Txoj Cai:
1. Solute thauj
(1) Diffusion: Nws yog lub luag haujlwm tseem ceeb ntawm kev tshem tawm lub sijhawm HD. Lub solute yog thauj los ntawm high-concentration sab mus rau qis-concentration sab los ntawm ib tug concentration gradient, ib tug phenomenon hu ua dispersion. Lub zog ntawm kev thauj mus los ntawm cov kuab tshuaj diffusion yog los ntawm cov lus tsa suab tsis tu ncua (Brownian motion) ntawm cov molecules lossis cov khoom ntawm cov kua nplaum nws tus kheej.
(2) Convection: Lub zog ntawm cov kua los ntawm cov semipermeable membrane nrog rau cov kuab tshuaj hu ua convection. Tsis cuam tshuam los ntawm qhov hnyav molecular ntawm cov kuab tshuaj thiab nws cov concentration gradient sib txawv, lub zog tsav tsheb hla lub membrane yog hydrostatic siab sib txawv ntawm ob sab ntawm daim nyias nyias, uas yog hu ua solute rub nyhuv.
(3) Adsorption: Nws yog kev xaiv adsorption ntawm qee cov proteins, tshuaj lom thiab tshuaj (xws li 2-microglobulin, ntxiv, inflammatory mediators, endotoxin, thiab lwm yam). Qhov saum npoo ntawm tag nrho cov dialysis daim nyias nyias yog qhov tsis zoo, thiab tus nqi ntawm cov nqi tsis zoo ntawm daim nyias nyias yog txiav txim siab tus nqi ntawm cov protein adsorbed nrog cov nqi txawv teb chaws. Nyob rau hauv tus txheej txheem ntawm hemodialysis, qee qhov txawv txav ntawm cov proteins, tshuaj lom thiab tshuaj nyob rau hauv cov ntshav tau xaiv adsorbed rau saum npoo ntawm daim nyias nyias, kom cov kab mob no raug tshem tawm, thiaj li ua tiav lub hom phiaj ntawm kev kho mob.
2. Kev thauj dej
(1) Ultrafiltration txhais: Lub zog ntawm cov kua los ntawm ib lub semipermeable membrane nyob rau hauv qhov kev txiav txim ntawm ib tug hydrostatic siab gradient los yog ib tug osmotic siab gradient yog hu ua ultrafiltration. Thaum lub sij hawm dialysis, ultrafiltration yog hais txog kev txav ntawm cov dej los ntawm cov ntshav mus rau sab dialysate; ntawm qhov tsis sib xws, yog tias cov dej txav ntawm sab dialysate mus rau sab ntshav, nws yog hu ua thim rov qab ultrafiltration.
(2) Cov yam ntxwv cuam tshuam rau ultrafiltration: ① dej siab gradient; ② osmotic siab gradient; ③ transmembrane siab; ④ ultrafiltration coefficient.
Cov lus qhia
1. Mob raum raug mob.
2. Mob plawv tsis ua hauj lwm tshwm sim los ntawm qhov ntim ntau dhau los yog kub siab uas nyuaj rau kev tswj cov tshuaj.
3. Cov kab mob metabolic acidosis hnyav thiab hyperkalemia uas tsis yooj yim kho.
4. Hypercalcemia, hypocalcemia thiab hyperphosphatemia.
5. Lub raum tsis ua haujlwm ua ke nrog cov ntshav ntshav uas nyuaj rau kho.
6. Uremic neuropathy thiab encephalopathy.
7. Uremic pleurisy lossis pericarditis.
8. Lub raum tsis ua haujlwm ua ke nrog kev noj zaub mov tsis zoo.
9. Kev piav qhia ntawm lub cev tsis ua haujlwm lossis kev poob qis.
10. Tshuaj los yog lom lom
Hemodialysis khoom
Hemodialysis cov cuab yeej suav nrog lub tshuab hemodialysis, kev kho dej thiab tshuab lim dej, uas ua ke tsim cov kab ke hemodialysis.
1. Hemodialysis tshuab
Nws yog cov cuab yeej siv kho mob feem ntau siv hauv kev kho ntshav purification. Nws yog ib qho nyuaj electromechanical integration ntaus ntawv, uas muaj ib tug dialysate mov soj ntsuam cov cuab yeej thiab ib tug extracorporeal ncig xyuas ntaus ntawv.
2. Kev kho dej
Txij li thaum tus neeg mob cov ntshav nyob rau hauv kev sib cuag nrog ib tug loj npaum li cas ntawm dialysate (120L) los ntawm lub dialysis daim nyias nyias nyob rau hauv ib tug dialysis, thiab lub nroog kais dej muaj ntau yam kab kawm, tshwj xeeb tshaj yog hnyav hlau ntsiab, raws li zoo raws li ib co tshuaj tua kab mob, endotoxins thiab kab mob. ntshav yuav ua rau cov tshuaj no rau hauv lub cev. Yog li ntawd, cov kais dej yuav tsum tau lim, hlau tshem tawm, softened, activated carbon, thiab rov qab osmosis kev kho nyob rau hauv ib ntus. Tsuas yog cov dej rov qab osmosis tuaj yeem siv los ua cov dej dilution rau cov concentrated dialysate, thiab cov cuab yeej ua haujlwm ntawm kev kho cov dej kais dej yog qhov kev kho dej.
3. Dialyzer
Kuj hu ua "lub raum cuav", nws muaj cov hollow fibers ua los ntawm cov khoom siv tshuaj, thiab txhua qhov hollow fiber yog faib nrog ntau qhov me me. Thaum lub sij hawm dialysis, cov ntshav dhau los ntawm cov hollow fibers thiab cov dialysate ntws rov qab los ntawm hollow fibers. Qee cov molecules me me ntawm cov kuab tshuaj thiab dej hauv hemodialysate tau pauv los ntawm cov qhov ntawm cov hollow fibers. Qhov kawg tshwm sim ntawm kev sib pauv yog cov ntshav hauv cov ntshav. Uremic co toxins, qee cov electrolytes, thiab dej ntau dhau nkag mus rau hauv dialysate kom tshem tawm, thiab qee qhov bicarbonate thiab electrolytes hauv dialysate nkag mus rau hauv cov ntshav. Yog li kom ua tiav lub hom phiaj ntawm kev tshem tawm cov co toxins, dej, tswj cov kua qaub-puag sib npaug thiab ruaj khov hauv ib puag ncig. Tag nrho cheeb tsam ntawm tag nrho cov hollow fiber, uas yog, qhov chaw sib pauv, txiav txim siab qhov kev muaj peev xwm ntawm cov me me molecules, thaum qhov loj ntawm daim nyias nyias pore loj txiav txim siab qhov muaj peev xwm ntawm nruab nrab thiab loj molecules.
4. Dialysate
Lub dialysate yog tau los ntawm proportionally diluting lub dialysis concentrate uas muaj electrolytes thiab bases nrog rov qab osmosis dej, thiab thaum kawg tsim ib tug tov nrog ib tug concentration nyob ze rau cov ntshav electrolytes kom tswj ib txwm electrolyte theem, thaum muab bases rau lub cev los ntawm ib tug ntau dua puag concentration. , los kho tus neeg mob cov acidosis uas twb muaj lawm. Feem ntau siv dialysate hauv paus feem ntau yog bicarbonate thiab tseem muaj me me ntawm acetic acid.
