以尿素清除率为依据对透析器复用次数和清除效果的初步探讨

目的探讨高通量F50透析器和F6透析器的复用次数及其溶质清除效果。方法通过在线尿素清除率监测(OCM)测定60例患者,在其使用F50和F6透析器第1次及其复用第3、6、9次时Kt/V值的变化及透析器血室容积(Tcv)的数值。并对部分患者检测了透析前后血清尿素水平计算了Kt/V值。结果60例使用F50透析器的患者在第1次使用及其复用中,Kt/V值相互间比较均差异无显著。复用的F50透析器质量检测也全部合乎要求。使用F6透析器的患者在第1次使用及其复用中,Kt/V值相互间比较也均无显著下降。但F6透析器在复用至第9次时约90%的Tcv下降≥20%。检测的Kt/V值与OCM监测的Kt/V值比较无明显差别。结论F50透析器复用至第9次时,其质量和清除效果无明显改变。F6透析器复用至第9次时Kt/V值与第1次使用时比较下降无统计学差异,但大多透析器Tcv下降≥20%,故F6透析器复用不应用超过9次。     

肾透析发展趋势与创新材料

拜耳材料科技开发出一系列的医用级聚碳酸酯（P C）材料,多年来已广泛应用于全球众多医疗元器件及设备制造商。本文说明肾病医疗透析器壳体材料的特性要求以提高透析疗程安全性,再探讨为透析器无氧包装而开发的新一代聚碳酸酯（P C）材料-模克隆？ Rx2440的材料性能。     

Improvement of Intradialytic Hypotension in Diabetic Hemodialysis Patients Using Vitamin E‐Bonded Polysulfone Membrane Dialyzers

Currently, there are no detailed reports on the effects of vitamin E‐bonded polysulfone (PS) membrane dialyzers on intradialytic hypotension (IDH) in diabetic hemodialysis (HD) patients. This study was designed to evaluate changes in intradialytic systolic blood pressure (SBP) using “VPS‐HA” vitamin E‐bonded super high‐flux PS membrane dialyzers. The subjects were 62 diabetic HD patients whose intradialytic SBP fell by more than 20%. Group A comprised patients who required vasopressors to be able to continue treatment or who had to discontinue therapy due to their lowest intradialytic SBP being observed at 210 min (28 patients). Group B comprised patients who showed no symptoms and required no vasopressors but showed a gradual reduction in blood pressure, with the lowest intradialytic SBP seen at the end of dialysis (34 patients). The primary outcome was defined as the lowest intradialytic SBP after 3 months using VPS‐HA. Secondary outcomes included changes in the following: lowest intradialytic diastolic blood pressure, pulse pressure, pulse rate, plasma nitric oxide and peroxynitrite, serum albumin, and hemoglobin A1c. Group A's lowest intradialytic SBP had significantly improved at 3 months (128.0 ± 25.1 mm Hg vs. 117.1 ± 29.2 mm Hg; P = 0.017). Group B's lowest intradialytic SBP had significantly improved at 1 month (134.4 ± 13.2 mm Hg vs. 121.5 ± 25.8 mm Hg; P = 0.047) and 3 months (139.1 ± 20.9 mm Hg vs. 121.5 ± 25.8 mm Hg; P = 0.011). We conclude that VPS‐HA may improve IDH in diabetic HD patients.     

维护工作对透析机的价值

本文以三例常见故障的原因和处理方法说明了平时的维护工作对透析机能长期稳定安全地工作的重要性.提出医疗器械维修人员应重视平时的维护工作.     

不同冲管方法对复用透析器冲洗后消毒液残余剂量的影响

目的探讨两种不同的冲管方法对复用透析器冲洗后残余消毒剂反跳现象的影响,以保证透析器消毒剂残余量在允许范围。方法将采用伦拿灵（peracidin）透析器使用浓缩液消毒的100个复用透析器随机分为A、B两组,A组采用常规冲洗方法,B组采用改良后的冲洗方法,即在冲洗结束血泵降至90ml／min,继续循环60min;冲洗结束后用peracidin残余测试条在设定时问检测透析器内残余的peracidin浓度,并记录结果。结果A、B两组相：15min内透析器内残留的peracidin浓度均在正常范围,15min到60min内B组透析器内残留的peracidin浓度在正常范围,A组透析器内残留的peracidin浓度超标。结论可重复使用透析器在冲洗结束后15min内即要开始血液净化治疗;如若不能及时上机,冲洗就不能停止;否则,透析器内残留的peracidin水平会升高（反跳）,需要再次冲洗并检测消毒液残留剂量水平,以保证透析安全。     

单片机在血液透析机超滤控制系统中的应用

本文针对用户对血液透析机提出的实际需求 ,设计了一套基于单片机控制的超滤控制改进系统。经实验和实际应用 ,论证了本文所设计的系统是有效可行的 ,且满足用户的实际需求     

γCDCoBr2 complexes as catalysts in sulfide oxidation and its reused

γCDCoBr₂ complexes synthesized in ethyl acetate or dichloromethane solvents or CoBr₂ were used as catalysts in sulfoxidation reactions giving very good yields and high chemoselectivity. Sulfoxidation takes place in the presence of other functional groups such as –COOH, –NO₂ or –CHO. A structure-reactivity analysis was carried out, correlating the Hammet σ parameters and the TOF values obtained in the oxidation reaction of the para-substituted arylmethylsulfides in the presence of each catalyst. Additionally, the effect of groups of different sizes attached to sulfur atom was analysed. Also, these reactions were evaluated using green chemistry metrics, good results were obtained in many cases. The solid complexes can be used several times, after three cycles the yield decreased only 7% (from 95 to 88%). Techniques as FT-IR and TGA were used to characterize used complexes after 1st and 6th cycles.     

透析患者的丙型肝炎感染

目的观察血液透析患者的丙型肝炎感染情况。方法用酶联免疫吸附试验检测175例血液透析患者血清中抗丙型肝炎病毒（抗HCV）。结果175例血液透析患者中,抗HCV阳性率透析〈2年为6.20％,透析〉2年为47．83％。结论随着透析年限延长,丙型肝炎感染概率加大。     

Effect of dialyzer membranes on mortality in uremic patients undergoing long-term hemodialysis: A Nationwide population-based study using the Taiwan Dialysis Registry Data System 2005–2012

The characteristics in dialyzer are associated with mortality in patients with end-stage renal disease (ESRD) receiving hemodialysis (HD). This study is to investigate the effects of dialyzer membranes on 3-year mortality in ESRD patients. From the long-term nationwide population database. Prevalent HD patients during 2005–2012 were enrolled. Our main analysis to calculate the effect was cox regression multivariate model. Overall, the mean age of all population (N = 73 565) was 61.0 ± 13.6 years, the observation period is 2.46 years ±0.98 within 3 years and 64.6% used polysulfone (PS), polymethyl methacrylate (PMMA) (11.6%), polyethersulfone (11.4%), and cellulose triacetate (CTA) (10.7%), ethylene vinyl alcohol (EVAL) (hazard ratio [HR] 2.72, 95% confidence interval [CI] 1.71–4.33) and CTA (HR 1.35, 95% CI 1.12–1.64) were associated with higher mortality than PS, but PMMA was not. EVAL and CTA adversely affected mortality and PMMA had no protective role. Further investigations on membrane characters on HD patients are warranted. Taipei Medical University (TMU) (TMU-JIRB (No. N201804051).