Hemodialysis

Hemodialysis yana daya daga cikin maganin maye gurbin koda ga marasa lafiya masu fama da gazawar koda. Yana fitar da jini daga jiki zuwa wajen jiki kuma ya ratsa cikin na'urar dialize da ke kunshe da filaye marasa adadi. Jinin da maganin electrolyte (ruwa mai dialysis) tare da nau'ikan nau'ikan nau'ikan jiki suna ciki da waje daga cikin filaye masu fa'ida ta hanyar yaduwa, ultrafiltration, da adsorption. Yana musayar abubuwa tare da ka'idar convection, yana kawar da sharar gida a cikin jiki, yana kula da ma'aunin electrolyte da acid-base; a lokaci guda, yana kawar da ruwa mai yawa a cikin jiki, kuma dukkanin tsarin dawo da jinin da aka tsarkake ana kiransa hemodialysis.

ka'ida

1. Solute sufuri
(1) Watsawa: Ita ce babbar hanyar cire solute a HD. Ana jigilar solute daga ɓangaren haɓaka mai girma zuwa ɓangaren ƙananan hankali dangane da ƙaddamarwa. Wannan al'amari ana kiransa watsawa. Ƙarfin sufuri mai tarwatsewa na solute yana fitowa ne daga motsi mara kyau na ƙwayoyin solute ko barbashi da kansu (Motsi na Brown).
(2) Convection: Motsi na solutes ta cikin semipermeable membrane tare da sauran ƙarfi ake kira convection. Ba tare da tasiri da nauyin ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar cuta ba, ikon da ke cikin membrane shine bambancin matsa lamba na hydrostatic a bangarorin biyu na membrane, wanda shine abin da ake kira solute traction.
(3) Adsorption: Yana da ta hanyar hulɗar m da kuma mummunan zargin ko van der Waals sojojin da hydrophilic kungiyoyin a saman dialysis membrane don zaɓar adsorb wasu sunadaran, guba da kwayoyi (kamar β2-microglobulin, complement, masu shiga tsakani. Endotoxin, da dai sauransu). Ana cajin saman duk membranes na dialysis mara kyau, kuma adadin cajin mara kyau akan farfajiyar membrane yana ƙayyade adadin furotin da aka tallata tare da caji iri-iri. A cikin aikin hemodialysis, wasu sunadaran sunadaran da ba su da ƙarfi, da guba da magunguna a cikin jini ana zaɓan su a kan saman membrane na dialysis, ta yadda za a cire waɗannan abubuwa masu cutarwa, don cimma manufar magani.
2. Canja wurin ruwa
(1) Ma'anar ultrafiltration: Motsi na ruwa ta hanyar daɗaɗɗen ƙwayar cuta a ƙarƙashin aikin gradient na matsin lamba na hydrostatic ko gradient matsa lamba osmotic ana kiransa ultrafiltration. A lokacin dialysis, ultrafiltration yana nufin motsin ruwa daga gefen jini zuwa gefen dialysate; Sabanin haka, idan ruwan ya motsa daga gefen dialysate zuwa gefen jini, ana kiran shi reverse ultrafiltration.
(2) Abubuwan da suka shafi ultrafiltration: ① tsarkake ruwa matsa lamba gradient; ② matsa lamba osmotic gradient; ③ matsa lamba transmembrane; ④ ultrafiltration coefficient.

Alamu

1. Mummunan raunin koda.
2. Mummunan ciwon zuciya wanda ke haifar da hauhawar girma ko hauhawar jini wanda ke da wahalar sarrafawa da kwayoyi.
3. Mummunan acidosis mai tsanani da hyperkalemia mai wuyar gyarawa.
4. Hypercalcemia, hypocalcemia da hyperphosphatemia.
5. Rashin gazawar koda na lokaci-lokaci tare da anemia mai wuyar gyarawa.
6. Uremic neuropathy da kwakwalwa.
7. Uremia pleurisy ko pericarditis.
8. Ciwon koda na tsawon lokaci tare da rashin abinci mai gina jiki mai tsanani.
9. Rashin aikin gabobin da ba a iya bayyanawa ko raguwa a yanayin gaba ɗaya.
10. Magani ko guba.

Contraindications

1. Zubar da jini na ciki ko ƙara yawan matsa lamba na ciki.
2. Matsanancin girgiza wanda ke da wuyar gyarawa da kwayoyi.
3. Ciwon zuciya mai tsanani tare da raunin zuciya mai raguwa.
4. Tare da rashin lafiyar kwakwalwa ba zai iya yin aiki tare da maganin hemodialysis ba.

Kayan aikin hemodialysis

Kayan aikin na hemodialysis sun hada da injin hemodialysis, maganin ruwa da dilyzer, wadanda tare suka samar da tsarin hemodialysis.
1. Injin haemodialysis
yana daya daga cikin kayan aikin warkewa da aka fi amfani da su wajen maganin tsarkakewar jini. Kayan aikin mechatronics ne mai rikitarwa, wanda ya ƙunshi na'urar sa ido kan wadatar dialysate da na'urar lura da kewayawa na waje.
2. Tsarin kula da ruwa
Tunda jinin majiyyaci a cikin zaman dialysis dole ne ya tuntubi wani adadi mai yawa na dialysate (120L) ta cikin membrane na dialysis, kuma ruwan famfo na birni yana dauke da abubuwa daban-daban, musamman ma karafa masu nauyi, da kuma wasu magungunan kashe kwayoyin cuta, endotoxins da kwayoyin cuta, tuntuɓar jini. zai haifar da wadannan Abun yana shiga jiki. Don haka, ruwan famfo yana buƙatar tacewa, cire ƙarfe, laushi, kunna carbon, da sarrafa osmosis a jere. Ruwan osmosis kawai za a iya amfani da shi azaman ruwan dilution don dialysate mai tattarawa, kuma na'urar don jerin jiyya na ruwan famfo shine tsarin kula da ruwa.
3. Dialyzer
ana kuma kiranta da "kyan aikin wucin gadi". Ya ƙunshi zaruruwa mara kyau da aka yi da kayan sinadarai, kuma kowane zaren zaren yana rarraba da ƙananan ramuka masu yawa. A lokacin dialysis, jini yana gudana ta cikin filaye mai zurfi kuma dialysate yana gudana baya ta cikin zaren maras kyau. Solute da ruwa na wasu ƙananan ƙwayoyin cuta a cikin ruwan hemodialysis ana musayar su ta cikin ƙananan ramukan da ke kan filaye mai zurfi. Sakamakon ƙarshe na musayar shine jini a cikin jini. Ana cire gubar Uremia, wasu electrolytes, da ruwa mai yawa a cikin dialysate, wasu bicarbonate da electrolytes a cikin dialysate suna shiga cikin jini. Don cimma manufar kawar da gubobi, ruwa, kiyaye ma'aunin acid-base da kwanciyar hankali na ciki. A jimlar yanki na dukan m fiber, da musayar yankin, kayyade nassi damar kananan kwayoyin, da kuma girman da membrane pore size kayyade nassi damar matsakaici da kuma manyan kwayoyin.
4. Dialysate
Ana samun dialysate ta hanyar diluting da dialysis maida hankali dauke da electrolytes da sansanonin da baya osmosis ruwa a gwargwado, kuma a karshe ya samar da wani bayani kusa da jini electrolyte maida hankali ga kula da al'ada electrolyte matakan, yayin da samar da sansanonin ga jiki ta mafi girma tushe maida hankali , To. gyara acidosis a cikin haƙuri. Abubuwan da aka fi amfani da su na dialysate galibi bicarbonate ne, amma kuma sun ƙunshi ƙaramin adadin acetic acid.