Intangiriro
Mu micungire yindwara zimpyiko zanyuma (ESRD) no gukomeretsa impyiko zikomeye (AKI) ,.dialyzer—Kenshi bita "impyiko yubukorikori" -ni intangiriroibikoresho by'ubuvuziikuraho uburozi n'amazi arenze mumaraso. Ihindura muburyo butaziguye uburyo bwo kuvura, ibisubizo byabarwayi, nubuzima bwiza. Kubatanga ubuvuzi, guhitamo dialyzer iboneye ni uburinganire hagati yintego zubuvuzi, umutekano w’abarwayi, nigiciro. Ku barwayi nimiryango, gusobanukirwa itandukaniro ryubwoko bwa dialyzer bibafasha kwitabira gufata ibyemezo bisangiwe.
Iyi ngingo isenya ibyiciro byingenzi bya dialyse, ibiranga tekinike, hamwe ningamba zifatika zo guhitamo zishingiye kumabwiriza agezweho nka KDIGO.
Ibyiciro Byibanze bya Dialyzers
Indwara ya hemodialyse ya kijyambere irashobora gushyirwa mubice bine byingenzi: ibikoresho bya membrane, igishushanyo mbonera, imiterere yimikorere, hamwe nibitekerezo byihariye byabarwayi.
1. Kubikoresho bya Membrane: Kamere na Sintetike
Cellulose ishingiye (Kamere)
Ubusanzwe bikozwe mubikomoka kuri selile nka cuprophane cyangwa selile ya selile, ibi bisobanuro birahendutse kandi birahari henshi. Ariko, zifite ubushobozi buke bwibinyabuzima, zirashobora gutuma ibikorwa byuzuzanya, kandi bishobora gutera umuriro cyangwa hypotension mugihe cya dialyse.
Synthetic (High-Performance) Membrane
Igizwe na polymers yo mu rwego rwo hejuru nka polysulfone (PSu), polyacrylonitrile (PAN), cyangwa methacrylate polymethyl (PMMA). Izi membrane zitanga ubunini bwa pore igenzurwa, hejuru ya molekile yo hagati, hamwe na biocompatibilité isumba iyindi, kugabanya gucana no kunoza kwihanganira abarwayi.
2. Ukurikije Igishushanyo mbonera: Fibre Fibre na Flat Plate
Fibre Fibre Dialyzers(≥90% yo gukoresha ivuriro)
Harimo ibihumbi byinshi bya fibre nziza ya capillary ifite ubuso bunini (1,3-2,5 m²) hamwe nubunini buke bwa priming (<100 mL). Zitanga uburyo bwiza bwo gukora neza mugihe zikomeza umuvuduko ukabije wamaraso.
Ikibaho cya Dialyzers
Ni gake ikoreshwa muri iki gihe, ibi bifite uduce duto duto (0.8-1.2 m²) hamwe nubunini bwa priming. Zibitswe kubikorwa byihariye nko guhuza plasma hamwe na dialyse.
3. Kubiranga Imikorere: Amazi Mabi na Flux Yisumbuye na HDF-Optimized
Dialyzers Ntoya (LFHD)
Coefficient ya Ultrafiltration (Kuf) <15 mL / (h · mmHg). Banza ukureho utuntu duto (urea, creatinine) ukoresheje diffusion. Ikiguzi-cyiza, ariko hamwe na molekile ntoya yo hagati (β2-microglobuline <30%).
Flux Dialyzers (HFHD)
Kuf ≥15 mL / (h · mmHg). Emerera convective gukuraho molekile nini, kugabanya ingorane nka dialyse ijyanye na amyloidose no kunoza ibisubizo byumutima.
Hemodiafiltration (HDF) -Dialyzers idasanzwe
Yashizweho kugirango arusheho kwiyongera hagati ya molekile yo hagati hamwe na poroteyine ihujwe no gukuramo uburozi, akenshi ikomatanya ibintu byinshi byogukora cyane hamwe na adsorption (urugero, gukora karubone ikora).
4. Umwirondoro w'abarwayi: Abakuze, Abana, Ubuvuzi bukomeye
Icyitegererezo cyabakuze: 1.3-22.0 m² membrane kubarwayi benshi bakuze.
Icyitegererezo cyabana: 0.5-1.0 m² membrane hamwe nubunini buke bwa priming (<50 mL) kugirango wirinde ihungabana rya hemodinamike.
Uburyo bukomeye bwo Kwitaho: Kwambara anticoagulant hamwe nubunini buke bwa priming (<80 mL) kubuvuzi buhoraho bwo kuvura impyiko (CRRT) kubarwayi ba ICU.
Kwibira cyane muburyo bukomeye bwa Dialyzer
Indwara ya selile isanzwe
Ibiranga: Byemewe, byashizweho neza, ariko biocompatible; ibyago byinshi byo gutwikwa.
Gukoresha Ivuriro: Birakwiriye gushyigikirwa mugihe gito cyangwa mugushinga aho ikiguzi aricyo kintu nyamukuru.
Syntetike Yisumbuye-Imikorere ya Membrane
Polysulfone (PSu): Ibikoresho bisanzwe bya flux dialyzer, bikoreshwa cyane muri hemodialyse-flux-flux na HDF.
Polyacrylonitrile (PAN): Yamenyekanye cyane kuri adsorption ikomeye yuburozi bwa poroteyine; ingirakamaro mu barwayi bafite hyperuricemia.
Polymethyl Methacrylate (PMMA): Kurandura buringaniye buringaniye bwa molekile, akenshi bikoreshwa muburwayi bwimpyiko ya diabete cyangwa indwara yamagufwa.
Guhuza Dialyzer Guhitamo Kuri Clinical Scenarios
Urugero rwa 1: Kubungabunga Hemodialyse muri ESRD
Basabwe: High flux synthetic dialyzer (urugero, PSu).
Impamvu: Ubushakashatsi bwigihe kirekire nubuyobozi bwa KDIGO bishyigikira membrane-flux membrane kugirango umusaruro mwiza wumutima nimiyoboro.
Urugero rwa 2: Inkunga ikabije yimpyiko (AKI)
Basabwe: selile flux selile cyangwa bije synthique dialyzer.
Impamvu: Ubuvuzi bwigihe gito bwibanda kumyanda mito-yoroheje hamwe nuburinganire bwamazi; gukora neza ni ngombwa.
Ibidasanzwe: Muri sepsis cyangwa inflammatory AKI, tekereza hejuru ya flux dialyzers yo gukuraho cytokine.
Urugero rwa 3: Urugo Hemodialyse (HHD)
Basabwe: Gito-yubuso-busa hollow fibre dialyzer hamwe na priming yikora.
Impamvu: Gushiraho byoroheje, kugabanya umuvuduko wamaraso, hamwe numutekano mwiza kubidukikije.
Urugero rwa 4: Hemodialysis y'abana
Basabwe: Guhindura amajwi make, biocompatible synthique dialysers (urugero, PMMA).
Impamvu: Kugabanya imihangayiko no gukomeza guhagarara neza mugihe cyo gukura.
Urugero rwa 5: Indwara zikomeye abarwayi ba ICU (CRRT)
Basabwe: Anticoagulant-yubatswe, amajwi make ya synthèque dialyzer yagenewe kuvura ubudahwema.
Impamvu: Kugabanya ibyago byo kuva amaraso mugihe hagaragaye neza neza abarwayi badahungabana.
Ibizaza muri tekinoroji ya Dialyzer
Kunoza Biocompatibilité: Endotoxin idafite membrane hamwe na bio-ihumeka ya endoteliyale kugirango igabanye umuriro hamwe ningaruka zo kwambara.
Ubwenge bwa Dialyzers: Yubatswe mugukurikirana kumurongo hamwe no kugenzura algorithm ishingiye kuri anticoagulation kugenzura igihe nyacyo cyo kuvura.
Impyiko zishobora kwambara Impyiko: Flexible hollow fibre membrane itwara ibintu byoroshye, dialyse yamasaha 24 kugirango abarwayi bagende.
Ibikoresho byangiza ibidukikije: Gutezimbere ibinyabuzima bishobora kwangirika (urugero, aside polylactique) kugirango ugabanye imyanda yubuvuzi.
Umwanzuro
Guhitamo dialyzer ya hemodialyse ntabwo ari icyemezo cya tekiniki gusa - ni uguhuza imiterere yabarwayi, intego zo kuvura, hamwe nibitekerezo byubukungu. Abarwayi ba ESRD bungukirwa cyane na flux dialyzers kugirango bagabanye ibibazo byigihe kirekire. Abarwayi ba AKI barashobora gushyira imbere ibiciro kandi byoroshye. Abana n'abarwayi-bakomeye bakeneye ibikoresho byateguwe neza. Mugihe udushya tugenda dutera imbere, abatanga ibiganiro ejo hazaza bazaba bafite ubwenge, umutekano, kandi begere imikorere yimpyiko-bizamura ubuzima ndetse nubuzima bwiza.
Igihe cyo kohereza: Nzeri-08-2025