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维护血液透析用水的质量

Author
Richard A Ward, PhD
Section Editor
Steve J Schwab, MD
Deputy Editor
Alice M Sheridan, MD
Translators
孙晶娣, 副主任医师，副教授

引言

血液透析患者特别容易受到用于制备浓缩液和透析液的水中污染物的影响，或受到用于透析器再处理的水中污染物的影响。与健康个体相比，血液透析患者需要接触极大容量的水，且针对此类毒素的屏障不完善，不易清除污染物：

  • 健康个体水的摄入量估计为每日2L或每周14L。与之相比，血液透析患者每周可能要接触350-500L的水，这取决于他们的治疗时间及透析液的流速。
  • 对于正常的个体，胃肠道可使血液与水中的污染物分隔开。与之相比，血液透析患者血液和水之间的屏障是一层薄薄的膜，污染物通过此膜的转运仅受污染物大小的限制。
  • 当重复使用透析器时，在再处理过程中，水被引入透析器的血液舱内。该水中的污染物可能滞留在血液舱，患者在下次透析治疗时会直接接触这些污染物。
  • 血液透析患者不能经肾脏排掉任何从透析液中获得的污染物。

累积的经验结合观察(某些毒性最强的污染物源自生活用水处理操作)表明，没有任何一种生活用水如果直接用于血液透析能够被认为是安全的。因此，所有的透析中心都需要一个合理设计且合理维护的水处理系统以保障患者的安全[1]。

确保水处理系统始终能够为透析提供合适用水的方法(包括各种水处理设备的维护和监测)将总结在此。血液透析患者接触的不同水源性污染物以及临床医生可用的各种水处理系统将单独讨论。 (参见“血液透析用水中的污染物”和“血液透析的水净化系统”)

维护水质

水质的维护首先要根据预定说明书和质量标准对水处理和分配系统进行正确的安装和确认。安装确认的责任由系统的销售方和透析中心共同承担。然而，一旦水处理及分配系统被安装并且完成性能确认，根据最低质量标准进行持续维护的责任仅由血液透析中心承担。

             

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Literature review current through: 2017-06 . | This topic last updated: 2016-07-14.
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