Introduction: Incidence of Hypersensitivity in Hemodialysis

Abstract: Hypersensitivity reactions in hemodialysis are rare. They have been identified only recently, since the U.S. dialysis patient population became sufficiently large for pattern recognition. These reactions might be the result of a variety of factors, including the manufacturing process and patient characteristics. Some reactions may be due to components of the dialysis system other than the dialyzer, such as the tubing sets. Data collected by the Food and Drug Administration showed that in 1982 there were 3.5 severe hypersensitivity reactions per 100,000 hollow-fiber dialyzers sold. This rate of reaction occurrence does not appear to be appreciably different from that in previous years for which information, though scant, was available. Recently, a significant reduction in the rate of the reactions seems to have occurred after some U.S. manufacturers changed their manufacturing procedures.     

血液透析中血气的特殊变化

目的：观察采用聚砜膜透析器加碳酸氢盐透析液进行血透是否造成低氧血症,并探讨其机制。方法：选择10例维持性血透的慢性肾功能不全患者,采用前述透析方式,于透前、透后15min,0.5、1、2、4、6h,分别采动脉血检测pH值、PaO2、PaCO2、HCO3-,以及呼吸频率、血补体C3,外周白细胞计数。结果：透析前后动脉血氧分压无显著性变化,P〉0.05。结论：采用此种方法透析,不发生低氧血症,其主要原因是克服了既往使用醋酸盐透析所造成的总CO2（CO2和HCO3-之和）的大量流失。     

血液透析机质量控制数据分析

目的：采集分析血液透析机质量控制检测的各项参数,为医疗设备的采购、维护以及正常运行提供依据。方法：利用HDM99XP型血液透析机质量检测仪对机器进行周期检测,采集第一手资料,按照上级文件指示精神和相应规程,主要从透析液电导率、透析液温度和透析液流量统计分析对比数据。结果：所检3种品牌共计45台血液透析机全部符合规定技术参数要求,但各项参数的误差率在合格范围内呈现不同规律。结论：通过对所得数据分析可知,金宝（GAMBRO）透析机的各项参数误差率更小,在精准度和统计性能稳定性方面更好,计量检定和质量控制检测在医疗设备的质量管理工作中具有重要的意义。     

影响维持性血液透析患者血磷水平的相关因素分析

目的 分析维持性血液透析患者血磷水平的相关影响因素.方法 选取维持性血液透析患者80例,年龄25～ 28岁,平均56.1岁;透龄3～80个月,平均19.13个月.观察透析前后血磷水平变化,对血磷水平的相关影响因素进行单因素分析及多因素分析.结果 患者透析后血磷水平低于透析前（P＜0.01）.透析前血磷值、肌酐下降率、透析器膜面积、有效血流速、血室容积、红细胞压积与血磷下降率密切相关.多因素分析示透析前血磷、肌酐下降率、有效血流速、透析器膜面积是血磷下降的独立因素（P均＜0.05）.结论 透析前血磷、肌酐下降率、有效血流速、透析器膜面积是影响维持性血液透析患者血磷水平下降的独立因素.     

人工肾代替人工肺治疗Ⅱ型呼吸衰竭的实验研究

应用人工肾空心纤维透析器持续正压（８～１２ｋＰａ）通入Ｏ２代替人工肺治疗５只Ⅱ型呼吸衰竭的家犬，经Ａ─Ｖ接体外转流２小时获得满意的效果。血流通过人工肾前、后氧分压（ＰＯ２）由９．１５±０．９５ｋＰａ上升到７２．５５±１４．０３ｋＰａ（Ｐ＜０．００１），二氧化碳（ＰＣＯ２）由６．３４士０．９６ｋＰａ下降到４．０８±０．９９ｋＰａ（Ｐ＜０．０１）。实验动物在治疗前、后氧分压（ＰＯ２）由７．１１±０．６１ｋＰａ上升到１０．６９±１．８１ｋＰａ（Ｐ＜０．０５），二氧化碳分压（ＰＣＯ２）由７．８３±０．９６下降到５．４７±１．４４ｋＰａ（Ｐ＜０．０５），５只实验动物无１例死亡。     

意大利产贝尔克血透仪维修实例

本文叙述了意大利产贝尔克血透仪的故障类型及维修方法。     

透析器复用过程中主要黏附物成分研究

本研究以复用的聚砜膜透析器为研究对象,对造成透析膜堵塞的黏附物质的主要成分作定量分析研究,并分析了不同复用次数的透析器膜表面残留成分的差异。结果显示:透析后用反渗水冲洗透析器,可去除膜表面黏附的大量蛋白质;用2%的次氯酸钠(NaClO)溶液浸泡使用后的透析器,可去除黏附物中的葡萄糖、胆固醇和甘油三脂;膜上大多数黏附物质随着透析次数的增加而缓慢增加。     

Development of a dialyzer with enhanced internal filtration to increase the clearance of low molecular weight proteins

Accumulated low molecular weight proteins in hemodialysis patients require a high-flux dialyzer. There have been several methods proposed for enhancing internal filtration, including narrowing the inside diameter of the hollow fibers, lengthening the fibers, and increasing the fiber density ratio. We tried to enhance the internal filtration by increasing the pressure drop in the dialysate compartment through increasing the fiber density ratio. If the fiber density ratio is too high, however, an irregular dialysate path may result, thus decreasing dialysis performance. Therefore, we took note of the shape of the inner housing and added a short taper structure, which improved the dialysate path dramatically. Consequently, we developed an internal filtration-enhanced dialyzer (APS-Prototype) to improve dialysis performance. The internal filtration rate in water (measured by Doppler ultrasound) was 13.2l/session for the APS-Prototype and 5.3l/session for the APS-15E. The amount of 1-microglobulin (1-MG) in bovine plasma was 0.34g for the APS-Prototype and 0.11g for the APS-15E. In addition, the amount of 1-MG in vivo was 29.0% ± 5.8% for the APS-Prototype, significantly higher than that for the APS-15E (13.6% ± 1.9%). The desirable loss of albumin is 2–4g in hemodiafiltration, and it was 3.92 ± 1.03g for the APS-Prototype. The prototype showed excellent solute removal performance with no clinical or engineering problems.     

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。