单床移动式水处理在儿童终末期肾脏病慢性血液透析中的应用

Application of portable water treatment system for maintenance hemodialysis in children with end stage renal disease

目的探讨单床移动式水处理在中国儿童终末期肾病慢性血液透析中的安全性和应用价值。方法采用单床移动式水处理系统,通过进水前处理装置、水质软化机、RO反渗透水处理机所产生的透析用水进行维持性血液透析。回顾性分析本血液透析中心2010年8月至2014年3月3台单床移动式水处理机水质检测指标以及20例终末期肾病慢性血液透析患儿的透析充分性、并发症及转归。结果 1单床移动式水处理装置所产生的透析用水,其内毒素、细菌计数及水质重金属检测各项指标均符合2010年卫生部发布的血液净化标准操作规程(SOP)标准。自2013年5月改进前处理装置后,每台透析机透析用水的内毒素测定值较前进一步下降,内毒素定量测定值均<0.5 EU/ml,其中88%的测定值<0.25EU/ml,细菌培养均无细菌生长,比SOP推荐的标准更优化。220例慢性血液透析患儿无一例发生热源反应、溶血、硬水综合征等并发症。透析充分性评估显示,Kt/V达1.2±0.23、尿素清除率(URR)(66.68±7.32)%。维持性血液透析治疗后6月、12月、18月患儿血红蛋白的达标率分别为66.7%、60%、87.5%。3随访终点,20例慢性血液透析患儿存活率100%,11例患儿在维持性血液透析治疗期间正常上学,其中4例患儿接受肾移植治疗。结论单床移动式水处理装置所产生的透析用水的水质符合透析用水标准、稳定可靠、安全有效,较SOP推荐的标准更优化,适合我国儿童终末期肾病慢性血液透析治疗,在小型透析中心值得推广应用。

Objective To explore the usefulness and safety of single bed mobile dialysis water treatment system for maintenance hemodialysis （MHD） children with end stage renal disease （ESRD） in China. Meth- ods The portable water treatment system is composed of three parts： water pretreatment, water softening and reverse osmosis, producing pure water for hemodialysis. We examined the quality of water from the system and retrospectively reviewed the dialysis adequacy, complication and outcome of 20 MHD children using the water for dialysate in our center during the period from Aug. 2010 to Mar. 2014. Results ①Water quality in- dices including endotoxin level, bacteria count and heavy metal content were consistent with the criteria of standard operation procedure （SOP） for blood purification issued by Chinese Ministry of Health. Endotoxin level in dialysis water decreased further after improvement of the water pretreatment device beginning from May 2013. Endotoxin reduced to 〈0.5 EU/ml in all water samples and to 〈0.25 EU/ml in 88% samples. ②No fever reaction, hemolysis, hard water syndrome and other water related complications occurred in the 20 MHD children using the water for hemodialysis dialysate. In the 20 children, dialysis Kt/V was 1.2±0.23 and urea reduction rate was 66.68±7.32%. After 6 months, 12 months and 18 months of liD therapy, the rate of he- moglobin achieved to the recommended level was 66.7%, 60% and 87.5%, respectively.③ At the end of fol- low-up, patient survival rate was 100%, 11 cases returned to normal school during MHD therapy, and 4 cases received renal transplantation. Conclusion The quality of dialysis water produced by the portable water treatment system conformed to the standard of dialysis water and was even superior to the criteria of SOP recommendation. This water treatment system is suitable for children with MHD treatment in China, especially in centers with a small number ofhemodialysis patients.