【摘要】 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%vs18.7%);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。更多还原

【Abstract】 Purpose To investigate the status of quality improvement of hemodialysis waterand dialysate made in the past 3 years in Hemodialysis Centers of Beijing. Methods A formalquestionnaire was prepared and distributed to hemodialysis centers in Beijing from 2002 to 2004.The questions were designed to acquire information on the frequency of monitor on hardness,electricity conductivity, chlorine, and bacteria culture of hemodialysis water, as well as onthe management of dialysate. Two censuses on chemistry contaminations in hemodialysis water hadbeen performed among 99 and 100 HD centers in 2003 and 2004, respectively. Also, a census onendotoxin contamination in dialysate was done in 2004. Results There were 88, 115 and 110Hemodialysis Centers completed the questionnaires in 2002, 2003 and 2004, respectively. Theparticipation rate was 95.7%, 95.8%, and 90.2%. In the past 3 years, the frequency of monitoringcompliance to AMMI standard for the hardness,electricity conductivity, chlorine and bacteriaculture of hemodialysis water has been improved significantly. All Hemodialysis Centers usebiocarbonate dialysate with about 35.7% centers use dialysate solution directly. 98.2% centerscan dissolve the dialysate concentrate properly. Individualized potassium and calcium concen-tration of dialysate can be prescribed in some centers. Overall non-compliance to the AAMIstandard for chemistry was 18.6% and 4% in 2003 and 2004, respectively. The common chemistrycontamination included calcium, nitrate, aluminum and chloramines in 2003, calcium and nitratein 2004. The overall non-compliance to the AAMI standard for endotoxin was 28%. After improvedthe quality of water system, the final compliance became 100% for chemistry, and 98% forendotoxin. Conclusions In the past 3 years, the awareness of the significance of hemodialysiswater and dialysate has been improved markedly among HD centers in Beijing. Nowadays, thechemistry and endotoxin contaminations of hemodialysis water and dialysate still exist in somecenters, so we should pay attention to these problems and some routine measures for monitorthe quality of hemodialysis water and dialysate should be taken by every HD center.更多还原