Kuyeretsa magazi

Hemodialysis ndi njira imodzi yochiritsira impso m'malo mwa odwala omwe ali ndi vuto la impso mwachangu komanso nthawi yayitali. Imachotsa magazi m'thupi kupita kunja kwa thupi ndipo imadutsa mu dialyzer yokhala ndi ulusi wambiri wopanda kanthu. Magazi ndi yankho la electrolyte (madzi a dialysis) okhala ndi kuchuluka kofanana kwa thupi amalowa ndi kutuluka mu ulusi wopanda kanthu kudzera mu kufalikira, kufinyidwa kwa ultrafiltration, ndi kulowetsedwa. Imasinthanitsa zinthu ndi mfundo ya convection, imachotsa zinyalala za kagayidwe kachakudya m'thupi, imasunga electrolyte ndi acid-base balance; nthawi yomweyo, imachotsa madzi ochulukirapo m'thupi, ndipo njira yonse yobweza magazi oyera imatchedwa hemodialysis.

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1. Kuyendera kopanda vuto
(1) Kufalikira: Ndi njira yayikulu yochotsera solute mu HD. Solute imasamutsidwa kuchokera kumbali ya concentration yapamwamba kupita kumbali ya concentration yochepa kutengera gradient ya concentration. Chochitika ichi chimatchedwa dispersion. Mphamvu yonyamula dispersive ya solute imachokera ku kayendedwe kosazolowereka kwa mamolekyulu a solute kapena tinthu tating'onoting'ono tokha (Brownian motion).
(2) Kuzungulira: Kuyenda kwa zinthu zosungunulira kudzera mu nembanemba yomwe imatha kulowa pang'onopang'ono pamodzi ndi chosungunulira kumatchedwa kuzungulira. Popanda kukhudzidwa ndi kulemera kwa molekyulu ya solute ndi kusiyana kwake kwa gradient, mphamvu yodutsa nembanemba ndi kusiyana kwa kuthamanga kwa hydrostatic mbali zonse ziwiri za nembanemba, komwe kumatchedwa kugwedezeka kwa solute.
(3) Kulowetsa: Ndi kudzera mu mgwirizano wa ma positive ndi negative charges kapena van der Waals forces ndi hydrophilic groups pamwamba pa dialysis membrane kuti atenge mapuloteni enaake, poizoni ndi mankhwala (monga β2-microglobulin, complement, inflammatory mediators, Endotoxin, ndi zina zotero). Pamwamba pa dialysis membranes zonse zimakhala ndi negative charge, ndipo kuchuluka kwa negative charge pamwamba pa nembanemba kumatsimikiza kuchuluka kwa mapuloteni olowetsedwa ndi ma charge osiyanasiyana. Mu hemodialysis, mapuloteni ena okwera modabwitsa, poizoni ndi mankhwala m'magazi amatengedwa mosankha pamwamba pa dialysis membrane, kuti zinthu zoyambitsa matendawa zichotsedwe, kuti akwaniritse cholinga cha chithandizo.
2. Kusamutsa madzi
(1) Tanthauzo la Ultrafiltration: Kuyenda kwa madzi kudzera mu nembanemba yomwe imalowa pang'onopang'ono pansi pa mphamvu ya hydrostatic pressure gradient kapena osmotic pressure gradient kumatchedwa ultrafiltration. Pa dialysis, ultrafiltration imatanthauza kuyenda kwa madzi kuchokera mbali ya magazi kupita mbali ya dialysate; mosiyana, ngati madzi asuntha kuchokera mbali ya dialysate kupita mbali ya magazi, amatchedwa reverse ultrafiltration.
(2) Zinthu zomwe zimakhudza kufinya kwa madzi m'thupi: ①kufinya kwa madzi m'thupi; ②kufinya kwa madzi m'thupi; ③kufinya kwa madzi m'thupi; ④kufinya kwa madzi m'thupi.

Zizindikiro

1. Kuvulala kwa impso kwambiri.
2. Kulephera kwa mtima chifukwa cha kuchuluka kwa magazi m'thupi kapena kuthamanga kwa magazi komwe kumakhala kovuta kulamulira ndi mankhwala.
3. Kuchuluka kwa acidosis m'thupi komanso hyperkalemia komwe kumakhala kovuta kukonza.
4. Kuchuluka kwa calcium m'thupi, kuchepa kwa calcium m'thupi ndi kuchuluka kwa phosphate m'thupi.
5. Kulephera kwa impso kosatha komanso kuchepa kwa magazi komwe kumakhala kovuta kukonza.
6. Matenda a mitsempha ya m'magazi (uremic neuropathy) ndi matenda a ubongo (encephalopathy).
7. Uremia pleurisy kapena pericarditis.
8. Kulephera kwa impso kosatha pamodzi ndi kusowa zakudya m'thupi kwambiri.
9. Kulephera kwa ziwalo kapena kuchepa kwa thanzi la ziwalo zonse.
10. Kupha mankhwala osokoneza bongo kapena poizoni.

Zotsutsana

1. Kutuluka magazi m'mutu kapena kupanikizika kwambiri m'mutu.
2. Kugwedezeka kwambiri komwe kumakhala kovuta kukonza ndi mankhwala.
3. Matenda a mtima oopsa omwe amatsagana ndi kulephera kwa mtima kosakhazikika.
4. Matenda amisala omwe amabwera chifukwa cha kusokonezeka kwa magazi sangagwirizane ndi chithandizo cha hemodialysis.

Zipangizo zoyeretsera magazi

Zipangizo zoyeretsera magazi zimaphatikizapo makina oyeretsera magazi, mankhwala a madzi ndi dialyzer, zomwe pamodzi zimapanga dongosolo la hemodialysis.
1. Makina oyeretsera magazi
ndi chimodzi mwa zida zochiritsira zomwe zimagwiritsidwa ntchito kwambiri pochiza magazi. Ndi zida zovuta kwambiri za mechatronics, zopangidwa ndi chipangizo chowunikira kuchuluka kwa magazi m'magazi ndi chipangizo chowunikira kuzungulira kwa magazi kunja kwa thupi.
2. Njira yoyeretsera madzi
Popeza magazi a wodwalayo panthawi ya dialysis ayenera kukhudza dialysate yambiri (120L) kudzera mu dialysis membrane, ndipo madzi a m'mphepete mwa mizinda ali ndi zinthu zosiyanasiyana, makamaka zitsulo zolemera, komanso mankhwala ena ophera tizilombo toyambitsa matenda, endotoxins ndi mabakiteriya, kukhudzana ndi magazi kumayambitsa izi. Mankhwalawa amalowa m'thupi. Chifukwa chake, madzi a m'mphepete ayenera kusefedwa, kuchotsedwa chitsulo, kufewetsedwa, kuyatsidwa kwa mpweya, ndikusinthidwa motsatizana. Madzi a reverse osmosis okha ndi omwe angagwiritsidwe ntchito ngati madzi osungunula a dialysate yokhazikika, ndipo chipangizo chothandizira kuchiza madzi a m'mphepete ndi njira yochizira madzi.
3. Choyezera Ma Dializa
Amatchedwanso "impso yopangira". Amapangidwa ndi ulusi wopanda kanthu wopangidwa ndi zinthu za mankhwala, ndipo ulusi uliwonse wopanda kanthu umagawidwa ndi mabowo ang'onoang'ono ambiri. Panthawi ya dialysis, magazi amadutsa mu ulusi wopanda kanthu ndipo dialysate imabwerera m'mbuyo kudzera mu ulusi wopanda kanthu. Solute ndi madzi a mamolekyu ang'onoang'ono mu hemodialysis fluid amasinthidwa kudzera m'mabowo ang'onoang'ono pa ulusi wopanda kanthu. Zotsatira zomaliza za kusinthana ndi magazi m'magazi. Poizoni wa uremia, ma electrolyte ena, ndi madzi ochulukirapo amachotsedwa mu dialysate, ndipo bicarbonate ndi ma electrolyte ena mu dialysate amalowa m'magazi. Kuti akwaniritse cholinga chochotsa poizoni, madzi, kusunga acid-base balance ndi kukhazikika kwa chilengedwe chamkati. Malo onse a ulusi wopanda kanthu wonse, malo osinthirana, amatsimikizira mphamvu yodutsa ya mamolekyu ang'onoang'ono, ndipo kukula kwa pores ya nembanemba kumatsimikizira mphamvu yodutsa ya mamolekyu apakati ndi akuluakulu.
4. Dialysate
Dialysate imapezeka pochepetsa mphamvu ya dialysis yokhala ndi ma electrolyte ndi ma bases ndi reverse osmosis madzi molingana, ndipo pamapeto pake imapanga yankho pafupi ndi kuchuluka kwa ma electrolyte m'magazi kuti isunge milingo ya electrolyte yabwinobwino, pamene ikupereka maziko ku thupi kudzera mu kuchuluka kwa maziko apamwamba, Kukonza acidosis mwa wodwalayo. Ma bases a dialysate omwe amagwiritsidwa ntchito kwambiri ndi makamaka bicarbonate, komanso amakhala ndi acetic acid yochepa.