Hemodialysis

Hemodialysis bụ otu n'ime ọgwụgwọ nnọchi gbasara akụrụ maka ndị ọrịa nwere nnukwu akụrụ na-adịghị ala ala.Ọ na-esi n'ahụ́ amịpụta ọbara gaa n'èzí ahụ ma na-esi na dialyzer nke nwere ọtụtụ eriri nwere oghere mejupụtara.Ọbara na ngwọta electrolyte (mmiri dialysis) nke nwere oke ahụ nke ahụ na-abanye na n'ime eriri oghere site na mgbasa, ultrafiltration, na adsorption.Ọ na-agbanwe ihe na ụkpụrụ nke convection, na-ewepụ ihe mkpofu metabolic n'ime ahụ, na-ejigide electrolyte na nguzozi acid-base;N'otu oge ahụ, na-ewepụ oke mmiri n'ime ahụ, na usoro niile nke iweghachi ọbara dị ọcha ka a na-akpọ hemodialysis.

ụkpụrụ

1. Solute njem
(1) Mgbasa: Ọ bụ isi usoro mwepụ solute na HD.A na-ebuga solute ahụ site n'akụkụ dị elu na-eme ka ọ dị elu na-adabere na ntinye uche.A na-akpọ ihe omume a dispersion.The dispersive iga ike nke solute na-abịa site na mgbe ụfọdụ ije nke solute molekul ma ọ bụ ahụ n'onwe ha (Brownian ngagharị).
(2) Convection: A na-akpọ mmegharị nke solutes site na membrane semipermeable yana ihe mgbaze.Na-enweghị mmetụta nke solute molecular arọ na ntinye uche ya dị iche iche, ike dị n'ofe akpụkpọ ahụ bụ ọdịiche nrụgide hydrostatic n'akụkụ abụọ nke akpụkpọ ahụ, nke a na-akpọ traction solute.
(3) Adsorption: Ọ bụ site na mmekorita nke ebubo dị mma na nke na-adịghị mma ma ọ bụ ndị agha van der Waals na ndị otu hydrophilic n'elu akpụkpọ ahụ dialysis iji họrọ nke ọma adsorb ụfọdụ protein, nsị na ọgwụ (dị ka β2-microglobulin, complement, mkpali mediators). Endotoxin, wdg).A na-ebubo elu nke akpụkpọ ahụ dialysis niile na-adịghị mma, na ọnụ ọgụgụ nke ụgwọ na-adịghị mma n'elu akpụkpọ ahụ na-ekpebi ọnụọgụ protein adsorbed na ebubo dị iche iche.N'ime usoro hemodialysis, a na-edobe ụfọdụ protein, nsị na ọgwụ ndị dị n'ọbara na-ahọrọ n'elu akpụkpọ ahụ dialysis, nke mere na a na-ewepụ ihe ndị a na-akpata ọrịa, iji nweta nzube ọgwụgwọ.
2. Nyefe mmiri
(1) Nkọwa nke Ultrafiltration: A na-akpọ mmegharị nke mmiri mmiri site na akpụkpọ ahụ nke na-adịghị agafe agafe n'okpuru ọrụ nke nrụgide hydrostatic gradient ma ọ bụ gradient osmotic gradient a na-akpọ ultrafiltration.N'oge dialysis, ultrafiltration na-ezo aka na mmegharị nke mmiri si n'akụkụ ọbara gaa n'akụkụ dialysate;N'aka nke ọzọ, ọ bụrụ na mmiri na-esi n'akụkụ dialysate gaa n'akụkụ ọbara, a na-akpọ ya reverse ultrafiltration.
(2) Ihe ndị na-emetụta ultrafiltration: ① gradient mmiri dị ọcha;② osmotic mgbali gradient;③ nrụgide transmembrane;④ ultrafiltration ọnụọgụ.

Ngosipụta

1. Nnukwu mmerụ ahụ akụrụ.
2. Mgbochi obi dị egwu kpatara oke ibu ma ọ bụ ọbara mgbali elu nke siri ike iji ọgwụ eme ihe.
3. Metabolic acidosis siri ike na hyperkalemia nke siri ike idozi.
4. Hypercalcemia, hypocalcemia na hyperphosphatemia.
5. Ọkpụkpụ akụrụ na-adịghị ala ala na anaemia nke siri ike idozi.
6. Uremic neuropathy na encephalopathy.
7. Uremia pleurisy ma ọ bụ pericarditis.
8. Ọkpụkpụ akụrụ na-adịghị ala ala jikọtara ya na erighị ihe na-edozi ahụ siri ike.
9. Arụghị ọrụ akụkụ ahụ na-enweghị nkọwa ma ọ bụ daa n'ọnọdụ izugbe.
10. Ọgwụ ma ọ bụ nsi.

Contraindications

1. Ọbara ọgbụgba intracranial ma ọ bụ mmụba intracranial.
2. Ujo siri ike nke siri ike iji ọgwụ emezi.
3. Ọrịa cardiomyopathy siri ike na-eso ya na nkụda mmụọ obi mgbawa.
4. Na-eso ya na nsogbu uche enweghị ike ịkwado ọgwụgwọ hemodialysis.

Ngwá ọrụ hemodialysis

Akụrụngwa nke hemodialysis gụnyere igwe hemodialysis, ọgwụgwọ mmiri na dialyzer, nke jikọtara usoro hemodialysis.
1. Igwe hemodialysis
bụ otu n'ime ngwa ọgwụgwọ a na-ejikarị eme ihe na ọgwụgwọ ọbara ọcha.Ọ bụ ngwa mechatronics dị mgbagwoju anya nke mejupụtara ngwaọrụ nleba anya ọkọnọ dialysate na ngwaọrụ nlekota mgbasa ozi extracorporeal.
2. Usoro ọgwụgwọ mmiri
Ebe ọ bụ na ọbara onye ọrịa na dialysis nnọkọ nwere ịkpọtụrụ a nnukwu ego nke dialysate (120L) site dialysis akpụkpọ ahụ, na obodo mgbata mmiri nwere dị iche iche Chọpụta ọcha, karịsịa arọ ọla, nakwa dị ka ụfọdụ disinfectants, endotoxins na nje bacteria, kọntaktị na ọbara. ga-eme ka ihe ndị a na-abanye n'ime ahụ.Ya mere, ọ dị mkpa ka ihicha mmiri mgbata, wepụ ígwè, mee ka ọ dị nro, mee ka carbon rụọ ọrụ, ma gbanwee osmosis n'usoro.Naanị mmiri reverse osmosis nwere ike iji dị ka mmiri dilution maka dialysate na-etinye uche, na ngwaọrụ maka usoro ọgwụgwọ nke mmiri mgbata bụ usoro ọgwụgwọ mmiri.
3. Dialyzer
a na-akpọkwa "akụrụ arụ ọrụ".Ihe mejupụtara ya bụ eriri ndị nwere oghere nke e ji ihe kemịkal mee, a na-ekesakwa eriri nke ọ bụla nwere oghere n'ọtụtụ obere oghere.N'oge dialysis, ọbara na-aga site na eriri oghere na dialysate na-aga azụ site na eriri oghere.Solute na mmiri nke ụfọdụ ụmụ irighiri ihe dị n'ime mmiri hemodialysis na-agbanwe site na obere oghere dị na eriri oghere.Nsonaazụ ikpeazụ nke mgbanwe ahụ bụ ọbara n'ime ọbara.A na-ewepụ toxins Uremia, ụfọdụ electrolytes, na oke mmiri na dialysate, na ụfọdụ bicarbonate na electrolytes dị na dialysate na-abanye n'ọbara.Ya mere iji nweta nzube nke iwepụ nsị, mmiri, ịnọgide na-enwe nguzozi acid-base na nkwụsi ike gburugburu ebe obibi.Ngụkọta ebe nke dum oghere eriri, mgbanwe ebe, na-ekpebi ụzọ ikike nke obere ụmụ irighiri ihe, na size nke akpụkpọ anụ pore size na-ekpebi ike Itie nke ọkara na nnukwu ụmụ irighiri ihe.
4. Dialysate
The dialysate na-enwetara site diluting dialysis uche nwere electrolytes na bases na laa azụ osmosis mmiri na nha, na n'ikpeazụ na-etolite a ngwọta nso na ọbara electrolyte ịta iji nọgide na-enwe nkịtị electrolyte etoju, mgbe inye bases na ahu site a elu isi ịta , Iji dozie acidosis na onye ọrịa.Ebe dialysate ndị a na-ejikarị eme ihe bụ bicarbonate, mana nwekwara obere ihe acetic acid.