针对医院在用的日机装DBB-27型血液透析机受信电极故障进行分析,运用从整体到局部的维修思路,迅速判断透析机故障的大致范围,通过采取对调方式,锁定并排除故障模块,发现其受信电极电压异常,通过在血液透析机内部水路部分管路中充满符合透析治疗要求的透析液后,使用钳夹工具夹闭管路,可有效阻断电信号传导,缩短了故障判断时间;采取电极线对调方式,快速完成电路信号传导,最终排除血液透析机受信电极故障,从而保证患者治疗过程中的安全.

目的:调研血液透析机内部超滤控制装置故障发生情况及特点,分析原因规范其维护保养.方法:对上海市82家血液净化中心(室)的3664台透析设备超滤故障进行调研,分析故障发生特点,找出超滤故障和超滤偏差发生原因.从执行透析设备自检程序、制定透析设备维护管理制度、掌握超滤控制装置结构部件误差和其他人为因素4个方面制定血液透析机超滤故障解决方案.结果:在82家血液净化中心(室)的3664台透析机中,超滤故障1692台(次),其中使用年限>5年的"平衡腔+超滤泵"类故障率最高,占比31.21％.血液透析机临床使用管理制度缺失、透析机日常消毒疏忽和专职透析临床工程师配置不足是超滤故障和超滤偏差发生的主要原因.结论:血液净化中心(室)应定期进行透析设备超滤控制装置的维护检查,规范血液透析机使用管理,严格细致的维护保养,配备专职透析临床工程师,保障血液透析机超滤控制装置日常运作的精准性和稳定性,确保透析患者获得最佳透析效果.

目的 血液透析机安全、稳定运行是日常透析治疗顺利开展的重要前提条件,需要定期进行机器的维护保养.通过对透析设备的调查,以了解透析机日常使用中故障发生情况及其特点,为临床规范透析机的维护保养提供依据.方法 采用回顾性分析方法,对上海市当前全部82家血液净化中心(室)进行透析设备的故障调研,分析故障发生的特点.结果 血液透析机临床使用过程中发生的水路故障大于其他故障,并且随着使用年数的增加而增加;专职透析临床工程师配置不足,对于年度保养中透析机生产厂商检测内容不明确等问题较为明显.结论 提高专职透析临床工程师的人员配置、业务能力以及进行规范化的年度保养能使透析治疗期间透析机的故障率下降,使得医患关系更加和谐,进一步保障透析治疗安全,提升透析治疗效果.

目的 符合透析治疗安全的透析用水是血液透析日常治疗开展的基本保障,根据统计分析内毒素含量的变化规律,探索控制透析用水内毒素含量的管理方式.方法 对上海市21家血液净化中心(室)2019年3月至2020年2月期间透析用水的内毒素(endotoxin,ET)含量数据进行汇总与统计分析.结果 透析用水内毒素含量在全年的春季与夏季中会存在部分偏高的情况,其中春季送检的样本中,ET含量>0.25 EU/ml比例占当季送检样本的0.57％,ET含量在0.03～0.25EU/ml之间的比例占7.34％;在夏季送检的样本中,ET含量>0.25EU/ml比例占当季送检样本的1.13％,ET含量在0.03～0.25EU/ml之间的比例占3.39％,与秋冬两季水平相比,差异有统计学意义(F11l.392,P值<0.001).结论 严格管控透析用水生产、输送过程的每个环节,规范采样流程、加强反渗机日常维护管理、重视水处理系统及配管的日常消毒等措施可减少血液透析相关的不良反应发生,提高患者透析质量.

目的:探究血液透析临床工程师对透析相关设备进行维护管理和监测的可行管理方法.方法:通过调研截止2019年底上海市82家血液净化中心(室)从事透析临床工程师人员岗位性质、从业情况及学历等信息,结合国内外临床工程师队伍发展状况,制定血液透析临床工程师的准入、培训、考核及职责等系统性管理办法.结果:在调研的82家血液透析治疗的血液净化中心(室)中,有66家配备专职透析临床工程师,透析工程师平均从业年限为4.5年,本科学历占比为82.32％.根据调研结果制定出了准入培训考核制度及血液透析设备日常维护管理职责.结论:血液透析中心(室)日常治疗的开展需要临床工程师的密切配合,配备专职血液透析临床工程师,定期维护管理和监测透析设备,能够有效降低透析设备故障,保障日常血液透析治疗安全有序开展.

血液透析机内部的超滤控制装置是日常透析治疗过程中,去除患者血液中多余水分的重要组成部分,根据目前不同品牌及型号的血液透析机超滤装置结构及原理进行分析比对,找出超滤故障和偏差发生的原因.

Objective To investigate endotoxin(ET) in hemdialysis water and dialysate used in the hemodialysis centers in Shanghai, and the factors relating to the ET contamination. Methods Specimens of hemdialysis water and dialysate were collected from 36 hemodialysis centers in Shanghai during Nov. 2010 to Oct. 2012. ET contamination in hemdialysis water and dialysate were evaluated. Results 1Of the 4438 samples obtained, 3790(85.40%) contained ET0.1 EU/ml, 482(10.86%) samples contained ET 0.1-0.5 EU/ml,and 166(3.75%) contained ET0.5EU/ml. 2In the 36 hemodialysis centers, 14 centers used double osmosis water treatment system and 22 centers used single osmosis water treatment system. In water samples from single osmosis system and double osmosis system, ET 0.1 EU/ml was found in 76.93% and 90.32% samples, respectively, and ET 0.1~0.5 EU/ml was detected in 15.48% and 6.93% samples, respectively. These differences were statistically significant. 3 The average ET level was significantly higher in August than in other months of the year. Conclusion The quality of hemdialysis water and dialysate was consistent with the national standards in most hemodialysis centers in Shanghai. Double osmosis system is better than single osmosis systems in treatment of water for hemodialysis. Seasonal influence also determined ET contamination in hemodialysis water.

Objective:To investigate the influence of water tank on endotoxin(ET)content in hemodialysis fluid.Methods:Specimens of hemodialysis fluid were collected from 36 hemodialysis centers in Shanghai from Nov 2010 to Oct 2012,and the ET content in hemodialysis fluid were detected by chromogenic substrate method.Results:A total of 2694 samples have been obtained from 36 hemodialysis centers during the 2 years’period.The contents of ET below 0.1 EU/mL were detected in 2348 (87.16%)samples,between 0.1 EU/mL and 0.5 EU/mL in 260(9.65%)samples,and above 0.5 EU/mL in 86(3.19%) samples.Water tanks were used in 19 of the 36 hemodialysis centers.ET contents of hemodialysis fluid in the hemodialysis cen-ters which used water tanks were higher than those didn’t use water tanks,and the difference showed statistical significance (P <0.05).Conclusion:The usage of water tank could significantly increase the ET content in hemodialysis fluid.Monitoring of water storage equipment should be strengthened.