复用透析器预充效果与预充技术相关因素研究

目的减少复用透析器中的甲醛含量 ,降低病人费用。方法选择内循环时间 (因素A)、0 9%氯化钠溶液(NS)预充量 (因素B)、血泵流速 (因素C) 3个因素 ,各因素取 3个水平 (第 1水平为因素A 10min、因素B 10 0 0ml、因素C 2 0 0ml/min ;第 2水平为因素A 2 0min、因素B 15 0 0ml、因素C 30 0ml/min ;第 3水平为因素A 30min、因素B2 0 0 0ml、因素C 4 0 0ml/min) ,分别预充经 4 %甲醛消毒后的复用透析器 ,用低含量甲醛检测盒测试甲醛残留量。结果甲醛残留量 (μg/ml)第 1水平 3个因素分别为 1 30± 1 32、1 2 7± 1 34、1 34± 1 30 ;第 2水平分别为 0 84± 0 2 0、0 71± 0 2 0、0 79± 0 2 0 ;第 3水平分别为 0 71± 0 2 0、0 88± 0 15、0 72± 0 2 1。第 1与第 2、3水平间比较 ,均P <0 0 1,第 2与第 3水平间比较 ,P >0 0 5。结论预充中各因素均选取第 2水平即内循环时间 2 0min ,NS预充量 15 0 0ml,血泵流速 30 0ml/min为最佳配伍     

快速预充复用透析器效果观察

目的观察伤口愈合快示格胶贴治疗静脉炎的效果。方法将68例静脉炎患者随机分成观察组和对照组各34例。观察组消毒皮肤后将伤口愈合快示格胶贴直接贴粘于受损静脉局部。对照组采用50%硫酸镁湿热敷局部皮肤。结果观察组治疗效果显著优于对照组（P〈0.01）。结论伤口愈合快示格胶贴能为局部皮肤提供湿润的愈合环境,使组织再生和修复,可提高静脉炎治疗效果,且操作简便。     

透析器复用的现状

透析器复用是维持性血液透析过程中非常重要的环节,为了提高透析病人的生存质量,透析器复用对于溶质的清除,透析器的生物相容性,致热源反应以及复用中乙肝和丙肝病毒的感染等方面,都有着不同程度的影响。透析质量的提高和透析器的复用方法有着非常密切的关系     

透析器复用的研究现状

不同国家和地区对透析器复用的态度存在着较大差异。在我国绝大多数透析中心是采用复用的。本文就透析器复用对患者的生存情况、透析膜的生物相容性、透析器的溶质清除、透析相关的感染等方面的影响进行了综述。     

高通量透析器复用效果的临床观察

高通量透析器的复用在临床较为常见。目前多采用过氧乙酸（ＰＡＡ）作消毒剂［１］,但单用ＰＡＡ消毒复用对滤器清除能力的影响尚无定论。我们研究监测了单用ＰＡＡ消毒后滤器对不同物质清除能力的变化,以证实其复用效果。一、对象和方法１ 病例选择：选择本透析中心维持性血液透析患者１３例,透析时间＞３月．近期透析稳定．无感染及发热;研究开始时患者全部使用聚砜膜ＢＬＳ６２７（ＰＳ,ｂｅｌｌｃｏ．膜面积 １．３６ ｍ～２）透析器及碳酸氢盐透析液透析．血流量２００－３００ｍｌ／ｍｉｎ．透析液流量５００ ｍｌ／ｍｉｎ．透析…     

透析器复用的展望

近年来,“血液透析患者丙型肝炎病毒感染的群发事件”时有报道,增加了患者的痛苦和医疗负担,在国内外产生不良的影响。其中有些感染事件被认为是与透析器的复用有关,故“透析器复用的前景”不仅作为一个医学专题引起我国透析同道们的高度关注,也成为社会各界敏感的话题。     

过氧乙酸与伦拿灵用于可复用透析器消毒效果比较

目的 通过过氧乙酸与伦拿灵对可复用透析器消毒效果监测的对比分析，选择对可复用透析器消毒可靠、经济和实用的消毒剂。方法 采取40例肾病患者血液透析2h后的透析液及透析用反渗水进行细菌学监测筛选菌种；确定过氧乙酸和伦拿灵的有效浓度，对标准菌株进行杀、抑菌试验；观察2种消毒剂在不同pH值、不同温度、不同作用时间下对标准菌株和样本液及HBsAg的杀灭效果；在透析器复用机上进行过氧乙酸破膜试验。结果 血液透析器污染菌以铜绿假单胞菌为主（占45．76％）；过氧乙酸与伦拿灵原始浓度分别为19．2％和4．99％，杀、抑菌浓度均相同，分别为0．125％和0．0313％，且在pH1．07～4．21、温度9～32℃、浓度为0．5％，作用时间不少于10min条件下，对样本液和标准菌株及HBsAg具有较强杀灭作用；可复用透析器经压力测试未出现破膜现象。结论 过氧乙酸和伦拿灵比较，两者杀、抑菌浓度相同。在过氧乙酸溶液中加入适量稳定剂，可延长放置时间。在对可复用透析器消毒效果相同情况下，过氧乙酸因其成本低、易清洗，更值得在基层医院使用。     

肝素超滤加生理盐水预冲预防透析器凝血的效果观察

目的 探讨预防或减轻透析器凝血的方法.方法 将40例患者按随机数字表法分为A、B组进行交叉试验.A组:试验的第一阶段采用生理盐水密闭式预冲透析器,至透析器不能复用时转为第二阶段,采用普通肝素超滤、生理盐水预冲透析器.B组反之.统计分析2种预处理方法间透析器的复用次数.结果 第一、第二阶段透析器的复用次数A组分别为(4.0500±0.7592)次、(8.2500±1.1180)次;B组分别为(8.2000±1.0563)次、(4.1500±0.8127)次.两种预处理方法比较差异有统计学意义(F=403.18,P=0.0000).结论 应用普通肝素超滤、生理盐水预冲透析器后,透析器复用次数明显多于单纯生理盐水密闭式预冲者,提示应用普通肝素超滤、生理盐水预冲可以预防或减轻透析器凝血.     

过氧乙酸与伦拿灵用于可复用透析器消毒效果比较

目的 通过过氧乙酸与伦拿灵对可复用透析器消毒效果监测的对比分析,选择对可复用透析器消毒可靠、经济和实用的消毒剂.方法 采取40例肾病患者血液透析2 h后的透析液及透析用反渗水进行细菌学监测筛选菌种;确定过氧乙酸和伦拿灵的有效浓度,对标准菌株进行杀、抑菌试验;观察2种消毒剂在不同pH值、不同温度、不同作用时间下对标准菌株和样本液及HBsAg的杀灭效果;在透析器复用机上进行过氧乙酸破膜试验.结果 血液透析器污染菌以铜绿假单胞菌为主(占45.76%);过氧乙酸与伦拿灵原始浓度分别为19.2%和4.99%,杀、抑菌浓度均相同,分别为0.125%和0.0313%,且在pH 1.07～4.21、温度9～32℃、浓度为0.5%,作用时间不少于10 min条件下,对样本液和标准菌株及HBsAg具有较强杀灭作用;可复用透析器经压力测试未出现破膜现象.结论 过氧乙酸和伦拿灵比较,两者杀、抑菌浓度相同.在过氧乙酸溶液中加入适量稳定剂,可延长放置时间.在对可复用透析器消毒效果相同情况下,过氧乙酸因其成本低、易清洗,更值得在基层医院使用.     

预充式导管冲洗器预防PICC堵管的效果观察

目的探讨预充式导管冲洗器应用于经外周静脉置入中心静脉导管(PICC)冲管和封管的临床效果。方法将109例PICC留置患者按照随机数字表法分为观察组(55例)和对照组(54例)。每次输血、给药后观察组使用预充式导管冲洗器进行冲管和封管,对照组使用普通10 ml注射器抽取生理盐水冲管后再抽取肝素封管液进行封管。观察两组堵管发生率及导管留置时间。结果观察组堵管发生率为5.45%,导管留置时间为(55.49±3.61)d;对照组分别为25.93%、(47.32±2.68)d,两组比较,差异有统计学意义(均P<0.01)。观察组堵管等级显著轻于对照组(P<0.01)。结论使用预充式导管冲洗器对PICC进行冲管和封管,可有效减少堵管发生率,延长带管时间,且安全可靠。     

Effect of dialyzer geometry on granulocyte and complement activation

During hemodialysis with cuprophan membranes, the complement system as well as leukocytes become activated. In order to clarify the role of dialyzer geometry, the effect of hollow-fiber versus flat-sheet dialyzers and of different surface areas on C3a generation and leukocyte degranulation was investigated. Plasma levels of leukocyte elastase in complex with alpha 1-proteinase inhibitor were significantly increased after 1 h (+55%) and 3 h (+62%) of hemodialysis with flat-sheet dialyzers as compared to hollow-fiber devices. In addition, plasma levels of lactoferrin, released from the specific granules of leukocytes during activation, were significantly higher (+42%) 3 h after the onset of dialysis treatment with flat-sheet than with hollow-fiber dialyzers. With respect to surface area, larger dialyzers tended to cause more release of leukocyte elastase as compared to dialyzers with smaller surface areas, irrespectively of the configuration of the dialyzer used. On the other hand, activation of the complement system, as measured by the generation of C3a-desarg, did not differ with both types of configurations. The same held true for leukopenia, which was almost identical for hollow-fiber and flat-sheet dialyzers. From these findings two lines of evidence emerge: First, not only the type of membrane material used in a dialyzer may influence its biocompatibility, but the geometry of the extracorporeal device also determines the degree of compatibility. Hence, the extent of leukocyte activation correlated with both configuration of the dialyzer and surface area of the membrane.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of different dialyzer membranes on cutaneous microcirculation during hemodialysis

AIM: Biocompatibility profiles of synthetic membranes may vary. In this prospective crossover study, we examined the effect of various membranes on cutaneous microcirculation during HD. SUBJECTS AND METHODS: 11 HD patients without cardiovascular complications were enrolled in this study. They were dialyzed using three types of membrane in a randomized order: ethylene-vinyl alcohol copolymer (EVAL), vitamin E-bonded cellulose (VE-C) and polysulfone (PS). The transcutaneous oxygen tension (TcPO2) was examined on the dorsum of foot to assess the cutaneous microcirculation. Serum biochemical parameters were also measured. RESULTS: The TcPO2 as a percentage of the predialysis level decreased from the beginning of HD, and significant differences were observed after 15 min of HD between EVAL and the other 2 membranes (98 +/- 6% (mean +/- SD) for EVAL versus 89 +/- 7% for VE-C (p < 0.01) and 88 +/- 10% for PS (p < 0.01)). Furthermore, there were significant differences at 30 and 60 min between EVAL and PS (30 min: 93 +/- 9% for EVAL versus 85 +/- 7% for PS (p < 0.05); 60 min: 92 +/- 10% for EVAL versus 79 +/- 10% for PS (p < 0.01)). The serum level of thiobarbituric acid reactants (TBARs), a marker of lipid peroxidation, increased significantly at the end of HD relative to that at the beginning of HD when using a PS membrane (from 1.9 +/- 0.5 to 2.1 +/- 0.5 nmol/ml, p < 0.05). CONCLUSION: Our results indicate that an EVAL membrane is superior to PS and VE-C membranes in terms of its smaller influence on cutaneous microcirculation. The repeated occurrence of microcirculatory disturbance during HD sessions may cause chronic endothelial dysfunction and even cardiovascular complications in HD patients.     

Effect of vitamin E-bonded dialyzer on eosinophilia in haemodialysis patients.

BACKGROUND: Eosinophilia in haemodialysis patients probably results from allergy to haemodialysis-related materials, including dialyzer membranes. We examined the effects of vitamin E-bonded dialyzers on eosinophil counts in haemodialysis patients. METHODS: We enrolled seven patients who were on regular haemodialysis and had sustained eosinophilia. White blood cell, eosinophil, CD4- and CD8-positive lymphocyte counts, and serum interleukin-5 (IL-5) and IgE levels were determined before, 2 and 4 weeks after switching to vitamin E-bonded dialyzers. RESULTS: Eosinophil and CD4-positive lymphocyte counts and serum IL-5 were significantly (P = 0.003, 0.003 and 0.031, respectively) decreased after switching to vitamin E-bonded dialyzers. CD8-positive lymphocyte counts and serum IgE levels were unaltered. Crossover tests in two cases reproduced the higher eosinophilia within 4 weeks after returning to the original non-vitamin E-bonded dialyzer. Conclusion: Vitamin E-bonded dialyzers may ameliorate eosinophilia through a mechanism mediated by a decrease in IL-5 secretion by CD4-positive lymphocytes.