Relationship between dialyser type and signs and symptoms.
Relationship between dialyser type and signs and symptoms.
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透析器类型与体征和症状之间的关系。
DOI：
10.1093/ndt/8.supp2.30
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发表时间：
1993
期刊：
影响因子：
--
通讯作者：
G. Zasuwa
中科院分区：
文献类型：
--
作者：
N. Levin;G. Zasuwa
在4个国家的5个中心进行了一项交叉研究，比较了7种不同透析器对37例使用含醋酸盐透析液透析的患者透析中症状的影响。所有中心使用的每台透析器和血液管路套件的生产批次相同。收集了相同的临床数据（透析持续时间、血压、体重、体温、药物、症状和治疗）和技术数据（血流量、透析器清除率和超滤率）。尿素的Kt/V用于确定规定的透析。每小时或由工作人员使用血液透析治疗表观察时测量透析中症状和体征（见引言）。每周使用特定透析器治疗后，患者完成一份关于症状存在和严重程度的问卷。(Only有无症状）。观察到中心之间透析持续时间和血流量存在较大差异。这些可能导致了中心之间工作人员报告的对不同透析器的反应存在差异：体征和症状以及胸痛、背痛和瘙痒（任意指定的生物不相容性症状）发生率最低的透析器是Duo-Flux和Filtral，G120 M、CD 4000和T 150的发生率最高。根据患者问卷，生物相容性最好的透析器是T 150、F 60和Filtral，产生症状最多的是G120 M和G10- 3 N。患者和工作人员之间的症状感知差异很大，整体和中心之间。在两名患者中观察到超敏反应，这两名患者均发生在铜氨纤维素中空纤维透析中，尽管遵守了制造商关于生理盐水预充和清除的说明。两名患者均显示抗环氧乙烷-HSA的抗体滴度大于1：160。在透析器、血液管路套件或瘘管针中未检测到环氧乙烷（检测限1 ppm）。该研究表明，透析症状报告因个人感知、工作人员反应和记录效率而变得复杂。在这项研究中，种族和文化差异必须添加到血流动力学差异和其他处方相关因素对症状的影响。尽管存在这些问题，但可以识别出透析器相关症状和体征的层次结构，这在很大程度上证实了生物相容性的实验室结果。未来将透析学与膜和透析器结构相关的比较研究应考虑确定为影响症状及其报告的变量。
A crossover study to compare the effects of seven different dialysers on intradialytic symptoms in 37 patients during dialysis with acetate-containing dialysate was performed at five centres in four countries. The same manufacturing lot of each dialyser and of blood line sets were used by all centres. The same clinical data (duration of dialysis, blood pressure, weights, temperature, drugs, symptoms, and treatments) and technical data (blood flow, dialyser clearance, and ultrafiltration rate) were collected. Kt/V for urea was used to determine dialysis prescribed. Intradialytic symptoms and signs were measured hourly or when observed by staff using the haemodialysis treatment form (see Introduction). After each week of treatment with a particular dialyser, patients completed a questionnaire relating to the presence and severity of symptoms. (Only presence or absence of symptoms are presented.) Wide differences in dialysis duration and blood flow between centres were noted. These may have contributed to the differences between centres in relationship to staff reported responses to different dialyser: Dialysers with the lowest incidence of both signs and symptoms and of chest pain, back pain, and itching (arbitrarily designated bioincompatibility symptoms) were the Duo-Flux and Filtral, with the G120 M, the CD 4000, and the T 150 having the highest incidence. By patient questionnaire the most biocompatible dialysers were the T 150, F 60, and the Filtral, with the most symptom producing being the G120 M and the G10-3N. Perceptions of symptoms between patients and staff differed substantially overall and between centres. Hypersensitivity reactions were noted in two patients, both occurring with cuprammonium cellulose hollow-fibre dialysis, despite adherence to manufacturers' instructions concerning saline priming and removal. Both patients showed antibody titres greater than 1:160 against ethylene oxide-HSA. Ethylene oxide was not detected (limit of detection 1 part per million) in dialysers, blood line sets, or fistula needles. The study suggests that dialysis symptom reporting is complicated by individual perceptions, staff reactions, and the efficiency of recording. In this study ethnic and cultural differences must be added to the haemodynamic differences and other prescription-related elements in influencing symptoms. Despite these problems a hierarchy of dialyser-related symptoms and signs could be discerned which largely paralleled laboratory findings of biocompatibility. Future comparative studies relating symptomatology to membrane and dialyser structure should consider the variables identified as influencing symptoms and their reporting.