Hemodialysis

Treatment mode

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Hemodialysis (HD) is urgent Chronic renal failure patient kidney replace Treatment mode one of. By draining blood from the body to the outside, it passes through a Dialyzer Medium, blood and body containing electrolyte solution （ Dialysate ）Inside and outside the hollow fibers, through dispersion Ultrafiltration , adsorption and convection principle Substance exchange , eliminate metabolic waste in the body, and maintain electrolyte and acid-base balance ； At the same time, the whole process of removing excess water from the body and returning purified blood is called hemodialysis.

Chinese name

Hemodialysis

Foreign name

Contraindication

Intracranial hemorrhage or high intracranial pressure

equipment

Hemodialysis machine, water treatment system, dialysate

Indications

Hypercalcemia, hypocalcemia, hyperphosphatemia, etc

atlas

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The certification expert of this term is

Zhang Guohua | Chief physician

Department of Traditional Chinese Medicine, Guangzhou Nanfang Hospital to examine

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essential information

Chinese name: Hemodialysis
Foreign name: HD

Contraindication: Intracranial hemorrhage or high intracranial pressure
Equipment: Hemodialysis machine, water treatment system, dialysate
Indications: Hypercalcemia, hypocalcemia, hyperphosphatemia, etc

principle

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1. Solute transport

(1) Dispersion: it is the main mechanism of solute removal in HD. Solute dependence concentration gradient Transport from the high concentration side to the low concentration side is called dispersion. The dispersion and transport energy of solute comes from the irregular movement of solute molecules or particles themselves（ Brownian motion ）。

(2) Convection: solute passes through together with solvent Semipermeable membrane The movement of is called convection. It is not affected by the molecular weight of solute and its concentration gradient difference. The transmembrane power is the hydrostatic pressure difference on both sides of the membrane, which is called solute Tractive action 。

(3) Adsorption: through positive negative charge Interaction or Van der Waals And dialysis membrane surface Hydrophilicity Selective adsorption of some groups protein , poisons and drugs (such as β 2-microglobulin 、 complement Inflammatory media, endotoxin, etc.). All dialysis membranes have negative charges on the surface, and the amount of negative charges on the membrane surface determines the amount of heterocharged protein absorbed. In the process of hemodialysis, some abnormally elevated proteins, poisons and drugs in the blood are selectively adsorbed on the surface of the dialysis membrane, so that these pathogenic substances can be removed to achieve the purpose of treatment.

2. Water transfer

(1) Definition of ultrafiltration: liquid in still water Pressure gradient or osmotic pressure The movement through the semipermeable membrane under gradient is called ultrafiltration. During dialysis, ultrafiltration refers to the movement of water from the blood side to the dialysate side; Conversely, if the water moves from the dialysate side to the blood side, it is called reverse ultrafiltration.

(2) Impact Ultrafiltration Factors of: ① pressure gradient of purified water; ② Osmotic pressure gradient; ③ Transmembrane pressure; ④ Ultrafiltration coefficient.

indication

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one Acute renal injury 。

two Capacity load Caused by overweight Acute heart failure Or drugs are difficult to control hypertension 。

3. Serious Metabolic acidosis And difficult to correct Hyperkalemia 。

four Hypercalcemia 、 Hypocalcemia and Hyperphosphatemia 。

five chronic renal failure Merge those that are difficult to correct anemia 。

six uremia Neuropathy and encephalopathy 。

7. Uremia pleurisy or pericarditis 。

8. Chronic renal failure with severe complications innutrition 。

9. Organs that cannot be explained dysfunction Or general condition declines.

10. Poisoning by drugs or poisons.

contraindication

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one intracranial hemorrhage or Increased intracranial pressure 。

2. Severe shock that is difficult to correct with drugs.

3. Severe myocardial disease accompanied by Refractory heart failure 。

4. Accompanying Mental disorders Incompatibility blood dialysis therapy 。

Hemodialysis equipment

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Hemodialysis equipment includes Hemodialysis machine , water treatment and dialyzer, which together form the hemodialysis system.

1. Hemodialysis machine

yes Blood purification treatment The most widely used therapeutic instrument in the Mechatronics The equipment is composed of dialysate supply monitoring device and extracorporeal circulation monitoring device.

2. Water treatment system

Because the patient's blood must be separated Dialysis membrane Contact with a large amount of dialysis fluid (120L), while urban tap water contains various trace element especially Heavy metal elements , and some disinfectant 、 endotoxin And bacteria, contact with blood will cause these substances to enter the body. Therefore, tap water needs to be filtered Iron removal , softening Activated carbon For reverse osmosis treatment, only reverse osmosis water can be used as dilution water for concentrated dialysate, while the device for a series of treatment of tap water is the water treatment system.

3. Dialyzer

Also called“ Artificial kidney ”It is composed of hollow fibers made of chemical materials, and each hollow fiber is distributed with numerous holes. During dialysis, the blood flows through the hollow fiber and the dialysate flows reversely through the hollow fiber Small molecule The solute and water of Uremic toxin And some electrolyte Excess water enters the dialysate and is removed. Some of the water in the dialysate Bicarbonate And electrolytes enter the blood. So as to eliminate toxin, water and maintain acid-base balance and Stable internal environment The purpose of. The total area of the entire hollow fiber, that is, the exchange area, determines the Trafficability The pore size of the membrane determines the passing ability of medium and large molecules.

4. Dialysate

Dialysate consists of electrolyte and Base It is obtained by diluting the dialysate concentrate and reverse osmosis water in proportion, and finally forms a solution close to the blood electrolyte concentration to maintain the normal electrolyte level. At the same time, it provides bases to the body through a higher base concentration to correct the presence of Acidosis 。 The commonly used dialysate bases are Bicarbonate , and a small amount acetic acid 。

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