I-Hemodialysis

I-Hemodialysis ingenye yezindlela zokwelapha esikhundleni sezinso zeziguli ezinenkinga yezinso ebukhali nehlala isikhathi eside. Ikhipha igazi emzimbeni liye ngaphandle komzimba futhi idlule ku-dialyzer eyakhiwe imicu eminingi engenalutho. Igazi kanye nesisombululo se-electrolyte (uketshezi lwe-dialysis) olunezinga elifanayo lomzimba lingena futhi liphuma emicu engenalutho ngokusabalala, ukuhlunga kakhulu, kanye nokumuncwa. Ishintshanisa izinto ngesimiso sokujikeleza kwegazi, isusa imfucuza ye-metabolic emzimbeni, igcina ibhalansi ye-electrolyte kanye ne-acid-base; ngesikhathi esifanayo, isusa amanzi angaphezulu emzimbeni, futhi yonke inqubo yokubuyisela igazi elihlanziwe ibizwa ngokuthi i-hemodialysis.

isimiso

1. Ukuthutha okuncibilikisiwe
(1) Ukuhlakazeka: Kuyindlela eyinhloko yokususa i-solute ku-HD. I-solute ithuthwa isuka ohlangothini olune-concentration ephezulu iye ohlangothini olune-concentration ephansi kuye ngokuthi i-concentration gradient ingakanani. Lesi simo sibizwa ngokuthi ukuhlakazeka. Amandla okuthutha ahlakazayo e-solute avela ekuhambeni okungajwayelekile kwama-molecule noma izinhlayiya ngokwazo (ukunyakaza kwe-Brownian).
(2) Ukuguqulwa kwe-Convection: Ukuhamba kwe-solutes nge-membrane engangeni kahle kanye ne-solvent kubizwa ngokuthi i-convection. Njengoba ingathinteki isisindo sama-molecule esinyibilikayo kanye nomehluko we-gradient yokuhlushwa kwayo, amandla kulo lonke ulwelwesi umehluko wokucindezela kwe-hydrostatic kuzo zombili izinhlangothi ze-membrane, okubizwa ngokuthi i-solute traction.
(3) Ukumuncwa: Kungokusebenzisana kwamacala amahle nangalungile noma amandla e-van der Waals namaqembu athanda amanzi ebusweni be-dialysis membrane ukuze kumuncwe ngokukhetha amaprotheni athile, ubuthi kanye nezidakamizwa (njenge-β2-microglobulin, i-complement, i-inflammatory mediators, i-Endotoxin, njll.). Ubuso bawo wonke ama-dialysis membranes bushajwa kabi, futhi inani le-negative charge ebusweni be-membrane linquma inani lamaprotheni axhashwayo ane-variables. Enkambisweni ye-hemodialysis, amaprotheni athile aphakeme ngendlela engavamile, ubuthi kanye nezidakamizwa egazini zimuncwa ngokukhetha ebusweni be-dialysis membrane, ukuze lezi zinto ezibangela izifo zisuswe, ukuze kufezwe injongo yokwelashwa.
2. Ukudluliselwa kwamanzi
(1) Incazelo ye-Ultrafiltration: Ukuhamba koketshezi nge-membrane engena kancane ngaphansi kwesenzo se-hydrostatic pressure gradient noma i-osmotic pressure gradient kubizwa ngokuthi i-ultrafiltration. Ngesikhathi se-dialysis, i-ultrafiltration ibhekisela ekuhambeni kwamanzi ukusuka ohlangothini lwegazi ukuya ohlangothini lwe-dialysate; ngokuphambene nalokho, uma amanzi ehamba esuka ohlangothini lwe-dialysate eya ohlangothini lwegazi, abizwa ngokuthi i-reverse ultrafiltration.
(2) Izici ezithinta ukuhluzwa kwe-ultrafiltration: ①ukuhluzwa kwengcindezi yamanzi ahlanzekile; ②ukuhluzwa kwengcindezi ye-osmotic; ③ingcindezi ye-transmembrane; ④i-coefficient ye-ultrafiltration.

Izinkomba

1. Ukulimala kwezinso okukhulu.
2. Ukwehluleka kwenhliziyo okukhulu okubangelwa ukugcwala ngokweqile noma umfutho wegazi ophakeme okunzima ukuwulawula ngemithi.
3. I-metabolic acidosis enzima kanye ne-hyperkalemia okunzima ukuyilungisa.
4. I-Hypercalcemia, i-hypocalcemia kanye ne-hyperphosphatemia.
5. Ukwehluleka kwezinso okungapheli okubangela i-anemia okunzima ukuyilungisa.
6. I-uremic neuropathy kanye ne-encephalopathy.
7. I-uremia pleurisy noma i-pericarditis.
8. Ukwehluleka kwezinso okungapheli kuhlangene nokungondleki kahle okukhulu.
9. Ukungasebenzi kahle kwezitho zomzimba okungachazeki noma ukwehla kwesimo esijwayelekile.
10. Ubuthi bezidakamizwa noma ubuthi.

Izimo zokuphikisana

1. Ukopha ngaphakathi kobuchopho noma ukwanda kwengcindezi ngaphakathi kobuchopho.
2. Ukushaqeka okukhulu okunzima ukukulungisa ngemithi.
3. I-cardiomyopathy enzima ehambisana nokwehluleka kwenhliziyo okungalawuleki.
4. Uma kuhambisana nokuphazamiseka kwengqondo, awukwazi ukubambisana nokwelashwa nge-hemodialysis.

Imishini yokuhlanza igazi

Imishini ye-hemodialysis ihlanganisa umshini we-hemodialysis, ukwelashwa kwamanzi kanye ne-dialyzer, okuhlanganisa konke okwakha uhlelo lwe-hemodialysis.
1. Umshini wokuhlanza igazi
ingenye yemishini yokwelapha esetshenziswa kakhulu ekwelapheni ukuhlanza igazi. Iyimishini ye-mechatronics eyinkimbinkimbi, eyakhiwe yidivayisi yokuqapha ukuphakelwa kwe-dialysate kanye nedivayisi yokuqapha ukujikeleza kwegazi ngaphandle komzimba.
2. Uhlelo lokwelapha amanzi
Njengoba igazi lesiguli esimisweni se-dialysis kufanele lithinte inani elikhulu le-dialysate (120L) nge-dialysis membrane, futhi amanzi ompompi asedolobheni aqukethe izakhi zokulandelela ezahlukahlukene, ikakhulukazi izinsimbi ezisindayo, kanye nezinye izibulala-magciwane, ama-endotoxins namabhaktheriya, ukuthintana negazi kuzobangela lokhu. Into ingena emzimbeni. Ngakho-ke, amanzi ompompi adinga ukuhlungwa, kususwe insimbi, kuthambe, kusebenze i-carbon, bese kucutshungulwa i-reverse osmosis ngokulandelana. Amanzi e-reverse osmosis kuphela angasetshenziswa njengamanzi okuxuba i-dialysate egxilile, futhi idivayisi yochungechunge lokwelashwa kwamanzi ompompi uhlelo lokwelapha amanzi.
3. I-Dialyzer
ibizwa nangokuthi “izinso zokwenziwa”. Yakhiwe ngemicu engenalutho eyenziwe ngezinto zamakhemikhali, futhi i-fiber ngayinye engenalutho isatshalaliswa ngemigodi eminingi emincane. Ngesikhathi se-dialysis, igazi ligeleza nge-fiber engenalutho bese i-dialysate igeleza emuva nge-fiber engenalutho. I-solute namanzi amanye ama-molecule amancane ku-hemodialysis fluid ashintshaniswa ngemigodi emincane ku-fiber engenalutho. Umphumela wokugcina wokushintshana kwegazi yigazi egazini. Ubuthi be-uremia, amanye ama-electrolyte, namanzi angaphezulu kususwa ku-dialysate, kanti amanye ama-bicarbonate nama-electrolyte ku-dialysate angena egazini. Ukuze kufezwe injongo yokususa ubuthi, amanzi, ukugcina ibhalansi ye-acid-base kanye nokuqina kwemvelo yangaphakathi. Indawo iyonke ye-fiber engenalutho, indawo yokushintshana kwegazi, inquma amandla okudlula kwama-molecule amancane, kanti ubukhulu be-membrane pore bunquma amandla okudlula kwama-molecule aphakathi namakhulu.
4. I-Dialysate
I-dialysate itholakala ngokunciphisa i-dialysis concentrate equkethe ama-electrolyte nezisekelo kanye namanzi e-osmosis abuyela emuva ngokulingana, futhi ekugcineni yakha isisombululo esiseduze nokuhlushwa kwe-electrolyte yegazi ukuze kulondolozwe amazinga ajwayelekile e-electrolyte, ngenkathi inikeza izisekelo emzimbeni ngokuhlushwa okuphezulu kwesisekelo, Ukulungisa i-acidosis esigulini. Izisekelo ze-dialysate ezisetshenziswa kakhulu yi-bicarbonate, kodwa futhi ziqukethe inani elincane le-acetic acid.