Ịgwọ ọbara n'ọbara

Ọgwụ hemodialysis bụ otu n'ime ọgwụgwọ nnọchi akụrụ maka ndị ọrịa nwere nsogbu akụrụ na-adịghị ala ala. Ọ na-amịpụta ọbara site n'ahụ gaa n'èzí ahụ ma na-agafe na dialyzer nke nwere ọtụtụ eriri oghere. Ọbara na mmiri electrolyte (mmiri dialysis) nke nwere oke nha ahụ dị n'ime na n'èzí eriri oghere site na mgbasa, ultrafiltration, na absorption. Ọ na-agbanwe ihe ndị dị na ụkpụrụ nke convection, na-ewepụ ihe mkpofu metabolic n'ahụ, na-eme ka nguzozi electrolyte na acid-base dịgide; n'otu oge ahụ, na-ewepụ mmiri gabigara ókè n'ahụ, a na-akpọkwa usoro niile nke iweghachi ọbara dị ọcha hemodialysis.

ụkpụrụ

1. Njem mmiri
(1) Mgbasa: Ọ bụ isi usoro nke iwepụ ihe mgbaze na HD. A na-ebuga ihe mgbaze site na akụkụ nke nnukwu mgbaze gaa na akụkụ nke obere mgbaze dabere na mgbaze njupụta. A na-akpọ ihe a mgbasa. Ike mbugharị nke ihe mgbaze sitere na mmegharị na-adịghị mma nke ihe mgbaze ma ọ bụ ihe ndị ahụ n'onwe ha (mgbagharị Brownian).
(2) Nchikota: A na-akpọ mmegharị nke ihe ndị na-agbaze site na akpụkpọ ahụ semipermeable yana ihe mgbaze convection. Ọ bụrụ na ibu molekul solute na ọdịiche gradient ya emetụtaghị ya, ike dị n'ofe akpụkpọ ahụ bụ ọdịiche nrụgide hydrostatic n'akụkụ abụọ nke akpụkpọ ahụ, nke bụ ihe a na-akpọ solute traction.
(3) Mkpọchi: Ọ bụ site na mmekọrịta nke ebubo dị mma na nke na-adịghị mma ma ọ bụ ike van der Waals na otu hydrophilic n'elu akpụkpọ ahụ dialysis iji họrọ itinye ụfọdụ protein, nsí na ọgwụ (dịka β2-microglobulin, complement, inflammatory mediators, Endotoxin, wdg). Elu akpụkpọ ahụ dialysis niile na-anata ụgwọ na-adịghị mma, ego nke ebubo na-adịghị mma na elu akpụkpọ ahụ na-ekpebi ọnụọgụ protein ndị a na-etinye n'ime ya nwere ebubo dị iche iche. N'usoro hemodialysis, a na-etinye ụfọdụ protein, nsí na ọgwụ ndị dị n'ọbara n'elu akpụkpọ ahụ dialysis, ka e wee wepụ ihe ndị a na-akpata ọrịa, iji mezuo ebumnuche ọgwụgwọ.
2. Nnyefe mmiri
(1) Nkọwa Ultrafiltration: A na-akpọ mmegharị nke mmiri mmiri site na akpụkpọ ahụ nke nwere ike ịbanye n'okpuru ọrụ nke hydrostatic pressure gradient ma ọ bụ osmotic pressure gradient. N'oge dialysis, ultrafiltration na-ezo aka na mmegharị nke mmiri site n'akụkụ ọbara gaa na akụkụ dialysate; n'aka nke ọzọ, ọ bụrụ na mmiri ahụ si n'akụkụ dialysate gaa n'akụkụ ọbara, a na-akpọ ya reverse ultrafiltration.
(2) Ihe ndị na-emetụta nzacha ultrafiltration: ① mgbada nrụgide mmiri dị ọcha; ② mgbada nrụgide osmotic; ③ nrụgide akpụkpọ ahụ; ④ ọnụọgụgụ nzacha ultrafiltration.

Ihe ngosi

1. Mmerụ ahụ akụrụ dị oke njọ.
2. Obi mgbawa nke na-esi n'oke olu ma ọ bụ ọbara mgbali elu nke siri ike ịchịkwa site na iji ọgwụ eme ihe kpatara ya.
3. Acidosis metabolic siri ike na hyperkalemia nke siri ike idozi.
4. Hypercalcemia, hypocalcemia na hyperphosphatemia.
5. Mmebi akụrụ na-adịghị ala ala nke na-akpata ọbara ọgbụgba nke siri ike idozi.
6. Ọrịa akwara uremic na encephalopathy.
7. Uremia pleurisy ma ọ bụ pericarditis.
8. Mmebi akụrụ na-adịghị ala ala yana nsogbu nri na-adịghị mma.
9. Nsogbu akụkụ ahụ ma ọ bụ mbelata n'ọnọdụ izugbe nke a na-apụghị ịkọwa.
10. Nsi ọgwụ ma ọ bụ nsi.

Ihe ndị na-egbochi ya

1. Ọbara ọgbụgba n'ime ụbụrụ ma ọ bụ mmụba nke nrụgide intracranial.
2. Mkpọtụ siri ike nke siri ike idozi site na iji ọgwụ.
3. Ọrịa obi dị oke njọ nke na-esochi nkụda obi na-adịghị mma.
4. Ndị nwere nsogbu uche agaghị enwe ike ijikọ aka na ọgwụgwọ hemodialysis.

Ngwa hemodialysis

Ngwa eji eme hemodialysis gụnyere igwe hemodialysis, ọgwụgwọ mmiri na dialyzer, nke na-eme usoro hemodialysis.
1. Igwe na-eme ka ọbara gbapụta
bụ otu n'ime ngwa ọgwụgwọ kachasị eji eme ihe n'ọgwụgwọ nhicha ọbara. Ọ bụ ngwa mechatronics dị mgbagwoju anya, nke mejupụtara ngwaọrụ nlekota ọkọnọ dialysate na ngwaọrụ nlekota mgbasa ọbara mpụga ahụ.
2. Sistemụ ọgwụgwọ mmiri
Ebe ọ bụ na ọbara onye ọrịa n'oge a na-eme dialysis ga-emetụ nnukwu dialysate (120L) site na akpụkpọ ahụ dialysis, mmiri ọkpọkọ obodo nwekwara ọtụtụ ihe ndị dị ndụ, ọkachasị ọla dị arọ, yana ụfọdụ ihe na-egbu nje, endotoxins na nje bacteria, mmetụ aka na ọbara ga-eme ka ihe ndị a banye n'ahụ. Ya mere, a ga-enyocha mmiri ọkpọkọ ahụ, wepụ ígwè, mee ka ọ dị nro, mee ka carbon rụọ ọrụ, na nhazi osmosis reverse n'usoro. Naanị mmiri reverse osmosis ka enwere ike iji dị ka mmiri dilution maka dialysate a chịkọtara, ngwaọrụ maka usoro ọgwụgwọ nke mmiri ọkpọkọ bụ usoro ọgwụgwọ mmiri.
3. Dialyzer
A na-akpọkwa ya "akụrụ arụrụ arụ". E ji eriri oghere e ji ihe kemịkalụ mee mee ya, eriri oghere ọ bụla na-ekesakwa ya na ọtụtụ obere oghere. N'oge dialysis, ọbara na-agafe eriri oghere ahụ, dialysate na-asọghachi azụ site na eriri oghere ahụ. A na-agbanwe solute na mmiri nke ụfọdụ obere molekul dị na mmiri hemodialysis site na obere oghere dị na eriri oghere ahụ. Nsonaazụ ikpeazụ nke mgbanwe ahụ bụ ọbara dị n'ọbara. A na-ewepụ nsị Uremia, ụfọdụ electrolytes, na mmiri gabigara ókè na dialysate, ụfọdụ bicarbonate na electrolytes dị na dialysate na-abanyekwa n'ọbara. Iji mezuo ebumnuche nke iwepụ nsị, mmiri, idobe nguzozi acid-base na nkwụsi ike gburugburu ebe obibi. Mpaghara zuru oke nke eriri oghere niile, mpaghara mgbanwe, na-ekpebi ikike ngafe nke obere molekul, nha nke nha oghere membrane na-ekpebikwa ikike ngafe nke molekul etiti na nnukwu.
4. Dialysate
A na-enweta dialysate ahụ site na ịgbasa ihe mejupụtara dialysis nke nwere electrolytes na bases na mmiri reverse osmosis n'ogo, ma mechaa mepụta ihe ngwọta dị nso na njupụta electrolyte ọbara iji nọgide na-enwe ọkwa electrolyte nkịtị, ebe ọ na-enye ntọala nye ahụ site na njupụta isi dị elu. Iji dozie acidosis dị n'ahụ onye ọrịa. Bases dialysate a na-ejikarị eme ihe bụkarị bicarbonate, mana ha nwekwara obere acetic acid.