Gault M H, Duffett A L, Murphy J F, Purchase L H
General Hospital and Memorial University, St. John's Newfoundland, Canada.
ASAIO J. 1992 Jul-Sep;38(3):M431-5. doi: 10.1097/00002480-199207000-00070.
Sterile dialysate, free of endotoxin (ET) and other cytokine inducing factors, will probably become a future standard. High-flux dialysis with bicarbonate and reuse has the membrane, the pressures, and bacteriologic potential for ET fragments to pass from dialysate to the blood side of the membrane with activation of monocytes and production of cytokines. Ultrafiltration through polysulfone filters has been shown to remove bacteria, ET, and its fragments and other cytotoxic inducing factors. The authors found that in spite of sterile, ET-free, reverse osmosis (RO) water, ET was usually present at the dialyzer inlet and arose from the RO storage tank water with bacteria < 30 CFU/ml, in spite of repeated disinfection. The authors now remove bacteria, ET, and fragments from RO tank water with a 5 mu cellulose filter followed by ultrafiltration with a Fresenius F-80 polysulfone dialyzer inserted between the wall RO delivery port and each delivery system. At the dialyzer inlet, monthly bacterial counts were < 30 cfu/ml, and ET values (n = 38) were not detectable in 89% and < 0.5 EU/ml in 11%. The F-80 filters were used for 180+ dialyses along with the 5 mu filters, which replaced the frequently endotoxin contaminated 10 mu filters in the Monitral-S delivery systems. The costs did not increase.
不含内毒素（ET）及其他细胞因子诱导因子的无菌透析液可能会成为未来的标准。使用碳酸氢盐和复用的高通量透析，其膜、压力以及细菌学条件使得ET片段有从透析液进入膜血液侧的可能，进而激活单核细胞并产生细胞因子。已证实通过聚砜滤器进行超滤可去除细菌、ET及其片段以及其他细胞毒性诱导因子。作者发现，尽管使用的是无菌、无ET的反渗透（RO）水，但尽管经过反复消毒，ET通常仍存在于透析器入口处，且源自RO储水箱中细菌含量<30 CFU/ml的水。作者现在先用一个5微米的纤维素滤器去除RO水箱水中的细菌、ET及其片段，然后在RO壁式出水口与每个输送系统之间插入一个费森尤斯F - 80聚砜透析器进行超滤。在透析器入口处，每月细菌计数<30 cfu/ml，ET值（n = 38）在89%的样本中检测不到，在11%的样本中<0.5 EU/ml。F - 80滤器与5微米滤器一起用于180多次透析，5微米滤器取代了Monitral - S输送系统中频繁被内毒素污染的10微米滤器，成本并未增加。
