Yin maganin hawan jini (hemodialysis)

Hemodialysis yana ɗaya daga cikin hanyoyin maye gurbin koda ga marasa lafiya da ke fama da gazawar koda mai tsanani da na yau da kullun. Yana fitar da jini daga jiki zuwa wajen jiki kuma yana ratsa ta cikin na'urar dialyzer wadda ta ƙunshi zaruruwa marasa adadi. Jini da ruwan electrolyte (ruwan dialysis) masu irin wannan yawan jiki suna shiga da fita daga zaruruwan da ke cikin rami ta hanyar yaɗuwa, tacewa, da kuma sharar jiki. Yana musanya abubuwa da ƙa'idar convection, yana cire sharar metabolism a jiki, yana kula da daidaiton electrolyte da acid-base; a lokaci guda, yana cire ruwa mai yawa a jiki, kuma dukkan tsarin dawo da jinin da aka tsarkake ana kiransa hemodialysis.

ƙa'ida

1. Jigilar sinadarin solute
(1) Watsawa: Ita ce babbar hanyar cire sinadarin a cikin HD. Ana jigilar sinadarin daga ɓangaren mai yawan maida hankali zuwa ɓangaren mai ƙarancin maida hankali dangane da yanayin maida hankali. Wannan lamari ana kiransa watsewa. Ƙarfin jigilar sinadarin a cikin solute ya fito ne daga motsi mara tsari na ƙwayoyin solute ko ƙwayoyin da kansu (motsin Brownian).
(2) Magudanar ruwa: Motsin magudanar ruwa ta cikin membrane mai iya shiga tare da magudanar ruwa ana kiransa convection. Ba tare da tasirin nauyin kwayoyin halitta da bambancin ma'auninsa ba, ƙarfin da ke kan membrane shine bambancin matsin lamba na hydrostatic a ɓangarorin biyu na membrane, wanda shine abin da ake kira magudanar ruwa.
(3) Shafawa: Ta hanyar hulɗar caji mai kyau da mara kyau ko ƙarfin van der Waals da ƙungiyoyin hydrophilic a saman membrane na dialysis ne ake amfani da su wajen shafa wasu sunadarai, guba da magunguna (kamar β2-microglobulin, complement, injunan kumburi, Endotoxin, da sauransu). Ana cajin saman dukkan membranes na dialysis mara kyau, kuma adadin cajin mara kyau akan membrane yana ƙayyade adadin furotin da aka sha tare da cajin iri-iri. A cikin tsarin hemodialysis, wasu furotin, guba da magunguna masu yawa a cikin jini ana shafa su a saman membrane na dialysis, don a cire waɗannan abubuwan da ke haifar da cutar, don cimma manufar magani.
2. Canja wurin ruwa
(1) Ma'anar Ultrafiltration: Motsin ruwa ta cikin membrane mai rabe-rabe a ƙarƙashin aikin hydrostatic pressure gradient ko osmotic pressure gradient ana kiransa ultrafiltration. A lokacin dialysis, ultrafiltration yana nufin motsi na ruwa daga gefen jini zuwa gefen dialysate; akasin haka, idan ruwan ya motsa daga gefen dialysate zuwa gefen jini, ana kiransa reverse ultrafiltration.
(2) Abubuwan da ke shafar tacewa ta hanyar amfani da ruwa mai tsafta: ① canjin matsin lamba na ruwa mai tsafta; ② canjin matsin lamba na osmotic; ③ matsin lamba na membrane; ④ ma'aunin tacewa ta hanyar amfani da ultrafiltration.

Alamomi

1. Raunin koda mai tsanani.
2. Matsalar zuciya mai tsanani da ke faruwa sakamakon yawan kitse ko hawan jini wanda ke da wahalar shawo kansa da magunguna.
3. Mummunan acidosis na metabolism da hyperkalemia wanda yake da wahalar gyarawa.
4. Hypercalcemia, hypocalcemia da hyperphosphatemia.
5. Rashin aikin koda na yau da kullun tare da rashin jinin jini wanda yake da wahalar gyarawa.
6. Ciwon jijiyoyi na uremic da kuma encephalopathy.
7. Ciwon uremia pleurisy ko pericarditis.
8. Rashin aikin koda na yau da kullun tare da rashin abinci mai gina jiki mai tsanani.
9. Rashin aiki a gabobin jiki ko raguwar yanayin da ba a iya bayyanawa ba.
10. Gubar ƙwayoyi ko guba.

Abubuwan da ba su dace ba

1. Zubar jini a cikin kwakwalwa ko kuma ƙaruwar matsin lamba a cikin kwakwalwa.
2. Mummunan girgiza wanda yake da wahalar gyarawa da magunguna.
3. Ciwon zuciya mai tsanani tare da gazawar zuciya mai tsauri.
4. Idan aka yi la'akari da matsalolin kwakwalwa, ba za a iya haɗa kai da maganin hemodialysis ba.

Kayan aikin zubar jini

Kayan aikin hemodialysis sun haɗa da injin hemodialysis, maganin ruwa da kuma dialyzer, waɗanda tare suka samar da tsarin hemodialysis.
1. Injin zubar jini
yana ɗaya daga cikin kayan aikin magani da aka fi amfani da su a fannin maganin tsarkake jini. Kayan aikin mechatronics ne masu rikitarwa, wanda ya ƙunshi na'urar sa ido kan wadatar dialysate da na'urar sa ido kan zagayawar jini daga jiki.
2. Tsarin maganin ruwa
Tunda jinin majiyyaci a lokacin da ake yin dialysis dole ne ya taɓa babban adadin dialysate (120L) ta cikin membrane na dialysis, kuma ruwan famfo na birni ya ƙunshi abubuwa daban-daban, musamman ƙarfe masu nauyi, da kuma wasu magungunan kashe ƙwayoyin cuta, endotoxins da ƙwayoyin cuta, taɓawa da jini zai haifar da waɗannan. Wannan sinadarin yana shiga jiki. Saboda haka, ana buƙatar a tace ruwan famfo, a cire ƙarfe, a tausasa shi, a kunna carbon, da kuma a sarrafa shi a jere. Ruwan reverse osmosis ne kawai za a iya amfani da shi azaman ruwan narkewa don dialysate mai ƙarfi, kuma na'urar da ake amfani da ita don jerin jiyya na ruwan famfo ita ce tsarin maganin ruwa.
3. Dialyzer
Ana kuma kiransa "ƙoda ta wucin gadi". Ya ƙunshi zare masu rami da aka yi da sinadarai, kuma kowace zare mai rami tana rarrabuwa da ƙananan ramuka da yawa. A lokacin dialysis, jini yana ratsa zare mai rami kuma dialysate yana ratsawa baya ta cikin zaren mai rami. Ana musayar ruwan da ke cikin ruwan hemodialysis ta cikin ƙananan ramuka a kan zaren mai rami. Sakamakon ƙarshe na musayar shine jini a cikin jini. Ana cire gubar uremia, wasu electrolytes, da ruwa mai yawa a cikin dialysate, kuma wasu bicarbonate da electrolytes a cikin dialysate suna shiga jini. Don cimma manufar cire guba, ruwa, kiyaye daidaiton acid-base da kwanciyar hankali na muhalli na ciki. Jimlar yankin dukkan zaren mai rami, yankin musayar, yana ƙayyade ƙarfin wucewar ƙananan ƙwayoyin cuta, kuma girman girman ramin membrane yana ƙayyade ƙarfin wucewar ƙwayoyin matsakaici da manyan.
4. Dialysate
Ana samun dialysate ta hanyar narkar da sinadarin dialysis mai ɗauke da electrolytes da tushe da kuma ruwan osmosis na baya daidai gwargwado, kuma a ƙarshe yana samar da mafita kusa da yawan electrolyte na jini don kiyaye matakan electrolyte na yau da kullun, yayin da yake samar da tushe ga jiki ta hanyar babban yawan tushe. Don gyara acidosis a cikin majiyyaci. Tushen dialysate da aka fi amfani da su galibi bicarbonate ne, amma kuma suna ɗauke da ƙaramin adadin acetic acid.