dialysis
The treatment that allows the components of body fluids (solutes or water) to pass through a semi-permeable membrane to be removed from the body is often used in cases of acute or chronic renal failure, accumulation of medications or other toxins in the body, and is commonly used to treat the condition with hemodialysis and peritoneal dialysis
Hemodialysis
Blood Dialysis therapy
The patient's blood and dialysis fluid are introduced into the dialyzer at the same time (the flow direction of the two is opposite), and the semi-permeable membrane of the dialyzer (artificial kidney) is used to remove excessive toxins and excessive water accumulated in the blood and replenish the alkaline base in order to correct acidosis and adjust the electrolyte disorders to replace the excretory function of the kidneys
Hemodialyzer, commonly known as the artificial kidney, has three types: hollow fiber type, coiled tubing type and flat plate type
The hemodialysis machine is commonly called artificial kidney, which includes hollow fiber type, coiled tubing type and peritoneal type. The most commonly used is the hollow fiber type
Consisting of 1~15,000 hollow fibers, the walls of the hollow fibers are the dialysis membrane, which has a semi-permeable membrane nature. When hemodialysis is performed, the blood flows into each of the hollow fibers while the dialysis solution flows outside of each of the hollow fibers
The direction of flow of the blood is in the opposite direction of the flow of the dialysis solution, which is through the principle of a semi-permeable membrane. Removal of water through ultrafiltration and osmosis
Indications for hemodialysis include: ① Acute renal failure ② Acute drug or toxic poisoning ③ Chronic renal failure ④ Renal failure before kidney transplantation or post-transplantation rejection reaction rendering the transplanted kidney non-functional ⑤ Other diseases such as hepatic failure, schizophrenia, psoriasis, etc.
Relative contraindications to hemodialysis include: ① Extremely critical, hypotension, and shock.
, shock ② severe infection sepsis ③ severe myocardial insufficiency or coronary artery disease ④ major surgery within 3 days ⑤ severe hemorrhagic tendency
, cerebral hemorrhage and severe anemia ⑥ psychiatric uncooperative ⑦ patients with malignant tumors
General patients need to be hemodialyzed three times a week for four to five hours each time
should be started as soon as possible in order to facilitate the correction of toxins due to excessive accumulation of irreversible organs The irreversible organ damage and metabolic disorders caused by the excessive accumulation of toxins should be started when the creatinine clearance drops to 10-12mL/min. Dialysis is effective and safe for patients aged 15-60 years old. However, due to the continuous improvement of dialysis technology and the emergence of new dialysis equipment, good results can also be obtained for patients aged 70 years old and above
In order to ensure the quality of life of dialysis patients
To improve the rate of recovery
In order to ensure the quality of life of dialysis patients
Improve the rate of recovery
In order to improve the rate of recovery
Hemodialysis patients should be guaranteed a daily intake of protein
1.0-1.2 g/kg and 146.3 kJ/kg, and at the same time, they should consume enough water-soluble vitamins and micronutrients to replenish the amount of loss from dialysis. The 5-year survival rate of dialysis patients varies from country to country and ranges from about 50% to 80%, and 10-year survival rates of more than 50% have been reported
Peritoneal dialysis therapy
Peritoneal dialysis patients should be given a daily intake of protein and micronutrients. Peritoneal dialysis therapy
Peritoneal dialysis is the use of the peritoneum as a semi-permeable membrane
Peritoneal dialysis fluid is injected into the peritoneal cavity through the peritoneal dialysis tubing through the principle of dispersion to remove toxins to correct the disorders of electrolyte and acid-base balance through the principle of osmosis (adding glucose to the peritoneal dialysis fluid to increase the osmolality of the peritoneal dialysis fluid) to achieve ultrafiltration and dehydration instead of the renal excretion
Peritoneal dialysis is a simpler device than hemodialysis. It can be operated at the bedside and can avoid sudden changes in fluid balance
Peritoneal dialysis is divided into continuous ambulatory peritoneal dialysis (CAPD patients can carry the equipment with them and move freely), continuous cyclic peritoneal dialysis (CCPD
Advantages are the same as those of CAPD, which relies on the peritoneal dialysis machine at night to perform dialysis but can still work during the day), and intermittent peritoneal dialysis (used for patients with acute illnesses). Peritoneal dialysis should be performed 4-6 times a day, each time 2000mL of peritoneal fluid is instilled Peritoneal dialysis does not need to rely on machines
Easy to operate, no special training is needed, so it is inexpensive and can be carried out in the primary health care units Although the indications for peritoneal dialysis and hemodialysis are the same, but they have their own advantages and disadvantages and cannot be replaced by each other, so it should be chosen according to the patient's primary cause of illness, condition, and medical and economic conditions, to maximize the benefits of the patient's life. The following cases should be given priority to consider peritoneal dialysis: ① elderly, poor cardiovascular system function ② the establishment of hemodialysis vascular access difficult ③ bleeding tendency is serious can not do hemodialysis systemic heparinization ④ diabetic nephropathy uremic insulin added to the peritoneal cavity can be better glycemic control the following conditions are contraindications to peritoneal dialysis
: ① abdominal surgery within three days after major surgery
② Peritoneal adhesions or intestinal obstruction
3 abdominal wall infection can not be colonized into the peritoneal dialysis tube ④ abdominal tumors, intestinal fistula, diaphragmatic hernia, etc.
Aseptic operation is not strict can cause peritonitis repeated episodes of peritonitis can be made in the abdominal wall of the dialysis area is reduced to reduce dialysis efficacy of dialysis In addition, due to the peritoneal membrane holes in the peritoneal membrane is larger than the aperture of the membrane of the hemodialysis apparatus, so the nutrients from the peritoneal dialysis solution is lost from the hemodialysis than the loss of serious, therefore, strict Aseptic operation and adequate nutrition is the guarantee of the success of peritoneal dialysis the survival rate of peritoneal dialysis in the 1st, 2nd, 3rd, 4th and 5th years are 90%, 80%, 70%
, 65% and 46% respectively
About 10% per year
Worldwide there are reports of people who have survived for 20 years
.