digestion procedures. The microwave procedure developed for digestion of small amounts of sample was applied in trace elements analysis of bone biopsy samples from dialysis patients.     

Creatinine concentration measurement in glucose based peritoneal dialysate

The measurement of creatinine concentrations in peritoneal dialysate is important for evaluating the effectiveness of peritoneal dialysis treatment. However, peritoneal dialysate often contains glucose, which has been reported to interfere with the measurement of creatinine concentrations in some creatinine assays. In this study creatinine concentrations in solutions containing increasing glucose concentrations (0–250?mmol/L) were evaluated using an enzymatic method. No relevant interference from glucose was observed. The creatinine concentration recovery percentages at creatinine concentrations of 250, 500, and 750?μmol/L in dialysate samples containing 250?mmol/L glucose were 101.9%, 101.6%, and 101.0%, respectively, and 101.6%, 102.2%, and 99.8% in water samples (0?mmol/L glucose). The measured creatinine concentrations in dialysate samples at constant glucose concentrations were linear at 0–1071?μmol/L creatinine, and the linear regression coefficient was 0.99. It is concluded that the enzymatic method described is reliable in measuring creatinine concentrations in dialysate containing glucose, and that the method can be used to evaluate the effectiveness of peritoneal dialysis treatment.     

Creatinine concentration measurement in glucose based peritoneal dialysate

The measurement of creatinine concentrations in peritoneal dialysate is important for evaluating the effectiveness of peritoneal dialysis treatment. However, peritoneal dialysate often contains glucose, which has been reported to interfere with the measurement of creatinine concentrations in some creatinine assays. In this study creatinine concentrations in solutions containing increasing glucose concentrations (0-250 mmol/L) were evaluated using an enzymatic method. No relevant interference from glucose was observed. The creatinine concentration recovery percentages at creatinine concentrations of 250, 500, and 750 micromol/L in dialysate samples containing 250 mmol/L glucose were 101.9%, 101.6%, and 101.0%, respectively, and 101.64%, 102.2%, and 99.8%, in water samples (0 mmol/L glucose). The measured creatinine concentrations in dialysate samples at constant glucose concentrations were linear at 0-1071 micromol/L creatinine, and the linear regression coefficient was 0.99. It is concluded that the enzymatic method described is reliable in measuring creatinine concentrations in dialysate containing glucose, and that the method can be used to evaluate the effectiveness of peritoneal dialysis treatment.     

生物样品中铜的石墨炉原子吸收检测及其在肝豆状核变性诊断中的应用

目的建立诊断肝豆状核变性患者的生物样品中微量铜的石墨炉原子吸收检测方法。方法尿液和血清样品经1％HNOsub3/sub 稀释后,采用石墨炉原子吸收光谱标准曲线法直接测定。结果线性范围0~200 g/L,相关系数0.9997,方法检出限为1.4 g/L,回收率96.7％～99.2％,相对标准偏差1.0%~1.7％,经冻干人尿标样（GBW 09102）对照测定,其结果在允许范围内,相对误差为-1.2％。结论采用GFAAS法测定生物样品中铜,方法可靠、准确、灵敏,能适用于肝豆状核变性诊断中生物样品微量铜检测的要求。     

Comparison of representative ranges based on U.S. patient population and literature reference intervals for urinary trace elements

Reference intervals for trace elements are very hard to obtain because of the difficulty of defining a nonexposed reference population. However, representative ranges for trace elements obtained from a general patient population can provide useful information in interpreting laboratory results. We have used urine specimens submitted for trace metal analysis from patients residing in the United States to calculate representative ranges for 25 urinary trace elements, and to compare them to reference values taken from the literature. All urine analytes were measured by inductively-coupled plasma-mass spectrometry except chromium, which was measured by graphite furnace atomic absorption spectroscopy. For representative range calculation two approaches were used. In the non-parametric calculation first, the top 10% of results were discarded assuming that those specimens came from individuals with unusually high trace element exposures. Next the central 95% of the remaining data was taken as the reference interval. In the parametric calculation the specimens from exposed or not healthy individuals were assumed to appear as outliers and were discarded. The mean and S.D. were calculated, and used to determine representative ranges. The two approaches yielded very similar results, and worked remarkably well for 14 analytes. There were minor discrepancies for 7 analytes, and major for 4 analytes. All analyses of urinary trace elements included a urine creatinine value, which was used to express urinary trace element concentrations in terms of creatinine ratio. This corrects for differences in urine concentration that affects the results for random specimens.     

Problems related to determination of trace elements in spent continuous ambulatory peritoneal dialysis fluids by electrothermal atomic absorption spectrometry.

Critical parameters which influence the direct determination of trace elements in spent continuous ambulatory peritoneal dialysis (CAPD) fluids by electrothermal atomic absorption spectrometry (ETAAS) were investigated. Samples were collected after CAPD fluid exchange in 5.0 ml polyethylene cups and stored at -20 degrees C. Daily spent CAPD fluids were frozen immediately, while nightly spent CAPD fluids were frozen 2-3 h after the morning exchange. Before analysis samples were equilibrated to room temperature and analysed within 8 h. It was found experimentally that some samples which were not frozen immediately leaked out of the pyrolytically coated graphite tube before the drying step. In order to keep the sample in the graphite tube and to obtain reproducible measurements of copper, aluminium and iron, samples were diluted before analysis 1 + 1 with 32% v/v nitric acid. The standard addition method was used in the calibration procedure. The results of direct ETAAS determinations for copper agreed well (+/-5-10%) with those obtained after acid digestion of CAPD fluids in Parr bomb. The procedure for direct determination of all three elements was validated with spiked samples.     

儿童头发中微量元素正常值的探讨

目的：结合近年来微量元素与儿童头发检查相关的研究报道文献资料,搜集各地区健康儿童头发中微量元素的水平范围,制定一个适合全国各地的标准值,以此来衡量儿童微量元素缺乏情况,为临床健康指导和疾病诊疗工作提供科学依据。方法：取儿童头发标本,酸溶处理后,用火焰原子吸收分光光度计检测处理后标本中锌、铁、钙、铜等微量元素的含量。结果：全国各地各地微量元素的正常值差别很大,而且没有明显的规律。结论：不同地区儿童头发中的有些微量元素差别特别大,临床上应结合当地健康儿童头发微量元素水平分布特点制定适合本地的标准值并指导临床诊疗工作。     

METHODS FOR THE DETERMINATION OF TRACE ALUMINIUM CONTAMINATION IN DIALYSIS FLUIDS

The problems associated with aluminium contamination of dialysis fluids are reviewed. The major sources of such contamination are generally the water supply or salts used in the manufacture of the fluids. It is generally desirable to keep the aluminium concentration of the dialysate below 15 micrograms/l. This trace level of aluminium results in problems of analysis. Literature methods, notably atomic absorption spectroscopy with electrothermal atomization, neutron activation analysis and inductively coupled plasma atomic emission spectroscopy are considered. Results from these methods are not always in agreement. It is concluded that graphite furnace atomic absorption spectroscopy (GF-AAS) is the most suitable technique. However, it is necessary to consider the effect of matrix interferences, notably chloride, on the determination of aluminium in dialysis fluids by this method. Reliable results for trace aluminium determinations by GF-AAS can be obtained using a suitable furnace programme together with matrix adjusters such as nitric or orthophosphoric acids.