人工肝支持系统的基本构成

人工肝支持系统是治疗肝意识的重要手段,该系统主要是通过对血液中毒素的去除,达到治疗目的。中介绍了访诉基本构成和采用的基本方法。     

Comparison of Clinical Performance of VectorFlow and Palindrome Symmetric-Tip Dialysis Catheters: A Multicenter,Randomized Trial

PurposeTo compare clinical performance of 2 widely used symmetric-tip hemodialysis catheters.Materials and MethodsPatients with end-stage renal disease initiating or resuming hemodialysis were randomized to receive an Arrow–Clark VectorFlow (n = 50) or Palindrome catheter (n = 50). Primary outcome was 90-d primary unassisted catheter patency. Secondary outcomes were Kt/V ([dialyzer urea clearance × total treatment time]/total volume of urea distribution), urea reduction ratio (URR), and effective blood flow (Q_B).ResultsPrimary unassisted patency rates with the VectorFlow catheter at 30, 60, and 90 d were 95.5% ± 3.3, 87.2% ± 7.3, and 80.6% ± 9.8, respectively, compared with 89.1% ± 6.2, 79.4% ± 10.0, and 71.5% ± 12.6 with the Palindrome catheter (P = .20). Patients with VectorFlow catheters had a mean Kt/V of 1.5 at 30-, 60-, and 90-day time points, significantly higher than the mean Kt/V of 1.3 among those with Palindrome catheters (P = .0003). URRs were not significantly different between catheters. Catheter Q_B rates exceeded National Kidney Foundation–recommended thresholds of 300 mL/min at all time points for both catheters and were similar for both catheters (median, 373 mL/min). Catheter failure, ie, poor flow rate requiring guide-wire exchange or removal, within the 90-day primary outcome occurred in 3 VectorFlow subjects and 5 Palindrome subjects (P = .72). Infection rates were similar, with 0.98 infections per 1,000 catheter days for VectorFlow catheters compared with 2.62 per 1,000 catheter days for Palindrome catheters (P = .44).ConclusionsThe 90-day primary patency rates of Palindrome and VectorFlow catheters were not significantly different, and both achieved sustained high Q_B through 90 day follow-up. However, dialysis adequacy based on Kt/V was consistently better with the VectorFlow catheter versus the Palindrome.     

复用透析器存放柜的制作与应用

为了保证血液透析病人医疗安全,规避医疗风险,落实卫生部《血液透析器复用规范》,我院改进复用透析器存放方式,减少了透析器转运、贮存及使用等环节污染的机会。2011年1月～2012年4月,我们应用自制的可复用透析器存放柜,对维持性血液透析患者的可复用透析器采取存放柜     

Effects of vitamin E-coated dialyzer on oxidative stress and inflammation status in hemodialysis patients: a systematic review and meta-analysis

Background: Vitamin E-coated dialyzer may have an effect on oxidative stress and inflammation status in hemodialysis (HD) patients. Therefore, we performed a systematic review to assess the anti-oxidation and anti-inflammatory effects of vitamin E-coated dialyzer in HD patients. Methods: The randomized controlled trials (RCTs) and quasi-RCTs of vitamin E-coated dialyzer versus conventional dialyzer for HD patients were searched from multiple databases. We screened relevant studies according to predefined inclusion criteria and performed meta-analyses using RevMan 5.1 software. Results: Meta-analysis showed vitamin E-coated dialyzer therapy could significantly decrease the serum thiobarbituric acid reacting substances (TBARS) (SMD, ?0.95; 95% CI, ?1.28 to ?0.61; p?p?=?0.005), interleukin-6 (IL-6) (SMD, ?0.65; 95% CI, ?0.97 to ?0.32; p?p?=?0.03) compared with that of the control group. However, vitamin E-coated dialyzer did not result in increasing the total antioxidant status (TAS) (SMD, 0.23; 95% CI, ?0.16 to 0.61; p?=?0.25) and the fractional clearance of urea index (Kt/v) levels (MD, ?0.07; 95% CI, ?0.14 to 0.00; p?=?0.06), in addition, there was no significant difference in plasma superoxide dismutase (SOD) level compared with that of the conventional dialyzer &; oral vitamin E group (SMD, 0.28; 95% CI, ?0.20 to 0.75; p?=?0.26). Conclusions: Vitamin E-coated dialyzer can reduce the oxidative stress and inflammation status reflected by the decreasing of serum TBARS, oxLDL, CRP, and IL-6 levels, and this new dialyzer does not affect the dialysis adequacy.     

JMS SDS-20血液透析机水路流程分析

本文详细分析了JMS SDS-20血液透析机水路流程,充分说明了各个元器件的工作状态、作用及有关参数。     

应用F6型透析器进行肝硬化自体腹水浓缩透析回输

目的:探讨应用F6型透析器进行肝硬化自体腹水浓缩透析回输的临床效果。方法:腹穿引流腹水,连接血路管泵前端,均匀输入腹水,应用F6型透析器进行透析超滤。检测治疗前和治疗后24h的体重、尿量、血清肌酐、血清尿素氮、血清白蛋白。结果:体重减轻(P<0.01),尿量增多(P<0.001),血清肌酐(P<0.01)和血清尿素氮(P<0.001)降低,血清白蛋白(P<0.01)增高,腹水减少或消失占总病例数90.62%。结论:应用F6型透析器进行肝硬化自体腹水浓缩透析回输治疗肝硬化腹水效果良好。     

NIPRO血液透析机血液回路气泡检测器的工作原理

本文详细的介绍了NIPRO血液透析机气泡检测器的工作原理和具体结构以及常见类型优缺点。     

ZOEY16L聚醚砜透析器对维持性血液透析患者的疗效和安全性的随机对照试验

目的 探讨ZOEY16L聚醚砜透析器对维持性血液透析(MHD)患者小分子毒素的清除效果,并观察其临床应用安全性。方法 选取宜宾市第二人民医院肾脏内科血液净化中心74例MHD患者为研究对象,采用随机、开放、平行对照试验方法,纳入者分为观察组和对照组,每组37例。比较观察组（ZOEY16L）和对照组（PES16LF）透析器对尿素氮、肌酐等指标的清除效果;同时分析两组透析前后外周血血红蛋白、白蛋白等安全性指标差异,记录不良事件发生情况,观察试验器械的临床疗效和安全性。 结果 两组临床基线资料比较差异无统计学意义（P＞0.05）,60 min肌酐清除率观察组与对照组比较,差异有统计学意义（P＜0.05）;两组间尿素氮清除率、尿素氮及血磷下降率、超滤率、spKt/V差异均无统计学意义（均P＞0.05）;两组治疗前后安全性指标差异无统计学意义（P＞0.05）,无严重不良反应。 结论 ZOEY16L与PES16LF对尿毒症小分子毒素的清除作用相当,ZOEY16L聚醚砜透析器临床应用安全有效。     

Proteomics investigation of the changes in serum proteins after high- and low-flux hemodialysis

Purpose: This study aimed to use proteomics methods to investigate the changes in serum protein levels after high- and low-flux hemodialysis (HD).

Methods: Before and after HD, serum samples were obtained from two selected patients who were treated with a Polyflux 140?H high-flux dialyzer and a Polyflux 14?L low-flux dialyzer during two continuous therapy sessions. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was performed to identify the proteins.

Results: A total of 212 and 203 serum proteins were identified after high-flux and low-flux HD, respectively. After high-flux HD, 21 proteins increased, and 132 proteins decreased. After low-flux HD, 87 proteins increased, and 45 proteins decreased. High-flux HD led to a significantly greater reduction in protein levels than low-flux HD (0.73?±?0.13 vs. 0.84?±?0.18, p?=?.00). Among the increased and decreased proteins, the isoelectric point (pI) values mainly ranged from 5 to 7, and the molecular weights (Mws) were mostly smaller than 30?kDa. The serum proteins showed no difference in pI or Mw for high- and low-flux HD. Gene ontology (GO) analysis showed that the detected proteins were related to immune system processes and complement activation.

Conclusions: Serum protein levels differentially changed after high- and low-flux HD. Long-term effects should be observed in future studies.     

日机装DBB27型血透机的维修

对DBB27血透机经常出现的负压报警、静脉端微小气泡报警和减压阀故障案例进行分析,与维修实验,排除了故障。提出平时的保养工作的针对性与方法,减少了设备故障率。