Hemodialysis

Hemodialysis ke e 'ngoe ea liphekolo tsa phetisetso ea renal bakeng sa bakuli ba nang le bothata bo matla le bo sa foleng ba renal. E ntša mali 'meleng ho ea karolong e ka ntle ea' mele 'me e feta ka har'a dialyzer e entsoeng ka likhoele tse se nang palo. Mali le motsoako oa electrolyte (dialysis fluid) tse nang le likarolo tse tšoanang tsa 'mele li kena le ho tsoa ka har'a likhoele tse se nang letho ka ho hasana, ho phunyeletsa, le ho adsorption. E fapanyetsana lintho ka molao-motheo oa convection, ho tlosa litšila tsa metabolism 'meleng, ho boloka tekanyo ea electrolyte le acid-base; ka nako e ts'oanang, e tlosa metsi a mangata 'meleng,' me ts'ebetso eohle ea ho khutlisa mali a hloekisitsoeng e bitsoa hemodialysis.

molao-motheo

1. Lipalangoang tse se nang letho
(1) Phatlalatso: Ke mokhoa o ka sehloohong oa ho tlosa solute ho HD. Solute e tsamaisoa ho tloha ka lehlakoreng le phahameng-concentration ho ea lehlakoreng le tlaase-concentration ho itšetlehile ka gradient ea mahloriso. Ketsahalo ena e bitsoa ho hasana. Matla a lipalangoang a solute a tsoa motsamaong o sa tloaelehang oa limolek'hule tsa solute kapa likaroloana ka botsona (Brownian motion).
(2) Convection: Ho tsamaea ha solutes ka lera le semipermeable hammoho le solvent ho bitsoa convection. Ha a angoa ke boima ba limolek'hule tsa solute le phapang ea eona ea "concentration gradient", matla ho pholletsa le lera ke phapang ea khatello ea hydrostatic mahlakoreng ka bobeli a lera, e leng seo ho thoeng ke solute traction.
(3) Adsorption: Ke ka ho sebelisana ha liqoso tse ntle le tse mpe kapa matla a van der Waals le lihlopha tsa hydrophilic holim'a lera la dialysis ho khetha liprotheine tse itseng, chefo le lithethefatsi (tse kang β2-microglobulin, complement, inflammatory mediators). , Endotoxin, joalo-joalo). Bokaholimo ba li-membrane tsohle tsa dialysis bo qosoa hampe, 'me palo ea tefiso e mpe holim'a lera e lekanya palo ea liprotheine tse adsorbed tse nang le litefiso tse fapaneng. Nakong ea hemodialysis, liprotheine tse ling tse phahameng ka tsela e sa tloaelehang, chefo le lithethefatsi tse maling li khethoa ka mokhoa o ikhethileng holim'a lera la dialysis, e le hore lintho tsena tsa pathogenic li tlosoe, e le ho fihlela sepheo sa kalafo.
2. Ho fetisa metsi
(1) Tlhaloso ea Ultrafiltration: Ho tsamaea ha mokelikeli ka har'a lera le nang le semi-permeable tlas'a ketso ea hydrostatic pressure gradient kapa osmotic pressure gradient e bitsoa ultrafiltration. Nakong ea dialysis, ultrafiltration e bolela ho tsamaea ha metsi ho tloha lehlakoreng la mali ho ea lehlakoreng la dialysate; ka lehlakoreng le leng, haeba metsi a tloha lehlakoreng la dialysate ho ea lehlakoreng la mali, a bitsoa reverse ultrafiltration.
(2) Lintho tse amang ultrafiltration: ① metsi a hloekisitsoeng a khatello ea likhatello; ② khatello ea osmotic gradient; ③ khatello ea transmembrane; ④ultrafiltration coefficient.

Lipontšo

1. Ho lemala ho hoholo ha liphio.
2. Ho hloleha ho hoholo ha pelo ho bakoang ke molumo o mongata kapa khatello ea mali eo ho leng thata ho e laola ka lithethefatsi.
3. Asiti e matla ea metabolism le hyperkalemia eo ho leng thata ho e lokisa.
4. Hypercalcemia, hypocalcemia le hyperphosphatemia.
5. Ho hloleha ho sa feleng ha renal ka phokolo ea mali eo ho leng thata ho e lokisa.
6. Uremic neuropathy le encephalopathy.
7. Uremia pleurisy kapa pericarditis.
8. Ho hloleha ha renal ho sa feleng ho kopantsoe le khaello ea phepo e nepahetseng.
9. Ho se sebetse hantle ha setho se sa hlaloseheng kapa ho fokotseha ha boemo bo akaretsang.
10. Chefo ea lithethefatsi kapa chefo.

Contraindications

1. Ho tsoa mali ka har'a cranial kapa khatello e eketsehileng ea methapo.
2. Tšabo e matla eo ho leng thata ho e lokisa ka lithethefatsi.
3. E matla cardiomyopathy tsamaea le refractory pelo ho hloleha.
4. Ho tsamaea le mathata a kelello ho ke ke ha sebelisana le phekolo ea hemodialysis.

Sesebelisoa sa hemodialysis

Thepa ea hemodialysis e kenyelletsa mochini oa hemodialysis, kalafo ea metsi le dialyzer, tse kopaneng li theha sistimi ea hemodialysis.
1. Mochini oa hemodialysis
ke o mong oa thepa ea phekolo e sebelisoang haholo ho phekola ho hloekisa mali. Ke sesebelisoa sa mechatronics se batlang se rarahane, se entsoeng ka sesebelisoa sa ho lekola phepelo ea dialysate le sesebelisoa sa ho lekola potoloho ea kantle ho naha.
2. Mokhoa oa ho hloekisa metsi
Kaha mali a mokuli ka har'a seboka sa dialysis a tlameha ho kopana le palo e kholo ea dialysate (120L) ka membrane ea dialysis, 'me metsi a pompo ea litoropong a na le likarolo tse fapaneng tsa trace, haholo-holo litšepe tse boima, hammoho le likokoana-hloko tse ling, li-endotoxins le libaktheria, ho kopana le mali. tla baka tsena Ntho e kenang mmeleng. Ka hona, metsi a pompo a hloka ho tlhotloa, ho ntšoa tšepe, ho nolofalloe, ho kenngoe k'habone, 'me ho lokisoe osmosis ka tatellano. Ke metsi a reverse osmosis feela a ka sebelisoang e le metsi a hlapollotsoeng bakeng sa dialysate e tebileng, 'me sesebelisoa sa letoto la liphekolo tsa metsi a pompo ke sistimi ea ho hloekisa metsi.
3. Dialyzer
e boetse e bitsoa "liphio tsa maiketsetso". E entsoe ka likhoele tse sekoti tse entsoeng ka lisebelisoa tsa lik'hemik'hale, 'me fiber e' ngoe le e 'ngoe e sekoti e ajoa ka masoba a mangata a manyane. Nakong ea dialysis, mali a phalla ka har'a fiber e sekoti 'me dialysate e phalla morao ka fiber e sekoti. Solute le metsi a limolek'hule tse ling tse nyane ka har'a mokelikeli oa hemodialysis li fapanyetsana ka masoba a manyane a faeba e sekoti. Sephetho sa ho qetela sa phapanyetsano ke mali a mali. Chefo ea Uremia, li-electrolyte tse ling, le metsi a feteletseng li ntšoa ka dialysate, 'me bicarbonate le li-electrolyte tse ka har'a dialysate li kena maling. E le ho fihlela sepheo sa ho tlosa chefo, metsi, ho boloka botsitso ba acid-base le botsitso ba tikoloho. Sebaka se felletseng sa fiber eohle e se nang letho, sebaka sa phapanyetsano, se khetholla boholo ba limolek'hule tse nyane, mme boholo ba pore ea membrane bo lekanya matla a phallo ea limolek'hule tse mahareng le tse kholo.
4. Dialysate
Dialysate e fumanoa ka ho hlapolla concentrate ea dialysis e nang le li-electrolyte le metheo le ho khutlisa metsi a osmosis ka tekanyo, 'me qetellong e etsa tharollo e haufi le khatello ea mali ea electrolyte ho boloka maemo a tloaelehileng a electrolyte, ha e ntse e fana ka metheo ea' mele ka bongata bo phahameng. lokisa acidosis ho mokuli. Metheo ea dialysate e sebelisoang hangata ke bicarbonate, empa hape e na le asiti e nyane ea acetic.