Lundberg L, Stegmayr B G, Wehle B
Department of Internal Medicine, University Hospital, Umeå, Sweden.
Int J Artif Organs. 1994 Mar;17(3):131-6.
Backdiffusion of dialysate during haemodialysis with low-flux membranes and the use of bicarbonate dialysatebase, may increase the risk for contamination. The influence on the complement system was studied by altering the flux of acetate or bicarbonate dialysate base across the membrane. Eight patients were dialysed with a transmembrane pressure of 100 mm Hg (group I) during the first 60 min to standardize the ultrafiltration (UF) and acetate as dialysate. In eight other patients (group II) the UF was "set at zero" ml during the first 60 min using an FCM 10-1 monitor (Gambro) and bicarbonate as base. The groups were dialysed three times on two hollow-fiber membranes made of Hemophan and cellulose acetate (CA). Blood samples were taken at 0, 15, 60 and 180 min, and analysed for plasma protein, haematocrit and complement C3d. In group II there was a reduction in plasma protein concentration at 15 and 60 min (p < 0.002) for Hemophan and at 60 min (p < 0.01) using CA. C3d was increased at 15 min for both filters (p < 0.03). The reduction of protein in group II was followed by changes in the haematocrit, indicating a backdiffusion of dialysate, which may contribute to the concomittant increase in C3d.
使用低通量膜进行血液透析期间透析液的反向扩散以及使用碳酸氢盐透析液碱，可能会增加污染风险。通过改变醋酸盐或碳酸氢盐透析液碱跨膜通量，研究了其对补体系统的影响。8名患者在前60分钟期间以100毫米汞柱的跨膜压力进行透析（第一组），以使超滤（UF）标准化并使用醋酸盐作为透析液。在另外8名患者（第二组）中，在前60分钟期间使用FCM 10 - 1监测仪（金宝公司）将超滤设置为“零”毫升，并使用碳酸氢盐作为碱。两组患者在由血仿膜和醋酸纤维素（CA）制成的两种中空纤维膜上各透析3次。在0、15、60和180分钟采集血样，分析血浆蛋白、血细胞比容和补体C3d。在第二组中，使用血仿膜时，15分钟和60分钟时血浆蛋白浓度降低（p < 0.002），使用CA膜时60分钟时血浆蛋白浓度降低（p < 0.01）。两种滤器在15分钟时C3d均升高（p < 0.03）。第二组中蛋白质的减少伴随着血细胞比容的变化，表明透析液发生了反向扩散，这可能导致C3d随之增加。
