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血液透析患者出现热原反应原因调查 |
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龚明勋 王荣芝 付军 王宣 宋梅
提要 为探寻血液透析患者出现热原反应的原因，进行了微生物污染与消毒剂浓度调查。结果，消毒透析器所用过氧乙酸浓度低至0.05％～0.16％，贮罐中自来水、反渗水及透析器入口处透析液的细菌总数分别高达11 200 cfu/ml、1 580 cfu/ml与1 250 cfu/ml，透析液、反渗水细菌内毒素阳性率均为100％（20/20）。经确保过氧乙酸浓度≥0.3％，缩短消毒周期，改善液体过滤除菌设备，液体微生物检测均达标，未再出现热原反应。
关键词 污染调查 透析液污染 细菌污染 热原反应
INVESTIGATION OF CAUSE OF PYROGEN REACTION
IN PATIENTS RECEIVING HEMODIALYSIS
Gong Mingxun
(Siping Municipal Hospital for Neuropsychiatric Diseases,
Jilin Province, Siping 136000)
Wang Rongzhi Wang Xuan Song Mei
（Jilin Provincial People s Hospital）
Fu Jun
（Jilin Provincial Sanitary and Anti-epidemic Station）
Abstract
In order to find out the cause of pyrogen reaction in patients receiving hemodialysis, microorganism contamination and disinfectant concentration were investigated. The results indicated that the concentration of peracetic acid used for disinfection of dialyzer was as low as 0.05%～0.16%, the total bacterial counts of tap water and reverse dialysis water in reservoir and the dialysate at the inlet of the dialyzer were as high as 11 200 cfu/ml, 1580 cfu/ml and 1250 cfu/ml respectively, and the positive rate of bacterial endotoxin both in dialysate and reverse dialysis water was 100% (20/20). After raising the concentration of peracetic acid to ≥0.3%, shortening the disinfection cycle and improving the equipment for fluid filtration and bacteria removal, microorganism examination of the fluid found to meet the sanitary standard and no pyrogen reaction occurred again.
Key words investigation of contamination contamination of dialysate bacterial contamination pyrogen reaction
每年到我院进行体外血液透析治疗的病人达千余人次。1999年4月，在近两周时间里进行血液透析的168名病人中，全部于透析开始后30～60 min出现不同程度的寒颤、发热等热原反应症状。透析结束后，上述症状消失。为制定对防止热原反应有效的消毒措施，进行了有关调查。现将结果报告于下。
1 方法
1.1 过氧乙酸浓度测定
对消毒用的过氧乙酸溶液浓度，用碘量法测定。
1.2 微生物污染检测
在每台透析器透析液出、入口处，以无菌操作采集透析液。以无菌操作[1] [2] 下一页
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