Hemodialysis

ʻO ka Hemodialysis kekahi o nā lāʻau lapaʻau pani puʻupaʻa no nā maʻi me ka hāʻule ʻana o ka puʻupaʻa koke a me ka lōʻihi. Hoʻokahe ia i ke koko mai ke kino a i waho o ke kino a hele ma o kahi dialyzer i haku ʻia me nā olonā hakahaka he nui ʻole. ʻO ke koko a me ka hopena electrolyte (ka wai dialysis) me nā ʻano like o ke kino e komo a puka i waho o nā olonā hakahaka ma o ka diffusion, ultrafiltration, a me adsorption. Hoʻololi ia i nā mea me ke kumumanaʻo o ka convection, wehe i nā ʻōpala metabolic i loko o ke kino, mālama i ke kaulike electrolyte a me ka acid-base; i ka manawa like, wehe i ka wai keu i loko o ke kino, a ʻo ke kaʻina holoʻokoʻa o ka hoʻihoʻi ʻana i ke koko i hoʻomaʻemaʻe ʻia ua kapa ʻia ʻo hemodialysis.

kumumanaʻo

1. Ka lawe ʻana i nā mea hoʻoheheʻe ʻia
(1) Hoʻopuehu: ʻO ia ke ʻano nui o ka wehe ʻana i ka solute ma HD. Hoʻoili ʻia ka solute mai ka ʻaoʻao kiʻekiʻe-hui i ka ʻaoʻao haʻahaʻa-hui ma muli o ke kahe o ka hui ʻana. Ua kapa ʻia kēia hanana he dispersion. Loaʻa ka ikehu lawe dispersive o ka solute mai ka neʻe ʻana o nā molekala solute a i ʻole nā ​​​​​​ʻāpana ponoʻī (neʻe Brownian).
(2) Convection: ʻO ka neʻe ʻana o nā solutes ma o ka membrane semipermeable me ka solvent ua kapa ʻia ʻo convection. ʻAʻole i hoʻopilikia ʻia e ke kaumaha molekala solute a me kona ʻokoʻa gradient concentration, ʻo ka mana ma waena o ka membrane ʻo ia ka ʻokoʻa o ke kaomi hydrostatic ma nā ʻaoʻao ʻelua o ka membrane, ʻo ia ka mea i kapa ʻia ʻo solute traction.
(3) Adsorption: Ma o ka launa pū ʻana o nā uku maikaʻi a me nā uku maikaʻi ʻole a i ʻole nā ​​​​mana van der Waals a me nā hui hydrophilic ma luna o ka membrane dialysis e koho ai i kekahi mau protein, nā mea make a me nā lāʻau lapaʻau (e like me β2-microglobulin, complement, inflammatory mediators, Endotoxin, etc.). ʻO ka ʻili o nā membrane dialysis āpau he hoʻopiʻi maikaʻi ʻole, a ʻo ka nui o ka uku maikaʻi ʻole ma luna o ka ʻili o ka membrane e hoʻoholo ai i ka nui o nā protein i hoʻopili ʻia me nā uku heterogeneous. I ke kaʻina hana o ka hemodialysis, ua koho ʻia kekahi mau protein kiʻekiʻe ʻole, nā mea make a me nā lāʻau lapaʻau i loko o ke koko ma luna o ka membrane dialysis, i wehe ʻia kēia mau mea pathogenic, i mea e hoʻokō ai i ke kumu o ka mālama ʻana.
2. Hoʻoili wai
(1) Wehewehena Ultrafiltration: ʻO ka neʻe ʻana o ka wai ma o kahi membrane semi-permeable ma lalo o ka hana o kahi gradient pressure hydrostatic a i ʻole kahi gradient pressure osmotic ua kapa ʻia ʻo ultrafiltration. I ka wā o ka dialysis, pili ka ultrafiltration i ka neʻe ʻana o ka wai mai ka ʻaoʻao koko a i ka ʻaoʻao dialysate; i ka ʻaoʻao ʻē aʻe, inā neʻe ka wai mai ka ʻaoʻao dialysate a i ka ʻaoʻao koko, ua kapa ʻia ʻo reverse ultrafiltration.
(2) Nā kumu e pili ana i ka ultrafiltration: ①ka gradient kaomi wai i hoʻomaʻemaʻe ʻia; ②ka gradient kaomi osmotic; ③ka kaomi transmembrane; ④ka coefficient ultrafiltration.

Nā hōʻailona

1. ʻEha puʻupaʻa koʻikoʻi.
2. Ka hāʻule ʻana o ka puʻuwai koʻikoʻi i hoʻokumu ʻia e ka nui o ka leo a i ʻole ke koko kiʻekiʻe i paʻakikī ke kaohi me nā lāʻau lapaʻau.
3. ʻO ka acidosis metabolic koʻikoʻi a me ka hyperkalemia paʻakikī e hoʻoponopono.
4. Hypercalcemia, hypocalcemia a me hyperphosphatemia.
5. Ka hāʻule mau ʻana o ka puʻupaʻa me ka anemia paʻakikī e hoʻoponopono.
6. ʻO ka neuropathy uremic a me ka encephalopathy.
7. ʻUremia pleurisy a i ʻole pericarditis.
8. Ka hāʻule mau ʻana o ka puʻupaʻa i hui pū ʻia me ka ʻai ʻole nui.
9. Ka hana pono ʻole o nā ʻōkana a i ʻole ka emi ʻana o ke kūlana maʻamau i hiki ʻole ke wehewehe ʻia.
10. Ka lāʻau make a lāʻau make paha.

Nā hōʻole

1. Ke kahe koko ʻana o loko o ke koko a i ʻole ka hoʻonui ʻia o ke kaomi intracranial.
2. Ke kūpilikiʻi nui i paʻakikī ke hoʻoponopono me nā lāʻau lapaʻau.
3. ʻO ka cardiomyopathy koʻikoʻi i hele pū ʻia me ka hāʻule ʻana o ka puʻuwai paʻakikī.
4. ʻAʻole hiki ke hana pū me ka mālama ʻana o ka hemodialysis me nā maʻi noʻonoʻo.

Nā lako hana hemodialysis

ʻO nā lako o ka hemodialysis e komo pū ana me ka mīkini hemodialysis, ka mālama wai a me ka dialyzer, e hana pū ana i ka ʻōnaehana hemodialysis.
1. Mīkini hemodialysis
ʻo ia kekahi o nā lako hana lapaʻau i hoʻohana nui ʻia i ka mālama ʻana i ka hoʻomaʻemaʻe koko. He lako mechatronics paʻakikī ia, i haku ʻia me ka mea nānā lako dialysate a me ka mea nānā kahe koko extracorporeal.
2. ʻŌnaehana mālama wai
ʻOiai ʻo ke koko o ka mea maʻi i ka wā dialysis e pono ai ke hoʻopili i ka nui o ka dialysate (120L) ma o ka membrane dialysis, a loaʻa i ka wai paipa kūlanakauhale nā ​​​​​​mea trace like ʻole, ʻoiai nā metala kaumaha, a me kekahi mau disinfectants, endotoxins a me nā bacteria, ʻo ka hoʻopili ʻana me ke koko e hoʻoulu ai i kēia mau mea. Komo ka mea i loko o ke kino. No laila, pono e kānana ʻia ka wai paipa, wehe ʻia ka hao, palupalu, hoʻāla ʻia ke kalapona, a hana ʻia ka osmosis hoʻohuli ma ke kaʻina. ʻO ka wai osmosis hoʻohuli wale nō ka mea hiki ke hoʻohana ʻia ma ke ʻano he wai hoʻoheheʻe no ka dialysate i hoʻopaʻa ʻia, a ʻo ka mea hana no kahi moʻo o nā mālama ʻana o ka wai paipa ʻo ia ka ʻōnaehana mālama wai.
3. Dialyzer
Ua kapa ʻia hoʻi ʻo "ka puʻupaʻa hana". Ua haku ʻia ia me nā olonā hakahaka i hana ʻia me nā mea kemika, a ua hoʻolaha ʻia kēlā me kēia olonā hakahaka me nā lua liʻiliʻi he nui. I ka wā o ka dialysis, ke kahe nei ke koko ma o ka olonā hakahaka a ke kahe nei ka dialysate i hope ma o ka olonā hakahaka. Hoʻololi ʻia ka solute a me ka wai o kekahi mau molekala liʻiliʻi i loko o ka wai hemodialysis ma o nā lua liʻiliʻi ma ka olonā hakahaka. ʻO ka hopena hope loa o ka hoʻololi ʻana, ʻo ia ke koko i loko o ke koko. Hoʻoneʻe ʻia nā mea ʻawaʻawa Uremia, kekahi mau electrolytes, a me ka wai keu i loko o ka dialysate, a komo kekahi bicarbonate a me nā electrolytes i loko o ka dialysate i ke koko. I mea e hoʻokō ai i ke kumu o ka wehe ʻana i nā mea ʻawaʻawa, ka wai, ka mālama ʻana i ke kaulike acid-base a me ke kūpaʻa o ke kaiapuni kūloko. ʻO ka ʻāpana holoʻokoʻa o ka olonā hakahaka holoʻokoʻa, ka ʻāpana hoʻololi, e hoʻoholo ai i ka hiki ke hele o nā molekala liʻiliʻi, a ʻo ka nui o ka nui o ka pore membrane e hoʻoholo ai i ka hiki ke hele o nā molekala waena a me nā molekala nui.
4. Dialysate
Loaʻa ka dialysate ma ka hoʻoheheʻe ʻana i ka dialysis concentrate e loaʻa ana nā electrolytes a me nā kumu a me ka wai osmosis hoʻohuli i ka like ʻana, a ma ka hopena e hana i kahi hopena kokoke i ka nui o ka electrolyte koko e mālama i nā pae electrolyte maʻamau, me ka hāʻawi ʻana i nā kumu i ke kino ma o kahi nui o ke kumu, e hoʻoponopono i ka acidosis i ka mea maʻi. ʻO nā kumu dialysate i hoʻohana pinepine ʻia he bicarbonate, akā loaʻa pū kekahi liʻiliʻi o ka acetic acid.