臺灣博碩士論文加值系統

血液透析時，超過濾程序負責除去病人血液中多餘的血漿水，超過濾速率係由超過濾係數(Kuf)與膜上壓(TMP)決定。Kuf為透析器薄膜固有的重要質傳特性。血液透析治療時，如果透析器薄膜對白蛋白具有高通過率，則病人血液中蛋白質類會穿過薄膜而大量流失。因此，透析器對白蛋白的篩出係數應儘可能低至安全範圍，以確保透析器對血液中必要物質有甚低的通過率。本研究依據ISO 8637之要求：「超過濾與篩出係數之測定，測試流體應採用含抗凝血劑及蛋白質含量60±5g/L之牛血漿，或採用含抗凝血劑全血（血球比容32±3％及蛋白質含量60±5g/L）。超過濾係數測定應涵蓋TMP範圍與血液流量範圍。篩出係數測定應包含白蛋白、葡萄糖與肌紅蛋白或β2-Microglobulin，涵蓋超過濾速率範圍。我們應用實驗數據資料來計算得到透析器160與180之超過濾速率(KUF)分別為65.7±3.4 mL/hr/mmHg及74.0±3.3mL/hr/mmHg；篩出係數(Sc)平均為Inulin=1、β2-MG=0.78、 Albumin=0.006；透析膜阻力分別為184.37 cm/min及200.19 cm/min；血液腔質傳阻力分別為13.98 cm/min及4.73 cm/min；β2-MG反射係數σ為0.576及0.548；利用這些數據來計算得到透析膜膜孔半徑為4.29 nm及4.47 nm。

Ultrafiltration is mainly responsible for the removal of excess plasma water from patient′s blood during hemodialysis. The ultrafiltration rate is determined by ultrafiltration coefficient of the dialyzer (Kuf) and transmembrane pressure (TMP). Kuf is a natural and important mass transfer characteristic of the membrane of the dialyzer. A high albumin permeability of a hollow-fiber membrane may lead to protein losses for the patient during hemodialysis. Therefore, the goal is to manufacture a dialyzer with the lowest possible sieving coefficient for albumin to ensure the dialyzer has low permeability of essential substances. This study conforms to the requirements of ISO 8637, “ when test the ultrafiltration and sieving coefficients, the tested fluid should be bovine plasma containing anticoagulant and protein of 60±5g/L or whole blood containing anticoagulant (The hematocrit level is 32±3% and the protein content is 60±5g/L), the test of ultrafiltration coefficient should covers TMP and blood flow volume.” The test of sieving coefficient should include albumin, glucose, myoglobin or β2-Microglobulin, covering the range of ultrafiltraion rate. Utilizing the experimental data to calculate, then the KUF of model 160 and 180 were 65.7±3.4 mL/hr/mmHg and 74.0±3.3 mL/hr/mmHg respectively; the average sieving coefficients (Sc) were: Inulin=1、β2-MG=0.78、 Albumin=0.006; the dialysis membrane resistance were 184.37 cm/min and 200.19 cm/min respectively; the Solute mass-transfer resistance of the blood compartment boundary layer were 13.98 cm/min and 4.73 cm/min respectively the reflection coefficient σ of β2-MG was 0.576 and 0.548 ; The above data was used to calculate the pore radius of the dialysis membrane and in 4.29 nm and 4.47 nm respectively.

目錄
中文摘要 I
Abstract II
致謝 III
目錄 IV
圖索引 V
表索引 VI
第一章 緒論 8
1.1前言 8
1.2 研究目的 2
第二章 文獻回顧 3
2.1血液透析 3
2.2透析模的材料 6
2.3血液透析器 7
2.4擴散與超過濾 7
2.5透析膜發展 8
2.6高通量與低通量透析器臨床比較 9
2.7 Kedem-Katchalsky方程式 9
第三章 實驗原理與設計 11
3.1實驗理論 11
3.1.1超過濾係數(KUF) 11
3.1.2篩出係數 11
3.1.3質傳阻力 12
第四章 實驗材料與方法 15
4.1實驗材料與設備 15
4.2實驗方法 16
4.2.1 Kuf血液流量範圍之探討 17
4.2.2篩出係數 17
4.3檢驗方法 18
第五章 研究結果與討論 20
5.1超過濾係數 20
5.2 篩出係數 22
5.3分子直徑與擴散係數 24
5.4血液腔質傳阻力與透析膜阻力 24
5.5透析膜膜孔半徑 27
第六章 結論與未來展望 28
參考文獻 29
符號說明 33
附錄一 中空纖維透析器之廓清率實驗數據表 34
附錄二 透析膜膜孔半徑計算 36

圖索引
圖- 1台灣血液透析人數及死亡人數[5] 4
圖- 2血液透析基本原理 [8] 5
圖- 3過濾作用 6
圖- 4濾膜的質量傳送[21] 10
圖- 5 R v.s.(1/QB)m作圖 14
圖- 6 R v.s.(1/QD)m作圖 15
圖- 7透析器測量超過濾係數或篩出係數之系統圖 18
圖- 8以透析器160-1為例將超過濾流量v.s.膜上壓(TMP) 22
圖- 9以透析器180-1為例將超過濾流量v.s.膜上壓(TMP) 22
圖- 10透析器160將總質傳阻力(R)v.s. (1/QB)m 26
圖- 11透析器180將總質傳阻力(R)v.s. (1/QB)m 26

表索引
表- 1台灣血液透析相關統計資料[5] 4
表- 2尿毒溶質依分子量分類 12
表- 3假設實驗數據 13
表-4實驗設備 15
表- 5透析器 15
表- 6實驗耗材 15
表- 7實驗藥品 15
表- 8國內研發兩型中空纖維透析器規格 16
表- 9透析器160在QB=300 mL/min之下涵蓋超過濾流量範圍測得超過濾係數 (Kuf, mL/hr/mmHg) 21
表- 10透析器180在QB=300 mL/min之下涵蓋超過濾流量範圍測得超過濾係數 (Kuf ,mL/hr/mmHg) 21
表- 11透析器160 (n=3)在QB=300mL/min之下涵蓋超過濾流量(QF)範圍測得篩出係數(Sc) 22
表- 12透析器180 (n=3)在QB=300mL/min之下涵蓋超過濾流量(QF)範圍測得篩出係數(Sc) 23
表- 13透析器160及180與上市高通量透析器比較篩出係數 23
表- 14各種尿毒素溶質半徑與擴散係數 24
表- 15透析器160(n=3)在QD=500mL/min之下涵蓋血液流量(QB)範圍測得透析膜阻力(RM)與血液腔質傳阻力(RB) 25
表- 16透析器180 (n=3)在QD=500mL/min之下涵蓋血液流量(QB)範圍測得透析膜阻力(RM)與血液腔質傳阻力(RB) 25
表- 17透析器160與180β2-MG之σ及透析膜膜孔半徑 27

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