Hemodialysis

ʻO ka hemodialysis kekahi o nā lāʻau lapaʻau hou no nā poʻe maʻi me ka hōʻino ʻole a me ka maʻi. Hoʻokahe ʻo ia i ke koko mai ke kino a i waho o ke kino a hele i loko o kahi dialyzer i haku ʻia me ka helu ʻole ʻana o nā ʻūhā. ʻO ke koko a me ka solution electrolyte (dialysis fluid) me nā ʻano like ʻole o ke kino aia i loko a i waho o nā ʻūhā hollow ma o ka diffusion, ultrafiltration, a adsorption. Hoʻololi ia i nā mea me ke kumu o ka convection, hoʻoneʻe i nā ʻōpala metabolic i loko o ke kino, mālama i ka electrolyte a me ka acid-base balance; i ka manawa like, wehe i ka wai nui i loko o ke kino, a ua kapa ʻia ke kaʻina holoʻokoʻa o ka hoʻihoʻi ʻana i ke koko i hoʻomaʻemaʻe ʻia he hemodialysis.

kumukānāwai

1. Ka lawe ʻana i ka solute
(1) Hoʻopuehu: ʻO ia ke kumu nui o ka wehe ʻana i ka solute ma HD. Lawe ʻia ka solute mai ka ʻaoʻao kiʻekiʻe a i ka ʻaoʻao haʻahaʻa ma muli o ka gradient hoʻopaʻa. Ua kapa ʻia kēia ʻano he dispersion. ʻO ka ikehu lawe hoʻopuehu o ka solute mai ka neʻe ʻole ʻana o nā molekole solute a i ʻole nā ​​mea ʻāpana iā lākou iho (Brownian motion).
(2) Convection: ʻO ka neʻe ʻana o nā solutes ma o ka membrane semipermeable me ka solvent i kapa ʻia he convection. ʻAʻole i hoʻopilikia ʻia e ka paona molecular solute a me kona ʻokoʻa gradient ʻokoʻa, ʻo ka mana ma waena o ka membrane ka ʻokoʻa hydrostatic pressure ma nā ʻaoʻao ʻelua o ka membrane, ʻo ia ka mea i kapa ʻia ka solute traction.
(3) Adsorption: Ma o ka hoʻopili ʻana o nā hoʻopiʻi maikaʻi a maikaʻi ʻole a i ʻole nā ​​kaha van der Waals a me nā pūʻulu hydrophilic ma ka ʻili o ka membrane dialysis e koho koho i kekahi mau protein, nā mea ʻawaʻawa a me nā lāʻau lapaʻau (e like me β2-microglobulin, hoʻohui, nā mea hoʻomakeʻe. , Endotoxin, etc.). Hoʻopiʻi maikaʻi ʻia ka ʻili o nā membrane dialysis a pau, a ʻo ka nui o ka uku maikaʻi ʻole ma ka ʻili membrane e hoʻoholo i ka nui o nā protein adsorbed me nā uku heterogeneous. I ke kaʻina o ka hemodialysis, ua koho ʻia kekahi mau protein kiʻekiʻe kiʻekiʻe, nā mea ʻawaʻawa a me nā lāʻau i loko o ke koko ma luna o ka ʻili o ka membrane dialysis, i hoʻopau ʻia kēia mau mea pathogenic, i mea e hoʻokō ai i ke kumu o ka mālama ʻana.
2. Hoʻoili wai
(1) ʻO ka wehewehe ʻana o Ultrafiltration: ʻO ka neʻe ʻana o ka wai ma o ka membrane semi-permeable ma lalo o ka hana o kahi gradient pressure hydrostatic a i ʻole kahi gradient pressure osmotic i kapa ʻia he ultrafiltration. I ka wā dialysis, e pili ana ka ultrafiltration i ka neʻe ʻana o ka wai mai ka ʻaoʻao koko a i ka ʻaoʻao dialysate; i ka ʻaoʻao ʻē aʻe, inā neʻe ka wai mai ka ʻaoʻao dialysate a i ka ʻaoʻao koko, ua kapa ʻia ʻo ia ka reverse ultrafiltration.
(2) Nā mea e pili ana i ka ultrafiltration: ①ka wai hoʻomaʻemaʻe ʻoniʻoni; ②osmotic kaomi gradient; ③transmembrane kaomi; ④Ultrafiltration coefficient.

Nā hōʻailona

1. ʻEha ʻeha ʻeha.
2. ʻO ka puʻuwai koʻikoʻi ma muli o ka nui o ka nui a i ʻole ke kiʻekiʻe kiʻekiʻe i paʻakikī ke mālama ʻia me nā lāʻau lapaʻau.
3. ʻO ka acidosis metabolic koʻikoʻi a me ka hyperkalemia i paʻakikī ke hoʻoponopono.
4. Hypercalcemia, hypocalcemia a me hyperphosphatemia.
5. ʻAʻole paʻakikī ka hoʻoponopono ʻana i ka renal renal me ka anemia.
6. Uremic neuropathy a me ka encephalopathy.
7. Uremia pleurisy a i ʻole pericarditis.
8. ʻAʻole i hui pū ʻia me ka ʻai ʻole nui.
9. ʻAʻole hiki ke wehewehe ʻia ka hana ʻino a i ʻole ka emi ʻana o ke kūlana maʻamau.
10. Ka lāʻau a i ʻole ka lāʻau ʻawaʻawa.

Contraindications

1. ʻO ka hemorrhage Intracranial a i ʻole ka piʻi ʻana o ke kaomi intracranial.
2. ʻO ka haʻalulu nui i paʻakikī ke hoʻoponopono me nā lāʻau lapaʻau.
3. ʻO ka cardiomyopathy koʻikoʻi i hele pū me ka puʻuwai refractory.
4. ʻAʻole hiki ke hui pū me nā maʻi noʻonoʻo me ka mālama hemodialysis.

Lako hemodialysis

ʻO nā mea hana o ka hemodialysis ka mīkini hemodialysis, ka mālama wai a me ka dialyzer, i hui pū ʻia i ka ʻōnaehana hemodialysis.
1. Mīkini hemodialysis
ʻO ia kekahi o nā mea lapaʻau i hoʻohana nui ʻia i ka hoʻomaʻemaʻe koko. He mea hana mechatronics paʻakikī, i haku ʻia me ka mea nānā lako hoʻolako dialysate a me ka mea nānā ʻana i ka extracorporeal circulation.
2. Pūnaehana mālama wai
Ma muli o ke koko o ka mea maʻi i loko o kahi kau dialysis pono e hoʻopili i ka nui o ka dialysate (120L) ma o ka membrane dialysis, a ʻo ka wai kīwī o ke kūlanakauhale aia nā ʻano mea like ʻole, ʻoi aku ka nui o nā metala kaumaha, a me kekahi mau disinfectants, endotoxins a me nā bacteria, pili me ke koko. ka mea e komo i ke kino. No laila, pono ke kānana ʻia ka wai paipu, hoʻoneʻe ʻia ka hao, hoʻopalupalu ʻia, carbon activated, a hoʻohuli i ka osmosis i hoʻopaʻa ʻia ma ke kaʻina. Hiki ke hoʻohana wale ʻia ka wai hoʻoheheʻe ʻia e like me ka wai dilution no ka dialysate concentrated, a ʻo ka mea hana no ke ʻano o ka mālama ʻana i ka wai paipu ʻo ia ka ʻōnaehana mālama wai.
3. Mea hoʻoheheʻe
ua kapa ʻia hoʻi ʻo "kikini artificial". Hoʻokumu ʻia ia me nā pulupulu i hana ʻia me nā mea kemika, a ua puʻunaue ʻia kēlā me kēia pulupulu me nā puka liʻiliʻi he nui. I ka wā o ka dialysis, kahe ke koko ma o ka hollow fiber a kahe ka dialysate i hope ma o ka hollow fiber. Hoʻololi ʻia ka solute a me ka wai o kekahi mau moleke liʻiliʻi i loko o ka wai hemodialysis ma o nā lua liʻiliʻi ma ka pulupulu. ʻO ka hopena hope loa o ka hoʻololi ʻana ʻo ke koko i loko o ke koko. Lawe ʻia nā toxins Uremia, kekahi mau electrolytes, a me ka wai nui i loko o ka dialysate, a komo kekahi bicarbonate a me nā electrolytes i loko o ka dialysate i ke koko. I mea e hoʻokō ai i ke kumu o ka wehe ʻana i nā toxins, ka wai, ka mālama ʻana i ke kaulike acid-base a me ka paʻa o ka nohona kūloko. ʻO ka huina o ka fiber hollow holoʻokoʻa, ka wahi hoʻololi, e hoʻoholo i ka hiki ke hele o nā molekole liʻiliʻi, a ʻo ka nui o ka nui o ka pore membrane e hoʻoholo i ka hiki ke hele o nā molekole medium a me ka nui.
4. Hoʻokaʻawale
Loaʻa ka dialysate ma ka hoʻoheheʻe ʻana i ka dialysis concentrate i loaʻa nā electrolytes a me nā kumu a hoʻohuli i ka wai osmosis i ka like, a i ka hopena e hana i kahi hopena kokoke i ke koko electrolyte ka hoʻomau ʻana i nā pae electrolyte maʻamau, ʻoiai e hāʻawi ana i nā kumu i ke kino ma o kahi kumu kiʻekiʻe. hoʻoponopono i ka acidosis i ka mea maʻi. ʻO nā kumu dialysate i hoʻohana mau ʻia he bicarbonate, akā loaʻa pū kekahi wahi liʻiliʻi o ka acetic acid.