摘要
目的 分析上海市 5所三级医院透析用水及透析液微生物的污染状况 ,评估联机血液透析滤过的微生物学安全性。方法 以 5所医院透析中心为调查对象 ,取反渗水和碳酸氢盐透析液样本 ,其中 1所医院取联机血液透析滤过不同阶段处理后的透析液 ,对样本进行细菌培养、内毒素检测 ,并研究对健康人全血白介素 1受体拮抗剂 (IL 1ra)产生的影响。结果 2所医院反渗水和 4所医院碳酸氢盐透析液中发现细菌生长 ,但各所医院的细菌克隆形成单位均数均 <2 0 0CFU/ml,发现的细菌中以施氏假单胞菌为主 (占 72 % )。 2所医院反渗水和 4所医院碳酸氢盐透析液中内毒素的平均含量分别 >0 .2 5和 0 .5 0EU/ml。各医院反渗水和碳酸氢盐透析液均可刺激健康人全血产生IL 1ra。联机血液透析滤过不同阶段处理后均未培养出细菌 ,一级处理后无论液体碳酸氢盐还是干粉碳酸氢盐 ,内毒素和IL 1ra含量均下降 ,与反渗水、未处理碳酸氢盐透析液的差异有显著性。二级处理后下降更明显 ,且二级干粉碳酸氢盐处理后与生理盐水的差异无显著性。结论 上海市 5所医院血液透析反渗水和透析液仍存在不同程度的微生物污染 ,内毒素检测较细菌培养更能准确反映透析用水的水质。另外 ,如能严格按照操作指南 。
Objective To analyse the microbial contamination of reverse osmosis (RO) water and dialysa te for hemodialysis treatment with evaluation to the safety of on-line hemodiaf iltration (HDF). Methods Specimens of RO water and bicarbonate dialysate were obtained from 5 hospitals i n Shanghai. In one of them, dialysates of different stages in HDF were also obta i ned. All specimens were monitored for microbial cultures, endotoxin (ET) and lev els of interleukin-1 receptor antagonist (IL- 1ra). Bacteriologic samples were processed on Tryptone Soya Agar (TSA) with pour plate technique. ET was measured by Limulus amoebocyte lysate (LAL) assay. Leve ls of IL-1ra were determined in supernatants of incubated whole blood. Results The culture of bacteria was positive in 2 hospitals' RO water and 4 hospitals' b icarbonate dialysates respectively, but lower than 200 CFU/ml. Most of the bact e ria detected were pseudomonas stutzeri (72%). The level of ET was higher than 0. 25 EU/ml in 2 hospitals' RO water and 0.50 EU/ml in 4 hospitals' bicarbonate dia ly sates respectively. All samples could induce IL-1ra. Bacteria were failed to be detected in all stages of HDF. After first-stage, both levels of ET and IL -1ra decreased, showing significant difference with RO water and bicarbonate d ialysate. They decreased more obviously after second-stage. In addition , no di fference could be detected between powder bicarbonate and saline in the second- stage. Conclusion HDF is a safe technology under strict operation directory for detecting microbia l contamination in dialysis water and dialysate.
出处
《上海医学》
CAS
CSCD
北大核心
2004年第10期732-735,共4页
Shanghai Medical Journal
