CAJ | 학술논문

目的：探讨血液透析室反渗水残余氯超标的原因以及对维持性血液透析(HD)患者的影响。方法将南通市第二人民医院(以下简称南通二院)2005年1月、3月、4月及5月36例 HD 患者血红细胞计数(RBC)、血红蛋白(Hb)和血细胞比容(Hct)进行比较,观察各参数的变化；将南通市第六人民医院(以下简称南通六院)2010年12月份、2011年1月份、2月份24例 HD 患者 RBC、Hb 和 Hct 进行比较,观察各参数的变化；观察2008年南通二院新水处理机安装后反渗水残余氯测定结果以及增装活性炭罐后残余氯测定结果。结果2005年2~3月,南通二院 HD 患者集体出现 Hb、RBC、Hct 下降,并伴有心悸、胸闷、乏力、透析低血压和心律失常等临床症状；Hb 下降速度较快(P<0.01)；更换同量的进口椰壳活性炭无效,Hb 继续下降(P <0.05)；增加活性炭容量后,病情未再恶化,贫血症状逐步改善,Hb 逐渐上升(P <0.01)。2006年2~3月份同样出现类似情况,更换活性炭后患者贫血症状逐渐缓解；2008年7月,南通二院新购入40床双级水处理系统,安装后采用比色法监测即发现残余氯超标(>0.5 mg/L),增装一个活性炭罐后,残余氯控制在允许范围内(<0.5 mg/L),投放使用后未出现集体贫血事件的发生。2011年1月南通六院新建血液透析室患者透析1个月后,发现所有患者均出现血常规的变化,血红蛋白下降(P <0.05)；透析2个月后血红蛋白进一步下降(P <0.05),大部分患者有临床症状；增加一个同型号炭罐,1个月后血红蛋白均上升(P <0.01),临床症状改善。结论 HD 患者集体溶血事件易发生在春季,且 Hb 下降速度较快,每月平均可下降20~30 g/L；这些溶血事件与水处理反渗水残余氯超标有关；活性炭对残余氯的吸附能力主要与活性炭数量有关,与其种类关系不大；目前通用的水处理系统中标准配置活性炭对残余氯的吸附能力不足易致残余氯超标,引起维持性血液透析患者出现集体急性溶血事件。目的：探討血液透析室反滲水殘餘氯超標的原因以及對維持性血液透析(HD)患者的影響。方法將南通市第二人民醫院(以下簡稱南通二院)2005年1月、3月、4月及5月36例 HD 患者血紅細胞計數(RBC)、血紅蛋白(Hb)和血細胞比容(Hct)進行比較,觀察各參數的變化；將南通市第六人民醫院(以下簡稱南通六院)2010年12月份、2011年1月份、2月份24例 HD 患者 RBC、Hb 和 Hct 進行比較,觀察各參數的變化；觀察2008年南通二院新水處理機安裝後反滲水殘餘氯測定結果以及增裝活性炭罐後殘餘氯測定結果。結果2005年2~3月,南通二院 HD 患者集體齣現 Hb、RBC、Hct 下降,併伴有心悸、胸悶、乏力、透析低血壓和心律失常等臨床癥狀；Hb 下降速度較快(P<0.01)；更換同量的進口椰殼活性炭無效,Hb 繼續下降(P <0.05)；增加活性炭容量後,病情未再噁化,貧血癥狀逐步改善,Hb 逐漸上升(P <0.01)。2006年2~3月份同樣齣現類似情況,更換活性炭後患者貧血癥狀逐漸緩解；2008年7月,南通二院新購入40床雙級水處理繫統,安裝後採用比色法鑑測即髮現殘餘氯超標(>0.5 mg/L),增裝一箇活性炭罐後,殘餘氯控製在允許範圍內(<0.5 mg/L),投放使用後未齣現集體貧血事件的髮生。2011年1月南通六院新建血液透析室患者透析1箇月後,髮現所有患者均齣現血常規的變化,血紅蛋白下降(P <0.05)；透析2箇月後血紅蛋白進一步下降(P <0.05),大部分患者有臨床癥狀；增加一箇同型號炭罐,1箇月後血紅蛋白均上升(P <0.01),臨床癥狀改善。結論 HD 患者集體溶血事件易髮生在春季,且 Hb 下降速度較快,每月平均可下降20~30 g/L；這些溶血事件與水處理反滲水殘餘氯超標有關；活性炭對殘餘氯的吸附能力主要與活性炭數量有關,與其種類關繫不大；目前通用的水處理繫統中標準配置活性炭對殘餘氯的吸附能力不足易緻殘餘氯超標,引起維持性血液透析患者齣現集體急性溶血事件。
목적：탐토혈액투석실반삼수잔여록초표적원인이급대유지성혈액투석(HD)환자적영향。방법장남통시제이인민의원(이하간칭남통이원)2005년1월、3월、4월급5월36례 HD 환자혈홍세포계수(RBC)、혈홍단백(Hb)화혈세포비용(Hct)진행비교,관찰각삼수적변화；장남통시제륙인민의원(이하간칭남통륙원)2010년12월빈、2011년1월빈、2월빈24례 HD 환자 RBC、Hb 화 Hct 진행비교,관찰각삼수적변화；관찰2008년남통이원신수처리궤안장후반삼수잔여록측정결과이급증장활성탄관후잔여록측정결과。결과2005년2~3월,남통이원 HD 환자집체출현 Hb、RBC、Hct 하강,병반유심계、흉민、핍력、투석저혈압화심률실상등림상증상；Hb 하강속도교쾌(P<0.01)；경환동량적진구야각활성탄무효,Hb 계속하강(P <0.05)；증가활성탄용량후,병정미재악화,빈혈증상축보개선,Hb 축점상승(P <0.01)。2006년2~3월빈동양출현유사정황,경환활성탄후환자빈혈증상축점완해；2008년7월,남통이원신구입40상쌍급수처리계통,안장후채용비색법감측즉발현잔여록초표(>0.5 mg/L),증장일개활성탄관후,잔여록공제재윤허범위내(<0.5 mg/L),투방사용후미출현집체빈혈사건적발생。2011년1월남통륙원신건혈액투석실환자투석1개월후,발현소유환자균출현혈상규적변화,혈홍단백하강(P <0.05)；투석2개월후혈홍단백진일보하강(P <0.05),대부분환자유림상증상；증가일개동형호탄관,1개월후혈홍단백균상승(P <0.01),림상증상개선。결론 HD 환자집체용혈사건역발생재춘계,차 Hb 하강속도교쾌,매월평균가하강20~30 g/L；저사용혈사건여수처리반삼수잔여록초표유관；활성탄대잔여록적흡부능력주요여활성탄수량유관,여기충류관계불대；목전통용적수처리계통중표준배치활성탄대잔여록적흡부능력불족역치잔여록초표,인기유지성혈액투석환자출현집체급성용혈사건。
Objective To explore the causes of the overproof of reverse osmosis water residual chlorine of hemodialysis room and its influence to maintenance hemodialysis(HD)patients.Methods Comparison was made on 36 HD patients in 2005 January,March,April and May from Nantong Second People's Hospital (referred Nantong Second Hospital),the number of red blood cells(RBC),hemoglobin(Hb)and red blood cell volume(Hct)were observed;Comparison was made on 24 HD patients in 2010 December,201 1 January and February from Nantong Sixth People's Hospital,the number of RBC,Hb and Hct were observed.;Observation was made on the installation of reverse osmosis water residual chlorine determination results and filled with activated carbon tank of Nantong Second Hospital in 2008 after taking the new water processor.Results Hb,RBC,Hct in HD patients from Nantong Second Hospital were decreased,accompanied by palpitations,chest,tightness,fatigue,dialysis hypotension and arrhythmia;Hb decreased faster (P <0.01);Replaced the same amounts of import coconut shell activated carbon were invalid,Hb continued to decline(P < 0.05 );The illness did not get worse after increasing capacity of activated carbon,anemia symptoms gradually improved,Hb increased (P < 0.01 ).In 2006 Feb-Mar,this situation appeared again,anemia symptoms gradually eased after replacing activated carbon;In 2008 July,Nantong Second Hospital bought new 40 bed hospital acquired two-stage water treatment system,after the installation of the colorimetric method was used to monitor residual chlorine exceed the standard (> 0.5 mg/L),after adding a canister,residual chlorine was controlled in the permissible range (<0.5 mg/L),the collective solution events did not happen after it was put to use.After dialysis 1 month in new hemodialysis room of Nantong Sixth Hospital ,all patients showed blood routine change ,Hb decreased (P <0.05);dialysis 2 months later,a further decline in Hb was observed (P <0.05),most of the patients had clinical symptoms;added same size carbon canister,1 month after the Hb increased (P < 0.01 )and clinical symptoms improved.Conclusion HD patients with collective hemolytic event occurred in Spring usually,Hb decreased faster,the average monthly decline of 20-30 g/L;These hemolytic events are relative to residual chlorine water reverse osmosis water exceeding the standard;The adsorption capacity of the activated carbon on the residual chlorine is related to the number but not the species,adsorption capacity of water treatment system in common use configuration of activated carbon on the residual chlorine residual chlorine may exceed the standard problem,it causes HD patients of acute hemolysis collective events.