I-Hemodialysis

I-Hemodialysis yenye yeendlela zokubuyisela izintso kwizigulana ezineengxaki zezintso ezibukhali nezingapheliyo. Ikhupha igazi emzimbeni liye ngaphandle komzimba kwaye idlula kwi-dialyzer eyenziwe ziintambo ezingenakubalwa ezingenanto. Igazi kunye nesisombululo se-electrolyte (ulwelo lwe-dialysis) olunezinga elifanayo lomzimba zingena kwaye ziphuma kwiintambo ezingenanto ngokusebenzisa i-diffusion, ultrafiltration, kunye ne-adsorption. Itshintshiselana ngezinto ngomgaqo we-convection, isusa inkunkuma ye-metabolic emzimbeni, igcina i-electrolyte kunye ne-acid-base balance; kwangaxeshanye, isusa amanzi angaphezulu emzimbeni, kwaye yonke inkqubo yokubuyisela igazi elicociweyo ibizwa ngokuba yi-hemodialysis.

umgaqo

1. Uthutho olunyibilikayo
(1) Ukusasazeka: Yindlela ephambili yokususa i-solute kwi-HD. I-solute ithuthwa ukusuka kwicala elinoxinzelelo oluphezulu ukuya kwicala elinoxinzelelo oluphantsi ngokuxhomekeke kwi-gradient yoxinzelelo. Le meko ibizwa ngokuba yi-dispersion. Amandla okuhambisa i-dispersive ye-solute avela kwintshukumo engaqhelekanga yee-molecules okanye amasuntswana ngokwawo (intshukumo kaBrownian).
(2) I-Convection: Ukuhamba kwe-solutes kwi-membrane engenakugqithwa kunye ne-solvent kubizwa ngokuba yi-convection. Engachaphazeleki bubunzima be-molecular ye-solute kunye nomahluko wayo we-concentration gradient, amandla angaphaya kwe-membrane ngumahluko woxinzelelo lwe-hydrostatic kumacala omabini e-membrane, okubizwa ngokuba yi-solute traction.
(3) Ukufunxa: Kungokusebenzisana kweetshaja ezilungileyo nezingalunganga okanye amandla e-van der Waals kunye namaqela athanda amanzi kumphezulu we-dialysis membrane ukuze kufunxe iiproteni ezithile, iityhefu kunye namayeza (ezifana ne-β2-microglobulin, i-complement, i-inflammatory mediators, i-Endotoxin, njl.njl.). Umphezulu wazo zonke ii-dialysis membranes unetshaja engalunganga, kwaye ubungakanani betshaja engalunganga kumphezulu we-membrane bumisela ubungakanani beeproteni ezifunxekileyo ezineetshaja ezahlukeneyo. Kwinkqubo ye-hemodialysis, iiproteni ezithile eziphakamileyo ngokungaqhelekanga, iityhefu kunye namayeza egazini zifunxeka ngokukhetha kumphezulu we-dialysis membrane, ukuze ezi zinto zibangela izifo zisuswe, ukuze kufezekiswe injongo yonyango.
2. Ukudluliselwa kwamanzi
(1) Inkcazo ye-Ultrafiltration: Ukuhamba kolwelo nge-membrane evulekayo ngaphantsi kwesenzo se-hydrostatic pressure gradient okanye i-osmotic pressure gradient kubizwa ngokuba yi-ultrafiltration. Ngexesha le-dialysis, i-ultrafiltration ibhekisa ekuhambeni kwamanzi ukusuka kwicala legazi ukuya kwicala le-dialysate; ngokuchaseneyo, ukuba amanzi ahamba ukusuka kwicala le-dialysate ukuya kwicala legazi, abizwa ngokuba yi-reverse ultrafiltration.
(2) Izinto ezichaphazela ukuhluzwa kwamanzi amaninzi: ①ukuhluzwa kwamanzi acocekileyo; ②ukuhluzwa koxinzelelo lwe-osmotic; ③uxinzelelo lwe-transmembrane; ④i-ultrafiltration coefficient.

Iimpawu

1. Ukulimala kwezintso okukhawulezileyo.
2. Ukusilela kwentliziyo okubangelwa kukugqithisa umthamo okanye uxinzelelo lwegazi olunzima ukulawula ngamayeza.
3. I-metabolic acidosis enzima kunye ne-hyperkalemia ekunzima ukuyilungisa.
4. I-Hypercalcemia, i-hypocalcemia kunye ne-hyperphosphatemia.
5. Ukungasebenzi kakuhle kwezintso okungapheliyo kunye ne-anemia enzima ukuyilungisa.
6. I-uremic neuropathy kunye ne-encephalopathy.
7. I-uremia pleurisy okanye i-pericarditis.
8. Ukungasebenzi kakuhle kwezintso okungapheliyo kunye nokungondleki kakuhle.
9. Ukungasebenzi kakuhle kwamalungu omzimba okanye ukwehla kwesimo somzimba ngokubanzi.
10. Ukutyhefwa ngamayeza okanye ngetyhefu.

Izimo zokungahambelani

1. Ukopha ngaphakathi kwentloko okanye uxinzelelo oluphezulu ngaphakathi kwentloko.
2. Umothuko omkhulu okunzima ukuwulungisa ngamayeza.
3. I-cardiomyopathy enzulu ehamba nokusilela kwentliziyo okungenakuphikiswa.
4. Unyango oluhamba neengxaki zengqondo alunakusebenzisana nonyango lwe-hemodialysis.

Izixhobo ze-Hemodialysis

Izixhobo ze-hemodialysis ziquka umatshini we-hemodialysis, unyango lwamanzi kunye ne-dialyzer, ezithi xa zidibene zenze inkqubo ye-hemodialysis.
1. Umatshini we-Hemodialysis
sesinye sezixhobo zonyango ezisetyenziswa kakhulu kunyango lokucoca igazi. Sisixhobo se-mechatronics esintsonkothileyo, esenziwe sisixhobo sokujonga ukunikezelwa kwegazi nge-dialysate kunye nesixhobo sokujonga ukujikeleza kwegazi ngaphandle komzimba.
2. Inkqubo yokucoca amanzi
Ekubeni igazi lesigulana kwiseshoni ye-dialysis kufuneka liqhagamshelane nenani elikhulu le-dialysate (120L) nge-dialysis membrane, kwaye amanzi epompo asezidolophini aqulethe izinto ezahlukeneyo, ngakumbi iintsimbi ezinzima, kunye nezinye izibulali-ntsholongwane, ii-endotoxins kunye neebhaktheriya, ukudibana negazi kuya kubangela ezi zinto. Ke ngoko, amanzi epompo kufuneka ahluzwe, kususwe i-iron, kuthambe, kusebenze i-carbon, kwaye kucutshungulwe i-reverse osmosis ngokulandelelana. Amanzi e-reverse osmosis kuphela angasetyenziswa njengamanzi okunyibilikisa kwi-dialysate exineneyo, kwaye isixhobo soluhlu lweendlela zonyango lwamanzi epompo yinkqubo yonyango lwamanzi.
3. I-Dialyzer
ikwabizwa ngokuba “zintso zokwenziwa”. Yenziwe ngeefayibha ezingenanto ezenziwe ngezinto zeekhemikhali, kwaye ifayibha nganye engenanto isasazwa ngemingxuma emininzi emincinci. Ngexesha le-dialysis, igazi lihamba ngefayibha engenanto kwaye i-dialysate ibuyela umva ngefayibha engenanto. I-solute kunye namanzi ee-molecule ezincinci kwi-hemodialysis fluid zitshintshiselwa ngemingxuma emincinci kwifayibha engenanto. Isiphumo sokugqibela sokutshintshiselana ligazi egazini. Iityhefu ze-uremia, ezinye ii-electrolytes, kunye namanzi angaphezulu ziyasuswa kwi-dialysate, kwaye ezinye ii-bicarbonate kunye nee-electrolytes kwi-dialysate zingena egazini. Ukuze kufezekiswe injongo yokususa iityhefu, amanzi, ukugcina ibhalansi ye-acid-base kunye nokuzinza kwendalo yangaphakathi. Indawo iyonke yefayibha engenanto yonke, indawo yokutshintshiselana, imisela amandla okudlula kwee-molecule ezincinci, kwaye ubungakanani be-membrane pore bumisela amandla okudlula kwee-molecule eziphakathi nezinkulu.
4. I-Dialysate
I-dialysate ifunyanwa ngokuxuba i-dialysis concentrate equlethe ii-electrolytes kunye nee-bases kunye namanzi e-osmosis abuyela umva ngokwemilinganiselo, kwaye ekugqibeleni yenza isisombululo esisondeleyo kuxinzelelo lwe-electrolyte egazini ukugcina amanqanaba aqhelekileyo e-electrolyte, ngelixa inika iziseko emzimbeni ngoxinzelelo oluphezulu lwesiseko, Ukulungisa i-acidosis kwisigulana. Iziseko ze-dialysate ezisetyenziswa rhoqo yi-bicarbonate, kodwa zikwanayo ne-acetic acid encinci.