Hemodialysis

Hemodialysis yog ib qho kev kho mob raum rau cov neeg mob uas mob raum tsis ua haujlwm thiab mob ntev. Nws tso cov ntshav los ntawm lub cev mus rau sab nraud ntawm lub cev thiab dhau los ntawm lub tshuab lim dej uas muaj ntau yam hollow fibers. Cov ntshav thiab cov tshuaj electrolyte (dialysis kua) uas zoo sib xws ntawm lub cev yog nyob rau hauv thiab tawm ntawm lub hollow fibers los ntawm diffusion, ultrafiltration, thiab adsorption. Nws pauv cov tshuaj nrog lub hauv paus ntsiab lus ntawm convection, tshem tawm cov metabolism hauv lub cev, tswj cov electrolyte thiab acid-base tshuav nyiaj li cas; Nyob rau tib lub sijhawm, tshem tawm cov dej ntau dhau hauv lub cev, thiab tag nrho cov txheej txheem ntawm cov ntshav rov qab los yog hu ua hemodialysis.

txoj cai

1. Solute thauj
(1) Dispersion: Nws yog lub ntsiab mechanism ntawm solute tshem tawm hauv HD. Lub solute yog thauj los ntawm high-concentration sab mus rau low-concentration sab nyob ntawm qhov concentration gradient. Qhov tshwm sim no hu ua dispersion. Lub dispersive thauj lub zog ntawm solute los ntawm kev txav tsis tu ncua ntawm solute molecules los yog hais lawv tus kheej (Brownian motion).
(2) Convection: Lub zog ntawm cov kua los ntawm cov semipermeable membrane nrog rau cov kuab tshuaj hu ua convection. Tsis muaj kev cuam tshuam los ntawm qhov hnyav molecular thiab nws cov concentration gradient sib txawv, lub zog thoob plaws hauv daim nyias nyias yog hydrostatic siab sib txawv ntawm ob sab ntawm daim nyias nyias, uas yog hu ua solute traction.
(3) Adsorption: Nws yog los ntawm kev sib cuam tshuam ntawm cov nqi zoo thiab tsis zoo lossis van der Waals rog thiab cov pab pawg hydrophilic nyob rau saum npoo ntawm daim nyias nyias nyias kom xaiv cov proteins, tshuaj lom thiab tshuaj (xws li β2-microglobulin, ntxiv, inflammatory mediators. , Endotoxin, thiab lwm yam). Qhov saum npoo ntawm txhua daim nyias nyias yog qhov tsis zoo, thiab tus nqi ntawm qhov tsis zoo ntawm daim nyias nyias yog txiav txim siab tus nqi ntawm adsorbed proteins nrog cov nqi sib txawv. Nyob rau hauv tus txheej txheem ntawm hemodialysis, tej yam txawv txav elevated proteins, tshuaj lom thiab tshuaj nyob rau hauv cov ntshav yog xaiv adsorbed nyob rau saum npoo ntawm lub dialysis membrane, thiaj li hais tias cov pathogenic tshuaj raug tshem tawm, thiaj li mus cuag lub hom phiaj ntawm kev kho mob.
2. Kev hloov dej
(1) Ultrafiltration txhais: Lub zog ntawm cov kua los ntawm ib lub semi-permeable membrane nyob rau hauv qhov kev txiav txim ntawm ib tug hydrostatic siab gradient los yog ib tug osmotic siab gradient yog hu ua ultrafiltration. Thaum lub sij hawm dialysis, ultrafiltration yog hais txog kev txav ntawm cov dej los ntawm cov ntshav mus rau sab dialysate; conversely, yog tias cov dej txav ntawm sab dialysate mus rau sab ntshav, nws yog hu ua thim rov qab ultrafiltration.
(2) Yam cuam tshuam rau ultrafiltration: ①purified dej siab gradient; ②osmotic siab gradient; ③ transmembrane siab; ④ Ultrafiltration coefficient.

Cov lus qhia

1. Mob raum raug mob.
2. Mob plawv tsis ua hauj lwm tshwm sim los ntawm ntim ntau dhau los yog kub siab uas nyuaj rau kev tswj nrog tshuaj.
3. Mob hnyav metabolic acidosis thiab hyperkalemia uas nyuaj rau kho.
4. Hypercalcemia, hypocalcemia thiab hyperphosphatemia.
5. Lub raum tsis ua haujlwm nrog cov ntshav ntshav uas nyuaj rau kho.
6. Uremic neuropathy thiab encephalopathy.
7. Uremia pleurisy lossis pericarditis.
8. Lub raum tsis ua haujlwm ua ke nrog kev noj zaub mov tsis zoo.
9. Kev piav tsis tau txog lub cev tsis ua haujlwm lossis kev poob qis hauv qhov xwm txheej.
10. Tshuaj los yog lom lom.

Contraindications

1. Intracranial hemorrhage lossis nce intracranial siab.
2. Kev poob siab hnyav uas nyuaj rau kho nrog tshuaj.
3. Mob hnyav cardiomyopathy nrog rau lub plawv tsis ua haujlwm refractory.
4. Nrog rau kev puas siab puas ntsws tsis tuaj yeem koom tes nrog kev kho hemodialysis.

Hemodialysis khoom

Cov cuab yeej ntawm hemodialysis suav nrog lub tshuab hemodialysis, kev kho dej thiab tshuab lim dej, uas ua ke tsim cov kab ke hemodialysis.
1. Hemodialysis tshuab
yog ib qho ntawm cov khoom siv kho mob uas siv ntau tshaj plaws hauv kev kho ntshav purification. Nws yog ib qho nyuaj mechatronics cov cuab yeej, muaj li ntawm dialysate mov xyuas cov cuab yeej thiab extracorporeal ncig xyuas cov cuab yeej.
2. Kev kho dej
Txij li thaum tus neeg mob cov ntshav nyob rau hauv ib lub lim tiam yuav tsum tau hu rau ib tug loj npaum li cas ntawm dialysate (120L) los ntawm lub dialysis daim nyias nyias, thiab lub nroog kais dej muaj ntau yam kab mob, tshwj xeeb tshaj yog hnyav hlau, raws li zoo raws li ib co tshuaj tua kab mob, endotoxins thiab kab mob, sib cuag nrog cov ntshav. yuav ua rau cov khoom no nkag mus rau hauv lub cev. Yog li ntawd, cov kais dej yuav tsum tau lim, hlau tshem tawm, softened, activated carbon, thiab thim rov qab osmosis ua tiav nyob rau hauv ib ntus. Tsuas yog cov dej rov qab osmosis tuaj yeem siv los ua cov dej dilution rau cov concentrated dialysate, thiab cov cuab yeej siv rau kev kho mob ntawm cov kais dej yog qhov kev kho dej.
3. Dialyzer
tseem hu ua "artificial raum". Nws yog tsim los ntawm hollow fibers ua los ntawm cov khoom siv tshuaj, thiab txhua qhov hollow fiber yog faib nrog ntau qhov me me. Thaum lub sij hawm dialysis, cov ntshav ntws los ntawm lub hollow fiber thiab lub dialysate ntws rov qab los ntawm lub hollow fiber. Cov kuab tshuaj thiab dej ntawm qee qhov me me hauv cov kua dej hemodialysis tau pauv los ntawm cov qhov me me ntawm cov hollow fiber. Qhov kawg tshwm sim ntawm kev sib pauv yog cov ntshav hauv cov ntshav. Uremia co toxins, qee cov electrolytes, thiab dej ntau dhau raug tshem tawm hauv dialysate, thiab qee qhov bicarbonate thiab electrolytes hauv dialysate nkag mus rau hauv cov ntshav. Txhawm rau kom ua tiav lub hom phiaj ntawm kev tshem tawm cov co toxins, dej, tswj cov kua qaub-puag tshuav thiab ib puag ncig kev ruaj ntseg. Tag nrho cheeb tsam ntawm tag nrho cov hollow fiber, thaj chaw pauv, txiav txim siab qhov kev muaj peev xwm ntawm cov me me molecules, thiab qhov loj ntawm daim nyias nyias pore loj txiav txim siab qhov muaj peev xwm ntawm nruab nrab thiab loj molecules.
4. Dialysate
Lub dialysate yog tau los ntawm diluting lub dialysis concentrate uas muaj electrolytes thiab bases thiab thim rov qab osmosis dej nyob rau hauv kev faib ua feem, thiab thaum kawg tsim ib qho kev daws teeb meem nyob ze rau cov ntshav electrolyte concentration kom tswj ib txwm electrolyte theem, thaum muab bases rau lub cev los ntawm ib tug siab dua puag concentration, kho cov acidosis hauv tus neeg mob. Feem ntau siv dialysate hauv paus feem ntau yog bicarbonate, tab sis kuj muaj me me ntawm acetic acid.