臺灣博碩士論文加值系統

摘要

透析膜在血液透析治療過程中扮演很重要的角色。病患體內累積的尿毒素、過多的電解質及水分皆經由透析膜而移除，同時也可從透析液中提供病患體內不足的電解質。透析膜的材質不外乎是以纖維素為主要成份的纖維素透析膜及化學聚合而成的合成膜。本研究為10位接受門診血液透析治療的末期腎臟疾病病患，利用傳統血液透析：使用修飾型纖維素透析膜(Hemophan®) 4個月，再更換為高透量血液透析：使用合成透析膜(polysulfone) 4個月，在血清白蛋白值及Kt / Vurea的影響。結果發現，血清白蛋白並沒有統計上差異，但是在Kt / Vurea 卻有顯著的改進。從本研究的結果建議，在選擇透析膜時，血清白蛋白並不是很重要的考量，但Kt / Vurea 卻是很重要的決定因素。

ABSTRACT

Dialysis membranes play an important role in hemodialysis treatment process. The membranes are used to remove accumulated uremic toxins, excess electrolytes and water from the blood of patients via the dialysate, and to supply insufficient electrolytes from the dialysate. Various materials, including cellulose-based materials and synthetic polymers, are used for dialysis membranes. In this study, there were ten patients with ESRD (end-stage renal disease) undergoing hemodialysis at an outpatient department. We studied the effect of changes of the dialysis membrane from conventional hemodialysis with modified cellulosic membrane (Hemophan®) for 4 months to high-flux hemodialysis with synthetic membrane (polysulfone) for 4 months on serum albumin levels and Kt / Vurea. No statistical difference was observed in the serum albumin. However, there was a beneficial effect on Kt / Vurea. The results of our study suggest that serum albumin is not an important consideration in choosing a membrane for dialysis; but the value of Kt / Vurea would benefit from the choice of a proper dialyzer.

目次

摘要(中文)…………………………………………………………..….i
摘要(英文)……………………………………………………………..ii
目次…………………………………………………………………….iii
圖表目次………………………………………………………………..v
第一章 緒論……………………………………………………………1
1.1 簡介……………………………………………………………...1
1.2 研究背景………………………………………………………...2
1.3 研究動機………………………………………………………...4
第二章 文獻回顧………………………………………………………6
2.1 腎臟的功能及構造……………………………………………...6
2.2 尿毒症…………………………………………………………...8
2.3 糖尿病腎病變………………………………………………….10
2.4 血液透析……………………………………………………….11
2.5 透析器………………………………………………………….13
2.6 傳統透析與高透量透析……………………………………….16
2.7 血清白蛋白值與Kt / Vurea值………………………………….16

第三章 材料與方法…………………………………………………..19
3.1 研究對象………………………………………………….……19
3.2 血液採集及檢測方法………………………………………….20
3.3 研究方法……………………………………………………….22
3.4 研究資料之統計分析………………………………………….24
第四章 結果…………………………………………………………..25
第五章 討論…………………………………………………………..26
5.1 實驗策略的探討……………………………………………….26
5.2 血清白蛋白與透析膜生物相容性關係的探討……………….27
5.3 血清白蛋白與人工腎臟重覆使用關係的探討……………….28
5.4 Kt / Vurea與透析條件關係的探討……………………………...28
第六章 結論…………………………………………………………..30
第七章 參考文獻……………………………………………………..31

圖表目次

圖一 透析原理示意圖………………………………………………..39
表一 實驗對象，糖尿病性血液透析病患基本資料………………..40
表二 傳統血液透析與高透量血液透析使用的人工腎臟特性……..40
表三 傳統血液透析與高透量血液透析之透析條件：血液流量、透析液流量、透析膜面積、透析時間…………………………….41
表四 糖尿病性血液透析病患(n=10)，利用傳統血液透析與高透量血液透析，血清白蛋白值(albumin)值、透析劑量(Kt / Vurea)、尿素降低率(URR)之比較……………………………………….41

第七章 參考文獻

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