Hemodialysis vs Peritoneal Dialysis!
Hemodialysis
Txog hemodialysis: Nws yog ib qho ntawm cov kev kho ntshav purification ntau tshaj plaws tam sim no. Cov txheej txheem yog coj cov ntshav tawm ntawm lub cev, los ntawm cov khoom siv hluav taws xob ntxiv nrog lub tshuab lim dej, thiab ua kom tiav qhov kev tshem tawm thiab thauj cov kuab tshuaj thiab dej los ntawm biophysical mechanisms. Nws tshem tawm ntau yam endogenous thiab exogenous co toxins nyob rau hauv cov ntshav los ntawm diffusion, convection thiab adsorption, tshem tawm cov dej khaws cia nyob rau hauv lub cev los ntawm ultrafiltration thiab osmosis, thiab tib lub sij hawm kho cov electrolyte acid -base tshuav nyiaj li cas, kom lub sab hauv ib puag ncig ntawm cov neeg mob dialysis yog ze li qub. .
Cov lus qhia:
1. Thaum kawg - kab mob raum
2. Mob raum raug mob: cov neeg mob uas muaj lub xeev decomposition siab yuav tsum tau lim ntshav tam sim. Yog tias tsis yog, txiav txim siab ua tiav raws li cov ntsuas hauv qab no: anuria ntau dua 48 teev, cov ntshav urea nitrogen ntau dua lossis sib npaug li 21.4 mmol / l, ntshav creatinine ntau dua lossis sib npaug rau 442umol / l, ntshav cov poov tshuaj ntau dua lossis sib npaug li 6.5. mmol / l, ntshav bicarbonate ion tsawg dua 15 mmol / l lossis pom tseeb edema, xeev siab, ntuav, lethargy, nyob tsis tswm, pulmonary edema, thiab lwm yam.
3. Cov tshuaj lom neeg mob, tshuaj lom neeg lom, thiab lwm yam.
4. Cov dej hnyav -electrolyte acid- puag ncig tsis zoo, hemolysis, daim siab tsis ua haujlwm, thiab lwm yam.
Cov txheeb ze contraindications:
1. Intracranial hemorrhage lossis nce intracranial siab
2. Shock refractory rau tshuaj
3. Mob plawv cardiomyopathy thiab refractory plawv tsis ua hauj lwm, hnyav arrhythmia, thiab lwm yam.
4. Kev ua haujlwm los ntshav.
5. Cov neeg muaj kev puas siab puas ntsws tsis tuaj yeem koom tes nrog hemodialysis.
Txoj kev ntawm ntshav purification:hemodialysis, hemofiltration, hemodiafiltration, yooj yim ultrafiltration. ntshav perfusion. Kev kho lub raum tsis tu ncua (CRRT), thiab lwm yam.
Txog kev lim ntshav: tus qauv thoob ntiaj teb tam sim no yog autologous arteriovenous fistula (radial artery plus cephalic vein). Thaum muaj xwm txheej ceev, lub hauv paus venous catheter tuaj yeem muab tso rau (sab hauv jugular, subclavian, thiab cov hlab ntsha sib sib zog nqus ntawm cov leeg qis tuaj yeem siv tau), xws li cov fistula stenosis nyob rau hauv vim yog vascular yam tsis zoo, siab sab hauv fistula lossis kev tsim kho lossis cov hlab ntsha. los yog balloon dilation yuav tsum tau. Cov no kuj yog nyiaj ntau heev. Balloon dilation yog qhov yuav tsum tau ua rau cov hlab ntsha dag txhua 3 lub hlis.
Kev lim ntshav peritoneal
Hais txog kev lim ntshav peritoneal: Qhov no yog -hu ua peritoneal dialysis yog lub transmembrane thauj cov kuab tshuaj thiab dej los ntawm ob lub kua dej cais los ntawm ib lub semipermeable membrane, ib qho: peritoneal capillaries, uas muaj uremic toxins xws li urea, creatinine thiab lwm yam kuab tshuaj. Thib ob: lub peritoneal dialysate nchuav rau hauv lub plab kab noj hniav muaj cov khoom siv electrolyte, buffers, osmotic agents, thiab dialysate thaum lub sij hawm tus txheej txheem nyob rau hauv lub plab kab noj hniav, kev thauj mus los yog nqa tawm nyob rau tib lub sij hawm, thiab cov co toxins - muaj dialysate yog drained tom qab nyob twj ywm rau ib lub sij hawm. Tuaj tawm thiab sau cov dialysate tshiab. , txawm tias kev hloov pauv dej peritoneal dialysis ua tiav.
Muaj ntau txoj hauv kev ntawm kev lim ntshav peritoneal: muaj kev ua haujlwm yooj yim, thiab cov tshuab lim ntshav peritoneal kuj siv rau kev lim ntshav. Cov kev siv feem ntau yog CAPD (24-teev kev lim ntshav tsis cuam tshuam) thiab APD (automatic peritoneal dialysis). Tau kawg, tseem muaj ob hom kev lim ntshav peritoneal. Muaj kev faib tshwj xeeb. CAPD yog tam sim no siv dav. Tsis pub dhau 24 teev hauv ib hnub, dialysate tau tso rau hauv lub plab kab noj hniav ntawm cov neeg mob, thiab kev sib pauv hloov pauv thiab ultrafiltration tau ua tsis tu ncua.
Cov lus qhia:
1. Kev lim ntshav peritoneal tuaj yeem muab qhov tseem ceeb hauv cov xwm txheej hauv qab no: cov neeg laus, menyuam mos, thiab menyuam yaus. Lub plawv, kab mob cerebrovascular lossis tsis ruaj khov ntawm cov hlab plawv. Cov mob vascular tsis zoo lossis rov ua dua arteriovenous fistula tsis ua haujlwm. Coagulopathy nrog cov cim los ntshav lossis los ntshav. Tseem zoo residual raum ua haujlwm. Nyiam rau cov kws kho mob hauv tsev. Cov neeg mob nrog kev thauj mus los tsis yooj yim.
2. Mob raum raug mob
3. Cov kab mob lom, tshwj xeeb tshaj yog hemodialysis contraindications
4. Lwm yam mob plawv tsis ua hauj lwm
Contraindications:
Kev sib txuam ntau hauv cov kab noj hniav, cov kab mob hauv lub plab zom mov tsis muaj qhov tso cai, cov teeb meem kho tshuab uas nyuaj rau kho, mob peritoneal tsis zoo, cov neeg mob tsis tuaj yeem ua haujlwm ntawm lawv tus kheej yam tsis muaj cov neeg saib xyuas tsim nyog, thiab lwm yam.
