透析用水和透析液中內毒素污染的探討

Endotoxin Contamination in Reverse Osmosis Treated Water and Dialysate-A Multi-Center Study

劉紹毅(Shaw-Yih Liou) ； 林梅圃(Mei-Pu Lin) ； 張琦玲(Chi-Lin Chang) ； 陳再晉(Tzay-Jinn Chen)

《中華民國血液淨化醫學會雜誌》 12卷1&2期 (2007/06) Pp. 59-69

https://doi.org/10.30024/JFBPS.200706.0006

摘要

由於在每次透析的過程中，洗腎病人的血液會與約100公升以上的透析液接觸。若透析液中含有內毒素，則此內毒素有可能藉逆過濾作用通過透析膜進入病人的血液中，誘發細胞素的釋出而增加罹病率本報告採集台北地區和台南地區共計23家洗腎中心的RO處理水和稀釋透析液，並以動力比色法用定量方式檢測其內毒素濃度。結果顯示RO處理水和稀釋透析液之內毒素濃度分別為0.21±0.40EU/ml和0.77±0.84EU/ml (P=0.0063)呈有意義的差別。我們發現部分的RO處理水以及稀釋透析液有內毒素汙染的情形。尤其是稀釋透析液中所含的內毒素濃度明顯地高於透析用水，亦即重碳酸鹽透析液容易遭受內毒素的嚴重汙染值得吾人重視。

關鍵字

血液透析 ； 逆滲透處理水 ； 透析液 ； 內毒素

並列摘要

Through a hemodialysis session, more than 100 liters of dialysate are used. Should the dialysate be contaminated with endotoxin, the endotoxin could be trans-forced to the patient's blood compartment via back-filtration and induced cytokine formation leading to various adverse reactions.
We investigated the endotoxin levels in the reverse osmosis treated (R.O.) water and the diluted dialysate collected from twenty-three dialysis centers located in Taipei Metropolitan and Tainan in 1994. The endotoxin levels in R.O. water and diluted dialysate were examined with kinetic QCL method. The result showed an average endotoxin concentration of 0.21±0.40EU/ml in R.O. water and 0.77±0.84 EU/ml in diluted dialysate (P=0.0063). R.O. water and diluted dials sate from few dialysis centers showed significant endotoxin contamination. Generally, the endotoxin level was higher in diluted dialysate than R.O. water. Susceptability of the bicarbonate dialysate to microbial and/or endotoxin contamination should arouse our serious concern.

並列關鍵字

hemodialysis ； reverse osmosis-treated water ； dialysate ； endotoxin