Hemodialysis

Hemodialysis ndeimwe yemishonga yekutsiva renal kune varwere vane acute uye vasingaperi renal kutadza. Inobvisa ropa kubva mumuviri kuenda kunze kwemuviri uye inopfuura nemudialyzer inoumbwa neasingaverengeke maburi fibers. Ropa nemhinduro ye electrolyte (dialysis fluid) ine mazinga akafanana emuviri ari mukati nekubuda kunze kwemafibers asina mhango kuburikidza nekupararira, ultrafiltration, uye adsorption. Inotsinhanisa zvinhu nemusimboti weconvection, inobvisa tsvina yemetabolism mumuviri, inochengetedza electrolyte uye acid-base balance; panguva imwecheteyo, inobvisa mvura yakawandisa mumuviri, uye nzira yose yekudzorera ropa rakanatswa inonzi hemodialysis.

musimboti

1. Solute transport
(1) Kupararira: Ndiyo nzira huru yekubvisa solute muHD. Iyo solute inotakurwa kubva kudivi repamusoro-yakadzika kuenda kune yakaderera-yakadzika parutivi zvichienderana neiyo concentration gradient. Chiitiko ichi chinonzi dispersion. Iyo inoparadzira simba rekutakura re solute rinobva mukusajairika kwekufamba kwe solute mamorekuru kana zvidimbu pachazvo (Brownian motion).
(2) Convection: Kufamba kwezvinonyunguduka kuburikidza nemembrane ye semipermeable pamwe chete ne solvent inonzi convection. Asina kukanganiswa neiyo solute molecular huremu uye iyo concentration gradient musiyano, simba pa membrane ndiyo hydrostatic pressure musiyano pamativi ese e membrane, inova inonzi solute traction.
(3) Adsorption: Iri kuburikidza nekubatana kwezvakanaka uye zvisina kunaka mhosva kana van der Waals masimba uye hydrophilic mapoka pamusoro pe dialysis membrane kuti adsorb adsorb mamwe mapuroteni, chepfu uye zvinodhaka (zvakadai se β2-microglobulin, inopindirana, mhirizhonga inoputika. Endotoxin, nezvimwewo). Iyo yepamusoro yeese dialysis membranes inopomerwa zvisina kunaka, uye huwandu hwekuchaja kwakashata pane membrane uso hunotaridza huwandu hweadsorbed mapuroteni ane heterogeneous charges. Mukuita hemodialysis, mamwe mapuroteni akakwira zvisina kujairika, chepfu uye zvinodhaka zviri muropa zvinosarudzika adsorbed pamusoro peiyo dialysis membrane, kuitira kuti izvi pathogenic zvinhu zvibviswe, kuitira kuzadzisa chinangwa chekurapa.
2. Kuendesa mvura
(1) Ultrafiltration tsananguro: Kufamba kwemvura kuburikidza nesemi-permeable membrane pasi pekuita kwehydrostatic pressure gradient kana osmotic pressure gradient inonzi ultrafiltration. Panguva yedialysis, ultrafiltration inoreva kufamba kwemvura kubva kudivi reropa kuenda kudivi redialysate; Ukuwo, kana mvura ikafamba kubva kudivi redialysate kuenda kudivi reropa, inonzi reverse ultrafiltration.
(2) Zvinhu zvinokanganisa ultrafiltration: ① yakacheneswa mvura inodzvinyirira gradient; ②osmotic pressure gradient; ③transmembrane pressure; ④ultrafiltration coefficient.

Zviratidzo

1. Kukuvara kwakanyanya kweitsvo.
2. Acute heart failure inokonzerwa ne volume overload kana hypertension yakaoma kudzora nemishonga.
3. Yakanyanya metabolic acidosis uye hyperkalemia izvo zvakaoma kugadzirisa.
4. Hypercalcemia, hypocalcemia uye hyperphosphatemia.
5. Kusashanda zvakanaka kwetsvo neanemia izvo zvakaoma kugadzirisa.
6. Uremic neuropathy uye encephalopathy.
7. Uremia pleurisy kana pericarditis.
8. Kusashanda zvakanaka kwetsvo pamwe chete nekushaya zvokudya zvinovaka muviri zvakanyanya.
9. Kusashanda zvakanaka kwenhengo kusingatsananguriki kana kudzikira mumamiriro ese.
10. Mushonga kana muchetura.

Contraindications

1. Intracranial hemorrhage kana kuwedzera intracranial pressure.
2. Kuvhunduka kwakanyanya kwakaoma kugadzirisa nemishonga.
3. Yakanyanya cardiomyopathy inoperekedzwa nerefractory heart failure.
4. Inoperekedzwa nekukanganiswa kwepfungwa haigoni kuwirirana nekurapa hemodialysis.

Hemodialysis midziyo

Midziyo yehemodialysis inosanganisira hemodialysis muchina, kurapwa kwemvura uye dialyzer, izvo pamwe chete zvinoumba hemodialysis system.
1. Hemodialysis muchina
ndeimwe yemidziyo inoshandiswa zvakanyanya mukurapa kwekuchenesa ropa. Iyo yakaomesesa mechatronics midziyo, inoumbwa nedialysate yekugovera yekutarisa mudziyo uye extracorporeal kutenderera kwekutarisa mudziyo.
2. Mvura yekurapa nzira
Sezvo ropa remurwere muchikamu chedialysis rinofanirwa kubata yakawanda dialysate (120L) kuburikidza nedialysis membrane, uye mvura yemumapombi yemudhorobha ine zvinhu zvakasiyana-siyana zvekutevera, kunyanya simbi dzinorema, pamwe nemamwe mishonga inouraya utachiona, endotoxins uye mabhakitiriya, kusangana neropa. zvichakonzera izvi Chinhu chinopinda mumuviri. Naizvozvo, mvura yemupombi inoda kusefa, simbi ibviswe, kupfava, activated kabhoni, uye reverse osmosis inogadziriswa mukutevedzana. Chete reverse osmosis mvura inogona kushandiswa semvura yekunyungudutsa yeiyo yakadzika dialysate, uye mudziyo wekutevedzana kwekurapa kwepombi yemvura ndiyo nzira yekurapa mvura.
3. Dialyzer
inonziwo "artificial itsvo". Iyo inoumbwa nehollow fibers yakagadzirwa nemakemikari zvinhu, uye yega yega fiber fiber inogoverwa nemaburi madiki akawanda. Panguva yedialysis, ropa rinoyerera nepakati pehollow fiber uye dialysate inoyerera ichidzokera kumashure kuburikidza nehollow fiber. Solute nemvura yemamwe mamorekuru ari muhemodialysis fluid inotsinhaniswa nemumaburi madiki ari paburi refiber. Mhedzisiro yekupedzisira yekuchinjana iropa riri muropa. Muchetura weuremia, mamwe maelectrolyte, nemvura yakawandisa zvinobviswa mudialysate, uye mamwe mabicarbonate nemaelectrolyte ari mudialysate anopinda muropa. Kuti uwane chinangwa chekubvisa chepfu, mvura, kuchengetedza acid-base chiyero uye kugadzikana kwemukati kwezvakatipoteredza. Iyo yakazara nharaunda yehollow fiber yese, iyo nzvimbo yekutsinhana, inosarudza nzira yekupfuura yemamorekuru madiki, uye saizi ye membrane pore saizi inotaridza kugona kwekupfuura kwemamorekuru epakati uye makuru.
4. Dialysate
Iyo dialysate inowanikwa nekudzikisa dialysis concentrate ine electrolytes uye mabhesi uye reverse osmosis mvura muchiyero, uye pakupedzisira inoumba mhinduro padhuze neropa electrolyte concentration kuchengetedza yakajairika electrolyte mazinga, uku ichipa mabhesi kumuviri kuburikidza nepamusoro base concentration, gadzirisa acidosis mumurwere. Mabhesi edialysate anowanzo shandiswa anonyanya kuve bicarbonate, asiwo ane acetic acid shoma.