Hemodialysis

Hemodialysis ndi imodzi mwa njira zochizira aimpso kwa odwala omwe ali ndi vuto laimpso komanso lolephera. Amatulutsa magazi kuchokera m'thupi kupita kunja kwa thupi ndipo amadutsa mu dialyzer yokhala ndi ulusi wosawerengeka wopanda kanthu. Magazi ndi ma electrolyte solution (dialysis fluid) omwe ali ndi minyewa yofananira m'thupi amakhala mkati ndi kunja kwa ulusi wapabowo kudzera mu kufalikira, kuchulukirachulukira, ndi kutsatsa. Imasinthanitsa zinthu ndi mfundo ya convection, imachotsa zinyalala zama metabolic mthupi, imasunga ma electrolyte ndi acid-base balance; nthawi yomweyo, imachotsa madzi ochulukirapo m'thupi, ndipo njira yonse yobwezeretsa magazi oyeretsedwa imatchedwa hemodialysis.

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1. Zoyendera zokhazikika
(1) Kubalalika: Ndilo njira yayikulu yochotsera solute mu HD. The solute imatengedwa kuchokera ku mbali yokhazikika kwambiri kupita ku mbali yotsika kwambiri malinga ndi kuchuluka kwa ndende. Chodabwitsa ichi chimatchedwa kubalalitsidwa. Mphamvu zoyendera zamtundu wa solute zimachokera kukuyenda kosakhazikika kwa mamolekyu a solute kapena tinthu tating'ono (Brownian motion).
(2) Convection: Kusuntha kwa zosungunulira kudzera mu nembanemba yotha kusungunuka pamodzi ndi zosungunulira kumatchedwa convection. Mosakhudzidwa ndi kulemera kwa maselo a solute ndi kusiyana kwake kwa gradient, mphamvu kudutsa nembanembayo ndi kusiyana kwa hydrostatic ya kuthamanga kwa mbali zonse za nembanemba, komwe kumatchedwa solute traction.
(3) Adsorption: Ndi kudzera mu kuyanjana kwa milandu yabwino ndi yolakwika kapena mphamvu za van der Waals ndi magulu a hydrophilic pamwamba pa dialysis membrane kuti adsorbe mapuloteni ena, poizoni ndi mankhwala (monga β2-microglobulin, wothandizira, oyimira pakati. Endotoxin, etc.). Pamwamba pa nembanemba onse dialysis ndi zoipa mlandu, ndi kuchuluka kwa mlandu zoipa pa nembanemba pamwamba zimatsimikizira kuchuluka kwa mapuloteni adsorbed ndi milandu heterogeneous. M'kati mwa hemodialysis, mapuloteni ena okwera kwambiri, ziphe ndi mankhwala osokoneza bongo m'magazi amasankhidwa mosankha pamwamba pa nembanemba ya dialysis, kuti zinthu izi zichotsedwe, kuti akwaniritse cholinga chamankhwala.
2. Kutumiza madzi
(1) Tanthauzo la Ultrafiltration: Kusuntha kwamadzi kudzera mu nembanemba yokhoza kutha pang'onopang'ono pansi pa hydrostatic pressure gradient kapena osmotic pressure gradient imatchedwa ultrafiltration. Pa dialysis, ultrafiltration imatanthawuza kuyenda kwa madzi kuchokera kumbali ya magazi kupita ku dialysate; Mosiyana ndi zimenezo, ngati madzi asuntha kuchokera kumbali ya dialysate kupita kumbali ya magazi, amatchedwa reverse ultrafiltration.
(2) Zinthu zomwe zimakhudza kuchulukirachulukira: ①kutsika kwamphamvu kwamadzi; ②osmotic kuthamanga gradient; ③ kuthamanga kwa transmembrane; ④ultrafiltration coefficient.

Zizindikiro

1. Kuvulala koopsa kwa impso.
2. Kulephera kwa mtima kwakukulu chifukwa cha kuchuluka kwa voliyumu kapena kuthamanga kwa magazi komwe kumakhala kovuta kuwongolera ndi mankhwala.
3. Kuchuluka kwa metabolic acidosis ndi hyperkalemia komwe kumakhala kovuta kukonza.
4. Hypercalcemia, hypocalcemia ndi hyperphosphatemia.
5. Kulephera kwaimpso kosatha ndi kuchepa kwa magazi m'thupi komwe kumakhala kovuta kukonza.
6. Uremic neuropathy ndi encephalopathy.
7. Uremia pleurisy kapena pericarditis.
8. Kulephera kwaimpso kosatha pamodzi ndi kuperewera kwa zakudya m'thupi.
9. Kusokonekera kwa chiwalo chosadziwika bwino kapena kuchepa kwa chikhalidwe.
10. Mankhwala osokoneza bongo kapena poizoni.

Contraindications

1. Kutaya magazi m'mitsempha kapena kuwonjezereka kwa intracranial pressure.
2. Kugwedezeka kwakukulu komwe kumakhala kovuta kukonza ndi mankhwala.
3. Kwambiri cardiomyopathy limodzi ndi refractory mtima kulephera.
4. Kuphatikizidwa ndi kusokonezeka kwa maganizo sikungathe kugwirizana ndi chithandizo cha hemodialysis.

Hemodialysis zida

Zida za hemodialysis zikuphatikizapo makina a hemodialysis, chithandizo cha madzi ndi dialyzer, zomwe pamodzi zimapanga dongosolo la hemodialysis.
1. Makina a hemodialysis
ndi chimodzi mwa zida zochizira zomwe zimagwiritsidwa ntchito kwambiri poyeretsa magazi. Ndi zida zovuta zamakanika, zopangidwa ndi zida zowunikira ma dialysate komanso chipangizo chowunikira ma circulation cha extracorporeal.
2. Njira yothetsera madzi
Popeza magazi a wodwala mu gawo la dialysis amayenera kulumikizana ndi dialysate yambiri (120L) kudzera mu nembanemba ya dialysis, ndipo madzi apampopi am'tawuni amakhala ndi zinthu zosiyanasiyana, makamaka zitsulo zolemera, komanso mankhwala ophera tizilombo, ma endotoxins ndi mabakiteriya, kukhudzana ndi magazi. zipangitsa izi Zomwe zimalowa m'thupi. Chifukwa chake, madzi apampopi amafunikira kusefedwa, kuchotsedwa kwachitsulo, kufewetsa, activated carbon, ndi reverse osmosis kukonzedwa motsatizana. Madzi obwerera okhawo a osmosis angagwiritsidwe ntchito ngati madzi osungunula a dialysate yokhazikika, ndipo chipangizo chamankhwala angapo amadzi apampopi ndi njira yoyeretsera madzi.
3. Dialyzer
imatchedwanso "impso zopangira". Amapangidwa ndi ulusi wopanda pake wopangidwa ndi zinthu za mankhwala, ndipo ulusi uliwonse wopanda kanthu umagawidwa ndi timabowo tambirimbiri. Pa dialysis, magazi amayenda kudzera mu ulusi womwewo ndipo dialysate imayenda cham'mbuyo kudzera mu ulusi womwewo. Solute ndi madzi a mamolekyu ang'onoang'ono amadzimadzi a hemodialysis amasinthidwa kudzera m'mabowo ang'onoang'ono a ulusi womwewo. Chotsatira chomaliza cha kusinthanitsa ndi magazi m'magazi. Poizoni wa uremia, ma electrolyte ena, ndi madzi ochulukirapo amachotsedwa mu dialysate, ndipo ma bicarbonate ndi ma electrolyte mu dialysate amalowa m'magazi. Kuti mukwaniritse cholinga chochotsa poizoni, madzi, kukhalabe ndi acid-base bwino komanso kukhazikika kwa chilengedwe. Chigawo chonse cha ulusi wopanda dzenje, malo osinthira, amatsimikizira kuchuluka kwa mamolekyu ang'onoang'ono, ndipo kukula kwa nembanemba pore kukula kumatanthawuza kuchuluka kwa mamolekyu apakati ndi akulu.
4. Dialysate
Dialysate imapezedwa ndikuchepetsa kuchuluka kwa dialysis komwe kumakhala ndi ma electrolyte ndi zoyambira ndikusinthira madzi a osmosis molingana, ndipo pamapeto pake amapanga yankho pafupi ndi ndende ya electrolyte yamagazi kuti asunge milingo ya electrolyte wamba, pomwe akupereka maziko ku thupi kudzera m'magulu apamwamba kwambiri. konzani acidosis mwa wodwalayo. Maziko a dialysate omwe amagwiritsidwa ntchito kwambiri ndi bicarbonate, komanso amakhala ndi asidi pang'ono.