Ward D M
Department of Medicine, University of California, San Diego, USA.
Adv Ren Replace Ther. 1996 Oct;3(4):337-47. doi: 10.1016/s1073-4449(96)80014-8.
Several outbreaks of hemolysis in hemodialysis patients have occurred when chloramines in the public water supply have not been adequately removed by the dialysis unit's water purification system. Chloramines are not removed by reverse osmosis or deionization, and need to be either adsorbed by filtration through granular activated carbon (GAC) or neutralized by chemical reduction by ascorbic acid (vitamin C) added to the dialysate. Chloramine levels in the incoming water can fluctuate unpredictably, and failures of both systems have occurred when chloramines have exhausted their capacity. The medical and technical issues associated with both methods are explored in detail. Safety depends on critical care in the design of the system and rigorous testing more than once daily. Most dialysis units now depend on GAC filters, two of which should be placed in series so that chloramine breakthrough can be detected after the first one, before the second one fails. Comprehensive standards in force in California have not yet been applied universally.
当透析单元的水净化系统未能充分去除公共供水系统中的氯胺时，血液透析患者中就会发生几起溶血事件。反渗透或去离子法无法去除氯胺，需要通过颗粒活性炭（GAC）过滤吸附或通过向透析液中添加抗坏血酸（维生素C）进行化学还原中和。进水的氯胺水平可能会出现不可预测的波动，当氯胺耗尽其容量时，两种系统都会出现故障。本文详细探讨了与这两种方法相关的医学和技术问题。安全性取决于系统设计中的严格把关以及每天不止一次的严格测试。现在大多数透析单元都依赖GAC过滤器，其中两个应串联放置，以便在第一个过滤器失效之前、第二个过滤器失效之前就能检测到氯胺穿透。加利福尼亚州现行的综合标准尚未得到普遍应用。
