Kuchenesa ropa

Kuchenesa ropa (hemodialysis) ndeimwe yenzira dzekurapa itsvo dzinotsiva varwere vane dambudziko reitsvo rakakomba uye risingaperi. Inoburitsa ropa kubva mumuviri kuenda kunze kwemuviri uye inopfuura nemuchina we dialyzer une fibers dzisina kuzara. Ropa nemushonga we electrolyte (dialysis fluid) zvine huwandu hwakafanana hwemuviri zvinopinda nekubuda mu fibers dzisina kuzara kuburikidza nekupararira, kupfapfaidza, uye kunyungudutsa. Inochinjana zvinhu nepfungwa ye convection, inobvisa tsvina ye metabolic mumuviri, inochengetedza electrolyte ne acid-base balance; panguva imwe chete, inobvisa mvura yakawandisa mumuviri, uye maitiro ese ekudzosa ropa rakacheneswa anonzi hemodialysis.

musimboti

1. Kutakurwa kwakasimba
(1) Kupararira: Ndiyo nzira huru yekubvisa solute muHD. Solute inotakurwa kubva kudivi rine concentration yakawanda kuenda kudivi rine concentration yakaderera zvichienderana ne gradient ye concentration. Chiitiko ichi chinonzi dispersion. Simba rekufambisa rinopararira re solute rinobva mukufamba kusina kurongeka kwemamorekuru kana zvidimbu zve solute pachazvo (Brownian motion).
(2) Kutenderera: Kufamba kwezvinonyungudutsa kuburikidza nemembrane inopindika zvishoma pamwe chete ne solvent kunonzi convection. Simba riri pamusoro pemembrane harina kukanganiswa nehuremu hwemolecular inonyungudutsa uye musiyano we gradient ye concentration, asi simba riri pamusoro pemembrane ndiro musiyano we hydrostatic pressure kumativi ese emembrane, inova inonzi solute traction.
(3) Kunyudzwa: Kuburikidza nekudyidzana kwezviripo uye zvisina kunaka kana van der Waals forces uye mapoka emvura pamusoro pe dialysis membrane zvinonyudzwa nemapuroteni, chepfu nemishonga (yakadai se β2-microglobulin, complement, inflammatory mediators, Endotoxin, nezvimwewo). Pamusoro pezviripo zvese zve dialysis membranes pane negative charge, uye huwandu hwe negative charge pamusoro pe membrane hunosarudza huwandu hwemapuroteni ane heterogeneous charges. Mukuita hemodialysis, mamwe mapuroteni akakwira zvisina kujairika, chepfu uye mishonga muropa zvinonyudzwa nemazvo pamusoro pe dialysis membrane, kuitira kuti zvinhu izvi zvinotapukira zvibviswe, kuitira kuti chinangwa chekurapa chibudirire.
2. Kutamisirwa kwemvura
(1) Tsanangudzo yeUltrafiltration: Kufamba kwemvura kuburikidza nekamera kanopindirana neropa pasi pesimba rehydrostatic pressure gradient kana osmotic pressure gradient kunonzi ultrafiltration. Munguva yedialysis, ultrafiltration zvinoreva kufamba kwemvura kubva kurutivi rweropa kuenda kurutivi rwedialysate; zvakasiyana, kana mvura ichifamba kubva kurutivi rwedialysate kuenda kurutivi rweropa, inonzi reverse ultrafiltration.
(2) Zvinhu zvinokanganisa kusvina kwemvura zvakanyanya: ①kusvina kwemvura yakachena; ②kusvina kwemhepo inoyerera; ③kusvina kweropa mumembrane; ④kusvina kwemvura zvakanyanya.

Zviratidzo

1. Kukuvara kwakanyanya kweitsvo.
2. Kukundikana kwemoyo kwakanyanya kunokonzerwa nekuwanda kweropa kana BP iyo inonetsa kudzora nemishonga.
3. Kuoma kwakanyanya kwe metabolic acidosis uye hyperkalemia iyo yakaoma kugadzirisa.
4. Kuwanda kwecalcium mumuviri, kushaya calcium mumuviri uye kuwedzera kwephosphate mumuviri.
5. Kutadza kushanda zvakanaka kweitsvo kwenguva refu pamwe nekushaya ropa kunonetsa kugadzirisa.
6. Uremic neuropathy uye encephalopathy.
7. Uremia pleurisy kana pericarditis.
8. Kutadza kushanda zvakanaka kweitsvo nguva dzose pamwe chete nekushaya kudya kwakakwana.
9. Kusashanda zvakanaka kwenhengo dzemuviri kana kudzikira kwemamiriro adzo.
10. Kuchetura zvinodhaka kana chepfu.

Zvinorambidzwa

1. Kubuda ropa mukati memusoro kana kuwedzera kwedzvinyiriro mukati memusoro.
2. Kuvhunduka kwakanyanya kunonetsa kugadzirisa nemishonga.
3. Kurwara kwakanyanya kwemwoyo pamwe chete nekutadza kushanda zvakanaka kwemoyo.
4. Kana paine matambudziko epfungwa, hazvigone kushanda pamwe chete nekurapa hemodialysis.

Midziyo yekuchenesa ropa

Midziyo ye hemodialysis inosanganisira muchina we hemodialysis, mushonga wemvura uye dialyzer, izvo zvinoumba pamwe chete system ye hemodialysis.
1. Muchina wekuchenesa ropa
ndeimwe yemichina inoshandiswa zvakanyanya pakurapa mukuchenesa ropa. Imuchina we mechatronics wakaoma kunzwisisa, unoumbwa nemudziyo wekutarisa kugoverwa kweropa nemudziyo wekutarisa kutenderera kweropa kunze kwemuviri.
2. Sisitimu yekurapa mvura
Sezvo ropa remurwere panguva yekuongorora ropa richifanira kubata dialysate yakawanda (120L) kuburikidza nedialysis membrane, uye mvura yemupombi yemumaguta ine zvinhu zvakasiyana-siyana, kunyanya simbi dzinorema, pamwe chete nemishonga inouraya utachiona, endotoxins nemabhakitiriya, kusangana neropa kuchaita kuti izvi zvipinde mumuviri. Nokudaro, mvura yemupombi inofanira kusefa, kubviswa kwesimbi, kunyoroveswa, activated carbon, uye kugadziriswa kwe reverse osmosis zvakatevedzana. Mvura ye reverse osmosis chete ndiyo inogona kushandiswa semvura yekudilution ye dialysate yakaomeswa, uye mudziyo wekurapa mvura yemupombi ndiyo nzira yekurapa mvura.
3. Chinovhara dhayi
Inonziwo "itsvo yekugadzira". Inoumbwa neshinda dzisina chinhu dzakagadzirwa nezvinhu zvemakemikari, uye shinda yega yega isina chinhu inoparadzirwa nemaburi madiki akawanda. Munguva yedialysis, ropa rinoyerera nepakati peshinda isina chinhu uye dialysate inoyerera ichidzokera kumashure nepakati peshinda isina chinhu. Solute nemvura yemamwe mamorekuru madiki ari mu hemodialysis fluid zvinotsinhaniswa kuburikidza nemaburi madiki ari pashinda isina chinhu. Mhedzisiro yekupedzisira yekuchinjana iropa riri muropa. Chepfu yeUremia, mamwe ma electrolyte, nemvura yakawandisa zvinobviswa mu dialysate, uye mamwe ma bicarbonate nema electrolyte ari mu dialysate zvinopinda muropa. Kuti zvizadzise chinangwa chekubvisa chepfu, mvura, kuchengetedza acid-base balance uye kugadzikana kwemukati menzvimbo. Nzvimbo yese yeshinda isina chinhu, nzvimbo yekuchinjana, inosarudza kugona kwekufambisa kwemamorekuru madiki, uye saizi yehukuru hwe membrane pore inosarudza kugona kwekufambisa kwemamorekuru epakati neemakuru.
4. Dialysate
Dialysate inowanikwa nekusanganisa dialysis concentrate ine ma electrolyte nema bases uye reverse osmosis water muchiyero, uye pakupedzisira inogadzira mhinduro iri pedyo nehuwandu hwe electrolyte muropa kuchengetedza huwandu hwe electrolyte hwakajairika, uku ichipa ma bases kumuviri kuburikidza nehuwandu hwepamusoro hwe base, Kugadzirisa acidosis mumurwere. Ma bases anowanzoshandiswa dialysate anonyanya kushandiswa anosanganisira bicarbonate, asi anewo acetic acid shoma.