I-Hemodialysis

I-Hemodialysis ingenye yezindlela zokwelapha zokubuyisela izinso ezigulini ezinokwehluleka okukhulu kwezinso okungapheli. Ikhipha igazi emzimbeni iye ngaphandle komzimba futhi idlule ku-dialyzer eyakhiwe imicu engenakubalwa engenalutho. Igazi nesisombululo se-electrolyte (uketshezi lwe-dialysis) olunokugxila okufanayo komzimba kungaphakathi nangaphandle kwemicu engenalutho ngokusabalalisa, ukucwenga okukhulu, nokukhanyiswa. Ishintshanisa izinto ngomgomo we-convection, isusa udoti we-metabolic emzimbeni, igcina ibhalansi ye-electrolyte ne-acid-base; ngesikhathi esifanayo, isusa amanzi amaningi emzimbeni, futhi yonke inqubo yokubuyisela igazi elihlanzekile ibizwa ngokuthi i-hemodialysis.

isimiso

1. Ezokuthutha ezingenalutho
(1) Ukusabalalisa: Kuyindlela eyinhloko yokususwa kwe-solute ku-HD. I-solute ithuthwa isuka ohlangothini lokugxilwa okuphezulu iye ohlangothini lokugxilwa kancane kuye ngegradient yokugxilisa ingqondo. Lesi simo sibizwa ngokuthi ukuhlakazeka. Amandla okuthutha ahlakazekayo e-solute avela ekuhambeni okungajwayelekile kwama-molecule e-solute noma izinhlayiya ngokwazo (ukunyakaza kwe-Brownian).
(2) I-Convection: Ukuhamba kwezinyibilikizo ngokusebenzisa ulwelwesi olungenamanzi kanye ne-solvent kubizwa ngokuthi i-convection. Athintwa isisindo se-solute sengqamuzana kanye nomehluko wegradient wokugxila, amandla kuwo wonke ulwelwesi umehluko wengcindezi ye-hydrostatic kuzo zombili izinhlangothi zolwelwesi, okuyilokho okubizwa ngokuthi i-solute traction.
(3) I-Adsorption: Kungokusebenzelana kwezindleko ezinhle nezimbi noma amandla e-van der Waals kanye namaqembu e-hydrophilic ebusweni bolwelwesi lwe-dialysis ukuze kukhethwe amaprotheni athile, ubuthi nezidakamizwa (njenge-β2-microglobulin, umphelelisi, abaxhumanisi abavuthayo. I-Endotoxin, njll.). Ingaphezulu lawo wonke ama-membrane e-dialysis akhokhiswa kabi, futhi inani lokukhokhiswa okungekuhle endaweni ye-membrane linquma inani lamaprotheni adsorbed anezindleko ezihlukile. Enqubweni ye-hemodialysis, amaprotheni athile aphakeme ngokungavamile, ubuthi nezidakamizwa ezisegazini zikhangiswa ngokukhetha phezu kolwelwesi lwe-dialysis, ukuze lezi zinto ze-pathogenic zisuswe, ukuze kufezwe injongo yokwelashwa.
2. Ukudluliswa kwamanzi
(1) Incazelo ye-Ultrafiltration: Ukuhamba koketshezi kulwelwesi olungena kancane ngaphansi kwesenzo se-hydrostatic pressure gradient noma i-osmotic pressure gradient kubizwa ngokuthi i-ultrafiltration. Ngesikhathi se-dialysis, i-ultrafiltration ibhekisela ekuhambeni kwamanzi kusuka ohlangothini lwegazi kuya ohlangothini lwe-dialysate; ngokuphambene, uma amanzi ehamba esuka ohlangothini lwe-dialysate eya ohlangothini lwegazi, kubizwa ngokuthi i-reverse ultrafiltration.
(2) Izinto ezithinta ukucwenga okuphezulu: ①igradient yamanzi ahlanzekile; ②i-osmotic pressure gradient; ③ingcindezi ye-transmembrane; ④i-coefficient ye-ultrafiltration.

Izinkomba

1. Ukulimala kwezinso kakhulu.
2. Ukwehluleka kwenhliziyo okukhulu okubangelwa ukugcwala kwevolumu noma umfutho wegazi ophakeme okunzima ukuwulawula ngezidakamizwa.
3. I-metabolic acidosis enzima kanye ne-hyperkalemia okunzima ukuyilungisa.
4. I-Hypercalcemia, i-hypocalcemia ne-hyperphosphatemia.
5. Ukwehluleka kwezinso okungapheli okune-anemia okunzima ukukulungisa.
6. I-Uremic neuropathy kanye ne-encephalopathy.
7. I-Uremia pleurisy noma i-pericarditis.
8. Ukwehluleka kwezinso okungapheli kuhlangene nokungondleki kahle.
9. Ukungasebenzi kahle kwesitho esingaqondakali noma ukwehla kwesimo esijwayelekile.
10. Izidakamizwa noma ushevu.

Contraindications

1. Ukopha kwe-intracranial noma ukwanda kwengcindezi ye-intracranial.
2. Ukushaqeka okukhulu okunzima ukukulungisa ngezidakamizwa.
3. I-cardiomyopathy enzima ehambisana nokuhluleka kwenhliziyo ephikisayo.
4. Ukuhambisana nokuphazamiseka kwengqondo akukwazi ukubambisana nokwelashwa kwe-hemodialysis.

Imishini ye-Hemodialysis

Imishini ye-hemodialysis ihlanganisa umshini we-hemodialysis, ukwelashwa kwamanzi kanye ne-dialyzer, okuhlangene kwakha uhlelo lwe-hemodialysis.
1. Umshini we-hemodialysis
ingenye yemishini yokwelapha esetshenziswa kakhulu ekwelashweni kokuhlanzwa kwegazi. Kuyimishini eyinkimbinkimbi uma kuqhathaniswa, eyakhiwe idivayisi yokuqapha ukunikezwa kwe-dialysate kanye nedivayisi yokuqapha ukujikeleza kwe-extracorporeal.
2. Uhlelo lokuhlanza amanzi
Njengoba igazi lesiguli kuseshini ye-dialysis kufanele lixhumane nenani elikhulu le-dialysate (120L) ngolwelwesi lwe-dialysis, futhi amanzi kampompi asemadolobheni aqukethe izakhi ezihlukahlukene zokulandelela, ikakhulukazi izinsimbi ezinzima, kanye nezinye izibulala-magciwane, ama-endotoxins namagciwane, ukuxhumana negazi. izobangela lezi Into ingena emzimbeni. Ngakho-ke, amanzi ompompi adinga ukuhlungwa, insimbi ikhishwe, ithanjiswe, icushwe ikhabhoni, futhi i-osmosis ehlehliswe icutshungulwe ngokulandelana. Amanzi e-osmosis ehlanekezelwe kuphela angasetshenziswa njengamanzi ahlanjululwayo e-dialysate egxilile, futhi idivayisi yochungechunge lokwelashwa kwamanzi kampompi uhlelo lokuhlanza amanzi.
3. I-Dialyzer
ibizwa nangokuthi “izinso zokwenziwa”. Yakhiwe ngemicu engenalutho eyenziwe ngezinto zamakhemikhali, futhi umcu ngamunye ongenalutho usakazwa ngemigodi emincane eminingi. Ngesikhathi se-dialysis, igazi ligeleza ku-fiber engenalutho futhi i-dialysate igeleza ihlehle nge-fiber engenalutho. I-solute namanzi kwamanye ama-molecule amancane kuketshezi lwe-hemodialysis ashintshaniswa ngezimbobo ezincane ku-fiber engenalutho. Umphumela wokugcina wokushintshisana yigazi egazini. Ubuthi be-uremia, amanye ama-electrolyte, namanzi engeziwe kukhishwa ku-dialysate, futhi amanye ama-bicarbonate nama-electrolyte ku-dialysate angena egazini. Ukuze kuzuzwe inhloso yokukhipha ubuthi, amanzi, ukugcina ibhalansi ye-acid-base kanye nokuzinza kwemvelo kwangaphakathi. Indawo ephelele yayo yonke i-fiber engenalutho, indawo yokushintshana, inquma amandla okudlula ama-molecule amancane, futhi usayizi wosayizi we-membrane pore unquma umthamo wokudlula wama-molecule aphakathi nendawo namakhulu.
4. I-Dialysate
I-dialysate itholakala ngokuhlambulula i-dialysis concentrate equkethe ama-electrolyte nezisekelo futhi ihlehlise amanzi e-osmosis ngesilinganiso, futhi ekugcineni yakha isisombululo eduze nokuhlushwa kwe-electrolyte yegazi ukuze kugcinwe amazinga e-electrolyte avamile, kuyilapho inikeza izisekelo emzimbeni ngokusebenzisa ukuhlushwa okuphezulu kwesisekelo , lungisa i-acidosis esigulini. Izisekelo ze-dialysate ezisetshenziswa kakhulu ikakhulukazi yi-bicarbonate, kodwa futhi ziqukethe inani elincane le-acetic acid.