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血液透析用水中的污染物

Authors
Nicholas Hoenich, PhD
Richard A Ward, PhD
Section Editor
Jeffrey S Berns, MD
Deputy Editor
Alice M Sheridan, MD
Translators
马迎春, 主任医师

引言

血液透析需要用水。对于制备浓缩液和透析液的用水以及再处理透析器的用水，水中污染物容易对血液透析患者造成伤害(参见“透析器复用”，关于‘再处理技术’一节)。导致透析患者易受伤害的原因包括：

●血液透析患者所暴露的水量极大。健康个体的估计摄水量为一日2L或一周14L。相比之下，如果在持续4小时的单次透析治疗中以800mL/min的透析液流速进行治疗，则血液透析患者暴露的水量为192L；如果一周接受3次治疗，患者暴露的水量就为576L/周。如果患者接受的是每日血液透析或夜间血液透析方案治疗，尤其是如果使用的透析液流速为常规流速而非降低流速，则暴露的水量还会进一步增加。

●血液透析患者缺少抵御水源性污染物的屏障。在未接受透析的健康个体中，胃肠道可将血液与水中的污染物分隔开来。相比之下，对于血液透析患者而言，血液与水之间的屏障是血液透析器中的透析膜，而透析膜只能靠污染物的大小来限制污染物透过。

●血液透析患者无法通过肾脏排泄来自透析液的任何污染物质。

对于许多患者而言，制备透析液的用水来自于大型市政供水。然而，对于某些患者而言，尤其是那些在农村地区的患者，或是接受治疗的透析机构位于有社区供水系统的小城镇的患者，透析用水可能来自于当地的钻井或水井。这类供水的微生物和化学物质污染情况就更加不确定。例如，一项公共卫生研究调查了美国244处公共供水井的未处理水中病原体的存在情况，发现在最初被认为更容易污染和更不容易污染的水井中，1种或多种粪便污染指标为阳性的水井比例分别约为50%和40%[总大肠菌群、大肠埃希菌(Escherichia coli)、肠球菌、感染大肠菌群的病毒和人类病毒][1]。

                   

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Literature review current through: 2017-06 . | This topic last updated: 2016-06-09.
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