Hemodialysis

IHemodialysis lolunye lonyango lokubuyisela izintso kwizigulana ezinokusilela okubukhali kunye nezingapheliyo. Ikhupha igazi emzimbeni ukuya ngaphandle komzimba kwaye idlula kwi-dialyzer eyenziwe yimicu engenakubalwa. Igazi kunye nesisombululo se-electrolyte (i-dialysis fluid) enezigxina ezifanayo zomzimba zingaphakathi kwaye ziphuma kwimicu engenanto ngokusasazwa, ukuhluza, kunye ne-adsorption. Itshintshiselana ngezinto ezinomgaqo wokuhambisa, isusa inkunkuma ye-metabolic emzimbeni, igcina ibhalansi ye-electrolyte kunye ne-acid-base; ngelo xesha, isusa amanzi amaninzi emzimbeni, kwaye yonke inkqubo yokubuyisela igazi elihlambulukileyo ibizwa ngokuba yi-hemodialysis.

umgaqo

1. Uthutho olululo
(1) Ukusasazwa: Yeyona ndlela iphambili yokususa i-solute kwi-HD. I-solute ithuthwa ukusuka kwicala eliphezulu lokugxininiswa ukuya kwicala eliphantsi-ngokuxhomekeka kwi-gradient yoxinaniso. Le nto ibizwa ngokuba yi-dispersion. I-dispersive transport energy of solute ivela kwintshukumo engaqhelekanga yeemolekyuli ze-solute okanye iincinci ngokwazo (i-Brownian motion).
(2) I-Convection: Ukuhamba kwee-solutes kwi-membrane e-semipermeable kunye ne-solvent ibizwa ngokuba yi-convection. Ukungachatshazelwa bubunzima bemolekyuli ye-solute kunye ne-concentration gradient mahluko, amandla ngaphaya kwe-membrane ngumahluko woxinzelelo lwe-hydrostatic kumacala omabini e-membrane, ebizwa ngokuba yi-solute traction.
(3) I-Adsorption: Kukusebenzisana kweentlawulo ezintle kunye nezibi okanye i-van der Waals imikhosi kunye namaqela e-hydrophilic kumphezulu we-membrane ye-dialysis ukuze ukhethe ngokukhethekileyo iiprotheni ezithile, iityhefu kunye neziyobisi (ezifana ne-β2-microglobulin, umncedi, abalamli abavuthayo. , Endotoxin, njl.). Umphezulu wazo zonke ii-membrane ze-dialysis uhlawuliswa kakubi, kwaye isixa sentlawulo embi kumphezulu we-membrane simisela inani leeprotheni ezithengiswayo kunye neentlawulo ezininzi. Kwinkqubo ye-hemodialysis, iiprotheni ezithile eziphakamileyo ngokungaqhelekanga, iityhefu kunye neziyobisi egazini zikhethwa ngokukhethekileyo kumphezulu we-dialysis inwebu, ukwenzela ukuba ezi zinto ze-pathogenic zisuswe, ukuze kuphunyezwe injongo yonyango.
2. Ukuhanjiswa kwamanzi
(1) Inkcazo ye-Ultrafiltration: Ukuhamba kolwelo nge-membrane e-semi-permeable phantsi kwesenzo se-hydrostatic pressure gradient okanye i-osmotic pressure gradient ibizwa ngokuba yi-ultrafiltration. Ngexesha le-dialysis, i-ultrafiltration ibhekisela ekuhambeni kwamanzi ukusuka kwicala legazi ukuya kwicala le-dialysate; ngokuchaseneyo, ukuba amanzi ahamba ukusuka kwicala le-dialysate ukuya kwicala legazi, kuthiwa yi-reverse ultrafiltration.
(2) Izinto ezichaphazela ukuhluzwa kwe-ultrafiltration: ① ukuthambeka koxinzelelo lwamanzi asulungekileyo; ②i-osmotic pressure gradient; ③uxinzelelo lwetransmembrane; ④i-coefficient ye-ultrafiltration.

Iimpawu

1. Ukwenzakala okuqatha kwezintso.
2. Ukungaphumeleli kwentliziyo ebukhali okubangelwa ukugqithiswa komthamo okanye uxinzelelo lwegazi olunzima ukulawula iziyobisi.
3. Ubunzima be-metabolic acidosis kunye ne-hyperkalemia ekunzima ukuyilungisa.
4. I-Hypercalcemia, i-hypocalcemia kunye ne-hyperphosphatemia.
5. Ukungaphumeleli kwezintso okungapheliyo kunye ne-anemia ekunzima ukuyilungisa.
6. Uremic neuropathy kunye ne-encephalopathy.
7. Uremia pleurisy okanye pericarditis.
8. Ukungaphumeleli kwezintso okungapheliyo kudityaniswa nokungondleki kakhulu.
9. Ukungasebenzi kakuhle kwelungu elingenakuchazwa okanye ukuhla kwimeko jikelele.
10. Iziyobisi okanye ityhefu yetyhefu.

Contraindications

1. I-Intracranial hemorrhage okanye ukunyuka kwengcinezelo ye-intracranial.
2. Umothuko omkhulu ekunzima ukuwulungisa ngeziyobisi.
3. I-cardiomyopathy enzima ehamba kunye nokungaphumeleli kwentliziyo ye-refractory.
4. Ukuhamba kunye nokuphazamiseka kwengqondo akukwazi ukusebenzisana nonyango lwe-hemodialysis.

Izixhobo zeHemodialysis

Izixhobo ze-hemodialysis ziquka umatshini we-hemodialysis, unyango lwamanzi kunye ne-dialyzer, ezihlangeneyo zenza inkqubo ye-hemodialysis.
1. Umatshini weHemodialysis
sesinye sezona zixhobo zonyango zisetyenziswa kakhulu kunyango lokucocwa kwegazi. Sisixhobo esinobuxhakaxhaka be-mechatronics, esiqulunqwe sisixhobo sokubeka iliso sokubonelela nge-dialysate kunye nesixhobo sokubeka iliso sokujikeleza kwe-extracorporeal.
2. Inkqubo yokucoca amanzi
Kuba igazi lesigulana kwiseshini ye-dialysis kufuneka linxibelelane nesixa esikhulu se-dialysate (120L) nge-dialysis membrane, kwaye amanzi epompo asezidolophini aqulethe izinto ezahlukeneyo zokulandela umkhondo, ngakumbi isinyithi esinzima, kunye nezinye iintsholongwane, ii-endotoxins kunye neebhaktheriya, ukudibana negazi. iya kubangela ezi Izinto zingena emzimbeni. Ke ngoko, amanzi etephu kufuneka ahluzwe, asuswe i-iron, athambe, asebenze ikhabhoni, kunye ne-osmosis ebuyela umva iqhutywe ngokulandelelana. Kuphela ngamanzi e-osmosis abuyela umva anokusetyenziswa njengamanzi okuxutywa kwe-dialysate egxininisiweyo, kunye nesixhobo soluhlu lonyango lwamanzi epompo yinkqubo yokucoca amanzi.
3. Dialyzer
ikwabizwa ngokuba “yizintso ezenziweyo”. Yenziwe ngeentsinga ezingenanto ezenziwe ngezinto zekhemikhali, kwaye ifayibha nganye engenanto isasazwa ngemingxunya emininzi emincinci. Ngexesha le-dialysis, igazi lihamba kwi-fiber engenanto kwaye i-dialysate igeleza ngasemva kwi-fiber engenanto. I-solute kunye namanzi kwezinye iimolekyuli ezincinci kulwelo lwe-hemodialysis zitshintshwa ngemingxunya emincinci kumsinga ongenanto. Isiphumo sokugqibela sotshintshiselwano ligazi egazini. Iityhefu ze-uremia, ezinye ii-electrolytes, kunye namanzi agqithisileyo akhutshwa kwi-dialysate, kwaye ezinye iibicarbonate kunye ne-electrolytes kwi-dialysate zingena egazini. Ukuze ufezekise injongo yokususa i-toxins, amanzi, ukugcina ibhalansi ye-acid-base kunye nokuzinza kwendawo yangaphakathi. Indawo epheleleyo yefiber engenanto, indawo yokutshintshiselana, imisela amandla okudlula iimolekyuli ezincinci, kwaye ubungakanani bobungakanani bemembrane yepore bumisela amandla okudlula kwiimolekyuli eziphakathi nezinkulu.
4. I-Dialysate
I-dialysate ifunyanwa ngokuhlambulula i-dialysis concentrate equlethe i-electrolytes kunye neziseko kunye nokubuyisela umva amanzi e-osmosis ngokomlinganiselo, kwaye ekugqibeleni yenza isisombululo esikufutshane noxinzelelo lwe-electrolyte yegazi ukugcina amanqanaba aqhelekileyo e-electrolyte, ngelixa ubonelela ngeziseko emzimbeni ngokusebenzisa isiseko soxinaniso oluphezulu. lungisa i-acidosis kwisigulane. Iziseko ze-dialysate ezisetyenziswa ngokuqhelekileyo ziyi-bicarbonate, kodwa zikwaqulethe i-acetic acid encinci.