Hemodialysis

Ko te hemodialysis tētahi o ngā maimoatanga whakakapinga whatukuhu mō ngā tūroro e pāngia ana e te ngoikore whatukuhu ohorere me te mau tonu. Ka ringihia te toto mai i te tinana ki waho o te tinana, ka haere mā roto i te dialyzer he maha ngā muka tuwhera. Ko te toto me te otinga electrolyte (wai dialysis) he rite te kukū o te tinana ka uru, ka puta i roto i ngā muka tuwhera mā te horapa, te tātaritanga ultra, me te mimiti. Ka whakawhiti matū me te kaupapa o te convection, ka tangohia ngā para pākia i roto i te tinana, ka pupuri i te taurite electrolyte me te waikawa-pūtake; i te wa ano, ka tangohia te wai nui i roto i te tinana, ā, ko te tukanga katoa o te whakahoki mai i te toto kua purea ka kiia ko te hemodialysis.

kaupapa

1. Te kawe i ngā matū wairewa
(1) Te Marara: Koinei te tikanga matua o te tango i te matū matū i roto i te HD. Ka haria te matū matū mai i te taha kukū teitei ki te taha kukū iti i runga i te pikinga kukū. Ka kiia tēnei āhuatanga ko te marara. Ko te kaha kawe marara o te matū matū matū ka ahu mai i te nekehanga koretake o ngā ngota matū ... mā te marara.
(2) Te Whakawhitiwhiti: Ko te nekehanga o ngā matū wairewa i roto i te kiriuhi haurua-whakauru me te whakarewa e kiia ana ko te whakawhiti. Ahakoa te taumaha ngota ngota wairewa me tōna rerekētanga kukū, ko te mana puta noa i te kiriuhi ko te rerekētanga pēhanga wai i ngā taha e rua o te kiriuhi, koinei te mea e kiia nei ko te kukume wairewa.
(3) Te mimiti: Mā te taunekeneke o ngā utu pai me ngā utu kino, ngā kaha van der Waals me ngā rōpū hydrophilic i runga i te mata o te membrane dialysis ka mimiti motuhake i ētahi pūmua, paitini me ngā rongoā (pērā i te β2-microglobulin, te tāpiri, ngā takawaenga mumura, te Endotoxin, me ētahi atu). He utu kino te mata o ngā membrane dialysis katoa, ā, ko te nui o te utu kino i runga i te mata o te membrane ka whakatau i te nui o ngā pūmua e mimitihia ana me ngā utu rerekē. I roto i te tukanga hemodialysis, ka mimiti motuhaketia ētahi pūmua, paitini me ngā rongoā teitei rawa i roto i te toto ki runga i te mata o te membrane dialysis, kia tangohia ai ēnei matū mate, kia tutuki ai te kaupapa o te maimoatanga.
2. Te whakawhiti wai
(1) Te whakamāramatanga o te tātaritanga-ā-rahi: Ko te nekehanga o te wai i roto i tētahi kiriuhi haurua-permeable i raro i te mahi a te pikinga pēhanga hydrostatic, te pikinga pēhanga osmotic rānei, ka kiia ko te tātaritanga-ā-rahi. I te wā o te dialysis, ko te tātaritanga-ā-rahi e pā ana ki te nekehanga o te wai mai i te taha toto ki te taha dialysate; i tetahi atu taha, ki te neke te wai mai i te taha dialysate ki te taha toto, ka kiia ko te tātaritanga-ā-rahi whakamuri.
(2) Ngā āhuatanga e pā ana ki te tātaritanga tino-rahi: ①te pikinga pēhanga wai parakore; ②te pikinga pēhanga osmotic; ③te pēhanga whakawhiti-membrane; ④te tauwehenga tātaritanga tino-rahi.

Ngā tohu

1. Te whara whatukuhu whakapeka.
2. Te ngoikore o te ngākau nā te nui rawa o te toto i roto i te tinana, te toto toto tiketike rānei, he uaua ki te whakahaere mā te rongoā.
3. Te waikawa pūmua kino me te hyperkalemia he uaua ki te whakatika.
4. Te hiperukarū nui, te korekarū nui me te hiperukarū nui.
5. Te ngoikore o te whatukuhu mau tonu me te anemia e uaua ana ki te whakatika.
6. Te neuropathy uremic me te encephalopathy.
7. Uremia pleurisy, pericarditis rānei.
8. Te ngoikore o te whatukuhu mau tonu me te kore kai pai nui.
9. Te ngoikore o ngā okana, te hekenga rānei o te āhua whānui, kāore e taea te whakamārama.
10. Paitini i te tarukino, i te paitini rānei.

Ngā ārai

1. Te totohu o roto o te angaanga, te pikinga rānei o te pēhanga o roto o te angaanga.
2. Te ohorere nui e uaua ana ki te whakatika ki ngā rongoā.
3. Te cardiomyopathy kino e haere tahi ana me te ngoikore o te ngakau uaua.
4. Kāore e taea te mahi tahi me te maimoatanga hemodialysis mēnā ka haere tahi mai ngā mate hinengaro.

Ngā taputapu hemodialysis

Kei roto i ngā taputapu mō te hemodialysis te mīhini hemodialysis, te maimoatanga wai me te dialyzer, e rua nei e hanga tahi ana i te pūnaha hemodialysis.
1. Mīhini hemodialysis
Ko tētahi o ngā taputapu rongoā e whakamahia whānuitia ana mō te maimoatanga purenga toto. He taputapu mechatronics tino uaua, he mea tito mai i te taputapu aroturuki tuku dialysate me te taputapu aroturuki tohanga toto i waho o te tinana.
2. Pūnaha maimoatanga wai
I te mea me pā te toto o te tūroro ki te nui o te dialysate (120L) mā roto i te kiriuhi dialysis, ā, kei roto i te wai paipa o te tāone ngā momo huānga iti, inā koa ngā konganuku taumaha, me ētahi patu huakita, ngā endotoxins me ngā huakita, ka puta ēnei matū ki te tinana ina pā ki te toto. Nō reira, me tātari te wai paipa, me tango te rino, me whakangawari, me whakamahi te waro whakahohe, ā, me tukatuka i te osmosis whakamuri i roto i te raupapa. Ko te wai osmosis whakamuri anake ka taea te whakamahi hei wai whakamātotoru mō te dialysate kukū, ā, ko te pūnaha maimoatanga wai te taputapu mō te raupapa maimoatanga o te wai paipa.
3. Pūwero Dialyzer
e kiia ana hoki ko te "whākihi horihori". He mea tito mai i ngā muka tuwhera i hangaia ki ngā rauemi matū, ā, he maha ngā kōhao iti o ia muka tuwhera. I te wā o te dialysis, ka rere te toto i roto i te muka tuwhera, ā, ka rere whakamuri te dialysate i roto i te muka tuwhera. Ka whakawhitihia te matū wairewa me te wai o ētahi ngota iti i roto i te wai hemodialysis mā roto i ngā kōhao iti i runga i te muka tuwhera. Ko te hua whakamutunga o te whakawhiti ko te toto i roto i te toto. Ka tangohia ngā paitini uremia, ētahi electrolytes, me te wai nui i roto i te dialysate, ā, ka uru ētahi paikāponate me ngā electrolytes i roto i te dialysate ki te toto. Kia tutuki ai te kaupapa o te tango i ngā paitini, te wai, te pupuri i te taurite waikawa-pūtake me te pumau o te taiao o roto. Ko te horahanga katoa o te muka tuwhera katoa, te horahanga whakawhiti, e whakatau ana i te kaha haere o ngā ngota iti, ā, ko te rahi o te rahi o te pūwero kiriuhi e whakatau ana i te kaha haere o ngā ngota reo me ngā ngota nui.
4. Te wai whakapūkara
Ka whiwhihia te dialysate mā te whakaranu i te kukū dialysis kei roto ngā electrolytes me ngā turanga me te wai osmosis whakamuri kia rite te ōwehenga, ā, ka mutu, ka hangaia he otinga e tata ana ki te kukū electrolytes toto hei pupuri i ngā taumata electrolytes noa, me te whakarato i ngā turanga ki te tinana mā te kukū turanga teitei ake, hei whakatika i te waikawa i roto i te tūroro. Ko ngā turanga dialysate e whakamahia whānuitia ana ko te bicarbonate, engari he iti noa te waikawa acetic kei roto.