Mob raum Kab Mob 5, Cov neeg mob yuav tsum tsis txhob txhawj txog kev lim ntshav, lawv tseem tuaj yeem noj tshuaj ntxiv, Kev tsom mus rau 5 hom tshuaj

Mob raum mob (CKD) feem ntau muab faib ua tsib theem raws li kev kwv yees lossis kuaj pom glomerular filtration rate (GFR), ntawm cov GFR.<15ml/min is CKD stage 5, which is also the advanced stage of chronic kidney disease, called the end-stage kidney disease (ESRD). Those with chronic kidney disease who have received dialysis or kidney transplantation have reached stage 5 of chronic kidney disease (CKD stage 5). Because of this, some patients may think that: when CKD stage 5 is reached, patients should undergo dialysis or kidney transplantation immediately! Is it true?

Nyem rau cistanche tubulosa tshuaj xyuas kab mob raum

Cov lus pom zoo ntawm cov lus qhia txog yav dhau los yog raws li hauv qab no: rau cov kab mob hauv lub raum uas maj mam tshwm sim los ntawm kev mob ntshav qab zib nephropathy tshwm sim los ntawm ntshav qab zib, thaum GFR poob qis dua 15ml / min, tus neeg mob yuav tsum tau txais kev kho mob dialysis; Rau cov kab mob hauv lub raum ntev uas tshwm sim maj mam, thaum GFR poob qis dua 10ml / min, cov neeg mob yuav tsum tau txais kev kho mob dialysis. Cov lus qhia tseem tau taw qhia tias rau cov neeg mob lub raum tsis ua haujlwm nrog cov teeb meem tshwj xeeb (xws li mob hnyav hyperkalemia lossis mob plawv sab laug tsis ua haujlwm, thiab lwm yam), kev kho mob ntshav qab zib yuav tsum tau ua ua ntej. Txawm li cas los xij, tseem muaj kev tsis sib haum xeeb txog thaum twg yuav pib kho ntshav lim ntshav hauv cov neeg mob uas muaj theem 5 mob raum mob. Cov kev tshawb fawb tau pom tias nyob rau hauv cov nqe lus ntawm lub neej zoo thiab lub sij hawm ciaj sia, tau txais kev kho mob lim ntshav ntxov tsis zoo dua li kev kho mob lim ntshav uas tuaj yeem ncua sijhawm. Raws li thaum pib kho kev kho mob ntshav qab zib, ntxiv rau GFR, nws tseem yuav tsum tau ua ke nrog tus neeg mob thawj kab mob, teeb meem, comorbidities, thiab lwm yam kab mob hauv qab. Xaus thiab txiav txim siab.

Peb pom tias GFR ntawm qee cov neeg mob uas muaj theem 5 mob raum tau poob mus rau 10-15ml / min lossis txawm tias 5-10ml / min. Kev sib khi quab yuam thiab lwm yam ntsuas tau raug kho kom haum rau ntau yam, thiab tseem tuaj yeem mus tsis tau rau lub sijhawm ntev, thiab tus neeg mob lub siab xav thiab lub neej zoo yog qhov zoo. Yog tias kev kho mob lim ntshav tau txais ntxov dhau lawm, qhov kev poob dej tom qab thiab ntau yam teeb meem cuam tshuam nrog kev lim ntshav yuav ua rau muaj kev vam meej ntawm kev lim ntshav thiab cuam tshuam rau lub neej zoo ntawm cov neeg mob.

Yog li ntawd, cov neeg mob uas nyuam qhuav tuaj txog rau theem thib tsib ntawm cov kab mob raum ntev, tsis txhob maj mus rau kev lim ntshav, thiab tus kws kho mob nephrologist uas tau kho lawv yuav tsum txiav txim siab raws li qhov tshwj xeeb. Peb ntseeg tias tseem muaj ntau tus neeg mob CKD theem 5 uas tseem tuaj yeem noj cov tshuaj hauv qab no thaum ua tib zoo saib xyuas cov kev hloov pauv hauv lawv cov mob thiab kev tshuaj xyuas tsis tu ncua ntawm cov ntsuas ntsuas.

1. Kho cov ntshav siab, tab sis kuj tiv thaiv hypotension

Los ntawm CKD theem 5, ntshav siab feem ntau tshwm sim, thiab cov neeg mob feem ntau muaj ntshav siab heev. Cov ntshav siab tuaj yeem ua rau cov neeg mob ua rau muaj teeb meem lossis ua rau lub plawv tsis ua haujlwm thiab mob hlab ntsha tawg, yog li ua rau muaj kev pheej hmoo ntawm kev tuag. Yog li ntawd, nws yog ib qho tsim nyog yuav tsum tau siv cov tshuaj tiv thaiv hypertensive. Tsuas yog cov tshuaj sartan lossis cov menyuam kawm ntawv cov tshuaj tiv thaiv ntshav siab uas tsis tsim nyog rau kev siv, lwm cov tshuaj tiv thaiv ntshav siab tuaj yeem siv tau raws li cov xwm txheej tshwj xeeb, thiab cov tshuaj "divine" antihypertensive yuav tsum nyiam dua. Nco ntsoov txo koj cov ntshav siab, tab sis koj tsis tuaj yeem txo koj cov ntshav siab tsawg dhau, cia nyob ib leeg hypotension.

2. Txhawm rau kho cov ntshav tsis txaus, tab sis kuj tiv thaiv cov hemoglobin ntau dhau

Nyob rau theem 5 ntawm CKD, anemia, uas yog, lub raum mob ntshav qab zib feem ntau tshwm sim, thiab feem ntau ntawm cov ntshav tsis txaus nyob rau lub sijhawm no yog nruab nrab lossis siab dua ntshav ntshav. Kev txo qis ntawm lub neej ntawm cov neeg mob kuj muaj feem xyuam rau qhov teeb meem no, uas tuaj yeem ua rau muaj ntau yam teeb meem, xws li ua rau lub plawv tsis ua hauj lwm hnyav, tsis muaj kab mob, thiab txhawb kev loj hlob ntawm cov kab mob. Yog li ntawd, nws yog ib qho tsim nyog yuav tsum tau siv cov tshuaj tiv thaiv kab mob ntshav qab zib. Ntxiv nrog rau erythropoietin lossis roxadustat, cov tshuaj xws li hlau lossis folic acid yuav tsum tau siv tib lub sijhawm. Nco ntsoov kho cov hemoglobin nyob nruab nrab ntawm 110-120g/L, tab sis kuj tiv thaiv cov teebmeem ntawm hemoglobin siab, xws li ua rau ntshav siab.

3. txhawm rau kho cov kab mob calcium thiab phosphorus, tab sis kuj tiv thaiv hypercalcemia

Thaum lub sij hawm 5th ntawm CKD, calcium thiab phosphorus metabolism tsis meej thiab theem nrab hyperparathyroidism feem ntau nyuaj, manifested li tsawg calcium (Ca), siab phosphorus (P), thiab elevated parathyroid hormone (PTH), thiab lwm yam. Cov kev txawv txav no yuav cuam tshuam rau lub cev ua rau. kev puas tsuaj ntxiv. Yog li ntawd, nws yog ib qho tsim nyog yuav tsum tau siv tshuaj ntxiv los kho nws. Koj tuaj yeem xaiv calcium-phosphate binders (xws li calcium acetate) thiab calcium-free phosphorus binders (xws li lanthanum carbonate), nrog rau cov vitamin D3 (xws li calcitriol). Nco ntsoov kho tus neeg mob cov ntshav calcium, ntshav phosphorus, thiab PTH hauv qhov tsim nyog, tab sis kuj tiv thaiv hypercalcemia, uas yuav ua rau lub cev puas tsuaj vim vascular calcification.

4. Txhawm rau kho hyperkalemia, hypokalemia yuav tsum tau zam

Nyob rau theem 5 ntawm CKD, hyperkalemia feem ntau nyuaj. Me hyperkalemia tej zaum yuav asymptomatic, thaum nruab nrab mus rau hnyav hyperkalemia tsis yooj yim li cov tsos mob, tab sis nws tuaj yeem ua rau arrhythmia thiab txawm tias mob plawv. Yog li ntawd, nws yog ib qho tsim nyog yuav tsum zam lossis kho hyperkalemia thaum noj tshuaj. Piv txwv li, tshuaj sartan lossis peril, potassium-sparing diuretics, thiab lwm yam tshuaj uas tuaj yeem ua rau hyperkalemia yuav tsum zam kom ntau li ntau tau. Thaum hyperkalemia tshwm sim, koj yuav tsum xaiv siv cov tshuaj uas txo cov poov tshuaj xws li furosemide, sodium bicarbonate, lossis insulin thaum xub thawj, tab sis koj yuav tsum tiv thaiv hypokalemia vim hypokalemia tseem yuav ua rau lub cev raug mob.

5. Acidosis yuav tsum tau kho txawm tias tsis muaj tsos mob

Nyob rau theem 5 ntawm CKD, metabolic acidosis feem ntau yog nrog los ntawm kev txo qis hauv cov pa roj carbon dioxide khi, thiab metabolic acidosis yuav ua rau muaj kev puas tsuaj rau ntau lub cev thiab ua kom lub raum tsis ua haujlwm. Yog li ntawd, yuav tsum tau siv cov tshuaj alkaline ntxiv xws li sodium bicarbonate. Cov tshuaj nquag siv yog cov ntsiav tshuaj sodium bicarbonate lossis 5 feem pua ​​sodium bicarbonate txhaj. Tsis hais seb puas muaj kab mob plab thiab lwm yam tsos mob xws li xeev siab thiab ntuav, cov neeg mob CKD theem 5 yuav tsum kho acidosis.

Cov saum toj no tsuas yog tham txog tsib yam ntawm kev kho tshuaj thiab kev ceev faj. Txawm li cas los xij, nyob rau theem ntawm CKD 5, cov teeb meem thiab cov cim qhia txawv txav ntawm cov neeg mob raum muaj ntau dua li cov no. Rau lwm yam teeb meem thiab cov cim qhia txawv txav, cov neeg mob yuav tsum tau kho thiab kho. Nyob rau tib lub sijhawm, peb kuj yuav tsum tau ua tib zoo saib xyuas kev tiv thaiv thiab kho lub plawv tsis ua haujlwm thiab kev tiv thaiv ntawm cov hlab ntsha ntawm forearm, los tsim lub hauv paus ruaj khov rau kev saib xyuas kev lim ntshav yav tom ntej, txhim kho lub neej zoo, thiab ua kom lub neej ntev. .

Yog xav paub ntxiv:ali.ma@wecistanche.com