Montagnac R, Schillinger F, Milcent T, Croix J C
Service de Néphrologie-Hémodialyse, Centre Hospitalier Général de Troyes.
Nephrologie. 1988;9(1):29-32.
Since the more frequent use of highly permeable membranes and bicarbonate dialysate, hypersensitivity reactions are more often described during hemodialysis and raise the question of the entry of pyrogens from dialysate towards blood due to high permeability of membranes and to possible backfiltration. During dialysis sessions with such membranes, authors observed a severe collapse in a patient on bicarbonate fluid and a repeated Quincke's edema in another on acetate fluid. After exclusion of other causes of such hypersensitivity accidents, they discuss the role of bacterial contamination of dialysis fluid. They analyse the phenomenons of bidirectional high permeability and of backfiltration linked to these new membranes. They recall the different causes of dialysate contamination and give some means of avoiding these inconveniences which expose on one hand to acute severe reactions and on the other are prejudicial in the long term for the patients because of interleukin 1 production.
由于高通透性膜和碳酸氢盐透析液的使用愈发频繁，血液透析期间超敏反应的描述更为常见，这引发了关于由于膜的高通透性和可能的反渗滤导致热原从透析液进入血液的问题。在用此类膜进行透析治疗期间，作者观察到一名使用碳酸氢盐透析液的患者出现严重虚脱，另一名使用醋酸盐透析液的患者反复出现昆克水肿。在排除此类超敏反应事件的其他原因后，他们讨论了透析液细菌污染的作用。他们分析了与这些新型膜相关的双向高通透性和反渗滤现象。他们回顾了透析液污染的不同原因，并给出了一些避免这些不便之处的方法，这些不便一方面会引发急性严重反应，另一方面由于白细胞介素1的产生，长期来看对患者有害。
