Ezigulini ezine-end-stage renal disease (ESRD), i-hemodialysis iyindlela yokwelapha ephephile nephumelelayo. Ngesikhathi sokwelashwa, igazi ne-dialysate kuthintana ne-dialyzer (izinso zokwenziwa) ngolwelwesi olungena kancane, okuvumela ukushintshana kwezinto eziqhutshwa ama-concentration gradients. Umshini we-hemodialysis udlala indima ebalulekile ekuhlanzeni igazi ngokususa udoti we-metabolic kanye nama-electrolyte amaningi ngenkathi wethula i-calcium ion ne-bicarbonate kusuka ku-dialysate iye egazini. Kulesi sihloko, sizohlola izinto eziyisisekelo zemishini ye-hemodialysis futhi siqondise indlela yokukhetha idivayisi yekhwalithi ephezulu ukwenza ukwelashwa kukhululeke kakhudlwana.

 

Ukuqonda Imishini Ye-Hemodialysis

Imishini yokuhlaziya i-hemodialysis ivamise ukuba nezinhlelo ezimbili eziyinhloko: uhlelo lokuqapha igazi kanye nohlelo lokuhlinzeka nge-dialysate. Uhlelo lwegazi lunesibopho sokulawula ukujikeleza kwegazi ngaphandle kwe-extracorporeal futhi uhlelo lwe-dialysate lulungisa isisombululo esifanelekayo se-dialysis ngokuxuba ama-concentrate kanye namanzi e-RO futhi ahambise isixazululo ku-dialyzer. Ku-hemodialyzer, i-dialysate yenza i-solute diffusion, ingene, futhi icwebeze ngegazi lesiguli ngolwelwesi olungena kancane, kanti okwamanje, igazi lokuhlanza lizobuyela emzimbeni wesiguli ngohlelo lokulawula igazi futhi uhlelo lwe-dialysate lukhipha uketshezi olungcolile. Le nqubo yokugibela ibhayisikili eqhubekayo ihlanza igazi ngokuphumelelayo.

Ngokuvamile, uhlelo lokuqapha igazi luhlanganisa iphampu yegazi, iphampu ye-heparin, ukuqapha kwe-arterial kanye ne-venous pressure, kanye nohlelo lokuthola umoya. Izingxenye ezibalulekile zesistimu yokuhlinzeka nge-dialysis yisistimu yokulawula izinga lokushisa, uhlelo lokuxuba, uhlelo lwe-degas, uhlelo lokuqapha i-conductivity, ukuqapha kwe-ultrafiltration, ukutholwa kokuvuza kwegazi, njalonjalo.

Izinhlobo ezimbili eziyinhloko zemishini esetshenziswa ku-hemodialysis yizinga elijwayelekileumshini we-hemodialysis (HD).kanye neumshini we-hemodiafiltration (HDF).. Imishini ye-HDF esetshenziswayoama-dialyzers ane-flux ephezuluhlinzeka ngenqubo yokuhlunga ethuthuke kakhulu--ukusabalalisa kanye nokuguquguquka ukuze kuthuthukiswe ukukhishwa kwama-molecule amakhulu nezinto ezinobuthi futhi kugcwalise ama-ion abalulekile ngokufaka esikhundleni somsebenzi wokuhlinzeka.

Kuyaphawuleka ukuthi indawo engaphezulu ye-membrane ye-dialyzer kufanele ibhekwe esimweni esithile sesiguli, okuhlanganisa isisindo, ubudala, isimo senhliziyo, nokufinyelela kwemithambo lapho kukhethwa ama-dialyzers. Hlala uthintana nesiphakamiso sikadokotela ukuze unqumei-dialyzer efanelekile.

 

Ukukhetha Umshini Ofanele We-Hemodialysis

Ukuphepha nokunemba yizinto eziza kuqala. Nazi ezinye izici ezibalulekile okufanele zicatshangelwe:

1. Izici Zokuphepha

Umshini oqeqeshiwe we-hemodialysis kufanele ube nokuqapha okuqinile kokuphepha kanye nezinhlelo ze-alamu. Lawa masistimu kufanele azwele ngokwanele ukuze abone noma yiziphi izimo ezingavamile futhi anikeze izexwayiso ezinembile kubaqhubi.

Ukuqapha kwesikhathi sangempela ukuqapha okuqhubekayo komfutho we-arterial kanye ne-venous, amazinga okugeleza, neminye imingcele ebalulekile ngesikhathi sokuhlanza. Izaziso zamasistimu e-alamu ngezindaba ezinjengomoya osezindaweni zegazi zeqe umfutho wegazi, noma amazinga okucwenga angalungile.

 2. Ukunemba kokusebenza

Ukunemba komshini kuthinta ukusebenza kahle kokwelashwa futhi ngokuvamile kuhlolwa izici ezilandelayo :

Isilinganiso sokuhlunga: umshini kufanele ulawule ngokunembile uketshezi olukhishwe esigulini.

Ukuqapha Conductivity: ukuqinisekisa ukuthi i-dialysate isezingeni elifanele le-electrolyte.

Ukulawula izinga lokushisa: umshini kufanele ulondoloze i-dialysate ekushiseni okuphephile nokunethezekile.

 3. Isixhumi esibonakalayo Esisebenziseka kalula

Isixhumi esibonakalayo esisebenziseka kalula singathuthukisa kakhulu ulwazi lweziguli nabasebenzi. Bheka imishini enezilawuli ezinembile nezibonisi ezicacile ezenza kube lula ukuqapha imingcele yokwelapha.

4. Isondlo kanye Nokwesekwa

Cabangela umthamo wosekelo lwezobuchwepheshe kanye nezinsizakalo zokunakekela zomkhiqizi womshini okhethiwe. Ukwesekwa okuthembekile kungaqinisekisa ukuthi noma yiziphi izinkinga zilungiswa ngokushesha, kuncishiswe ukuphazamiseka ekwelashweni.

 5. Ukuhambisana Namazinga

Umshini we-hemodialysis kufanele uhambisane nezindinganiso ezifanele zokuphepha nekhwalithi ezibekwe yimizimba elawulayo. Lokhu kuthobela kubalulekile ekuqinisekiseni ukuphepha kwesiguli kanye nokwelashwa okusebenzayo.

 

Imishini Encintisanayo Ye-Hemodialysis kanye Nomkhiqizi

Iimodeli yomshini we-hemodialysis W-T2008-Bekhiqizwa nguChengdu Wesleyihlanganisa cishe iminyaka engamashumi amathathu yeqembu lesipiliyoni sembonini kanye nokuqanjwa kabusha kobuchwepheshe. Umshini uklanyelwe ukusetshenziswa ezinyunithi zezokwelapha futhi uthole isitifiketi se-CE, esinobuchwepheshe obuphambili, ukuzinza, ukuphepha nokunethezeka kwesiguli, kanye nokusebenza kalula kwabasebenzi bezokwelapha. Inamaphampu amabili kanye negumbi elinembile lebhalansi ye-supply-and-return-liquid, idizayini eyingqayizivele yokuqinisekisa ukunemba kwe-ultrafiltration. Izingxenye ezibalulekile zomshini zingeniswa zisuka e-Europe nase-US, njengama-solenoid valves aqinisekisa ukulawulwa okunembile kokuvula nokuvala kweziteshi, nama-chips aqinisekisa ukuqapha okunembile nokuqoqwa kwedatha.

 

Okuthuthukile ukuvikela ukuphepha uhlelo

Lo mshini wamukela uhlelo olumbaxambili lokuqapha nokuvikela komoya, izinga loketshezi kanye nezitholi zebhamuza, ezingavimbela ngokuphumelelayo umoya osegazini ukuba ungangeni emzimbeni wesiguli ukuze umise izingozi ze-air embolism. Ukwengeza, umshini ufakwe amaphuzu amabili wokuqapha izinga lokushisa kanye namaphoyinti amabili wokuqhuba, ukuqinisekisa ukuthi ikhwalithi ye-dialysate igcinwa kulo lonke ukwelashwa. Isistimu ye-alamu ehlakaniphile ihlinzeka ngempendulo yesikhathi sangempela kunoma yikuphi ukungahambi kahle phakathi ne-dialysis. I-alamu ye-acousto-optic ixwayisa opharetha ukuthi baphendule ngokushesha kunoma yiziphi izinkinga, okukhuphula ukuphepha kwesiguli nokusebenza ngempumelelo kokwelashwa.

Ngokusekelwe esisekelweni se-W-T2008-B, iW-T6008S hemodiafiltration umshiniyengeza imonitha yomfutho wegazi, izihlungi ze-endotoxin, kanye ne-Bi-Cart njengokucushwa okujwayelekile. Ingashintsha kalula phakathi kwezindlela ze-HDF ne-HD ngesikhathi sokwelashwa. Faka ama-dialyzer ane-flux ephezulu, asiza ukukhishwa kwama-molecule amakhulu egazini, umshini uthuthukisa ukusebenza kahle kanye nokunethezeka kokwelashwa.