不同季节对血液透析机消毒效果的影响

Disinfection effect of blood dialysis machine in different season

目的：分析不同季节血液透析用水和透析液质量。方法 WaterMac RO-9000CT＋数字变频双级反渗透水处理装置（北京康德威医疗设备有限公司出品）。透析供水不锈钢管路由北京康德威医疗设备有限公司安装，用于中国中医科学院西苑医院透析中心。透析机：日机装7台DBB-26、27，3台尼普洛NCU-12，3台SUR-10。采用每周1次热消毒方法，每天1次化学消毒方法消毒透析机。分散固定8～10个取样口，其中1个为WaterMac RO-9000CT＋数字变频双级反渗透水处理装置回水口，1个为供水系统进入透析机的进水口，其余为透析机的混合液口。分别取水样1 mL，密封保存。同样方法采集A液、B液。进行化学污染物、细菌检测。结果混合液共采集178个样本，其中春季42个，夏季45个，秋季43个，冬季48个；进水口、回水口、A液、B液每个季度各采集6个样本。春季的细菌菌落数和内毒素量分别是（18.07±14.49） CFU/mL和（0.08±0.04） EU/mL，夏季的细菌菌落数和内毒素量分别是（40.43±16.18） CFU/mL和（0.43±0.16） EU/mL，秋季的细菌菌落数和内毒素量分别是（32.98±18.77） CFU/mL和（0.18±0.14） EU/mL，冬季的细菌菌落数和内毒素量分别是（19.59±12.27） CFU/mL和（0.19±0.12） EU/mL，夏秋2季的细菌菌落数和内毒素量高于冬春2季，透析液的不合格次数高于透析用水。结论夏秋2季应该加强血液透析机的消毒。

Objective To study the hemodialysis water and dialysate quality effects in different seasons. Methods The water treatment on hemodialysis was sterilized by heat sterilization once a week, and disinfected dialysis machine was sterilized by chemical disinfection methods once per day. Eight to ten sampling ports were decentralized fixed included one backwater mouth of WaterMac RO-9000CT＋digital inverter two-stage reverse osmosis water treatment devices, one inlet of supply system into dialysis machine, and the mixed liquid outlets. One milliliter of the liquid was extracted and sealed as samples. A and B liquid collection were collected by the same method. The chemical pollutants and bacteria were detected. Results The 178 samples were collected from mixed liquid, which included 42 in spring, 45 in summer, 43 in autumn and 48 in winter. Six samples of the inlet, return port, A liquid and B liquid were collected in each quarter. The amount of bacterial colonies and endotoxin in spring were （18.07 ± 14.49） CFU/mL and （0.08 ± 0.04） EU/mL, respectively. The amount of bacterial colonies and endotoxin in summer were （40.43 ± 16.18） CFU/mL and （0.43 ± 0.16） EU/mL, respectively. The amount of bacterial colonies and endotoxin in autumn were （32.98 ± 18.77） CFU/mL and （0.18 ± 0.14） EU/mL, respectively. The amount of bacterial colonies and endotoxin in winter were （19.59 ± 12.27） CFU/mL and （0.19 ± 0.12） EU/mL, respectively. The amount of bacterial colonies and endotoxin in summer and autumn were higher than those in winter and spring. The dialysate unqualified was higher than that of water treatment on hemodialysis. Conclusion It is demonstrated that the hemodialysis machine should disinfect strengthen in summer and autumn.