Cov ntsiab lus tseem ceeb cuam tshuam rau kev ciaj sia ntawm cov neeg mob ntshav qab zib nephropathy ntawm Dialysis

Raws li WHO kwv yees, tus naj npawb ntawm cov neeg mob ntshav qab zib thoob ntiaj teb yuav nce mus txog 300 lab hauv 2025 thiab 370 lab hauv 2030. Tib lub sijhawm, kev kis mob ntshav qab zib hauv Suav teb kuj tseem nce siab. Raws li kev txheeb cais, tus naj npawb ntawm cov neeg mob ntshav qab zib hauv Suav teb tau mus txog 92 lab, thiab tus naj npawb ntawm cov neeg mob ntshav qab zib ua ntej muaj ntau txog 148 lab. Ntawm lawv, qhov tshwm sim yog siab li 11.4% ntawm cov neeg nyob hauv nroog thiab 8.2% ntawm cov neeg nyob deb nroog.

Nyem rau Cistanche rau mob raum

Mob ntshav qab zib yog qhov tsis zoo rau kev noj qab haus huv, thiab ib qho ntawm nws cov teeb meem, ntshav qab zib nephropathy, tau dhau los ua qhov tseem ceeb ntawm cov kab mob raum kawg. Qhov thib peb National Health thiab Nutrition Examination Survey nyob rau hauv lub tebchaws United States pom tau hais tias feem ntau ntawm cov kab mob raum ntawm cov neeg mob ntshav qab zib thiab cov neeg mob uas tsis yog ntshav qab zib yog 42.3% thiab 9.4% feem. Lub teb chaws hemodialysis cov ntaub ntawv sau npe hauv 2022 qhia tias cov neeg mob ntshav qab zib nephropathy suav txog 21.1%, thiab cov neeg mob ntshav qab zib nephropathy tshiab suav txog 29.9%, tshaj li tus mob glomerulonephritis thawj zaug. Tsis tas li ntawd, tus neeg mob laus dua yog thaum pib mob ntshav qab zib nephropathy, lub sijhawm luv luv ntawm kev tshawb pom ntshav qab zib thiab pib lim ntshav; tus hluas tus neeg mob yog thaum pib mob ntshav qab zib, lub sijhawm ntev dua.

ntshav qab zib nephropathy dialysis

Kev hloov lub raum rau cov ntshav qab zib nephropathy muaj xws li peritoneal dialysis, hemodialysis, hloov raum lossis ua ke pancreas-mob hloov pauv.

1. Kev lim ntshav peritoneal

Daim ntawv tshuaj peritoneal dialysis pom zoo 2 L ntawm 1.5% mus rau 4.25% peritoneal dialysate, uas yuav tsum tau pauv 4 zaug ib hnub, thiab insulin lossis potassium chloride yuav tsum tau siv raws li xav tau. Peritoneal dialysis muaj teeb meem xws li orthostatic hypotension, hyperglycemia, dyslipidemia, kab mob, tsis noj zaub mov zoo, ultrafiltration lossis kev tshem tawm cov co toxins.

2. Hemodialysis

Hemodialysis cov neeg mob ntshav qab zib nephropathy muaj cov yam ntxwv hauv qab no: (1) Piv nrog rau cov neeg mob uas tsis yog mob ntshav qab zib nephropathy, cov neeg mob ntshav qab zib nephropathy muaj cov ntshav creatinine qis dua thaum pib lim ntshav; mob hnyav heev; thiab txo qis tag nrho cov tshuaj parathyroid. (2) Qhov laj thawj tseem ceeb rau cov neeg mob ntshav qab zib nephropathy pib lim ntshav yog mob plawv tsis txaus / edema. (3) Ib ntus central venous catheter feem ntau yog siv thaum pib lim ntshav. (4) 5-xyoo ciaj sia tus nqi ntawm kev saib xyuas hemodialysis cov neeg mob uas muaj ntshav qab zib nephropathy tsis zoo tagnrho. Feem ntau ua rau tuag taus muaj xws li mob plawv sab laug ua ke nrog pulmonary edema, myocardial infarction, arrhythmia, cerebral infarction, cerebral hemorrhage, kis kab mob, mob ntshav qab zib ko taw, qog nqaij hlav, Malnutrition thiab lwm yam. (5) 10-xyoo ciaj sia tus nqi ntawm kev kho hemodialysis Cov neeg mob ntshav qab zib nephropathy yog qhov qis dua li cov neeg mob uas tsis muaj ntshav qab zib nephropathy (33% vs 60%). Kab mob plawv yog ib qho ua rau muaj kev tuag ntau, thiab kev noj zaub mov tsis zoo ntxiv ua rau muaj kev pheej hmoo tuag.

Cov neeg mob ntshav qab zib nephropathy dialysis

tseem ceeb yam tseem ceeb rau kev ciaj sia

Lub hauv paus tseem ceeb cuam tshuam rau kev muaj sia nyob ntawm cov neeg mob ntshav qab zib mellitus ntawm kev lim ntshav suav nrog lub sijhawm lim ntshav, kev lim ntshav txaus, kev lim ntshav cuam tshuam, kev noj zaub mov zoo, dej lim dej, thiab kev tswj hwm qib ntawm lub chaw lim ntshav. Txawm li cas los xij, ntau tus neeg ua haujlwm lim ntshav tsis txaus paub txog qhov teeb meem no. Xibfwb Tu Xiaowen ntawm no tsom mus rau cov ntsiab lus hais txog lub sijhawm ntawm kev lim ntshav thiab kev lim ntshav txaus.

1. Lub sijhawm ntawm kev lim ntshav

Ib txoj kev tshawb nrhiav randomized tau tshuaj xyuas cov neeg tuag ntawm kev lim ntshav ntxov [kwv yees glomerular filtration rate (eGFR) 10 ~ 15 ml / (min·1.73m2)] thiab kev lim ntshav lig [eGFR 5 ~ 7 ml / (min· 1.73m2)] , cov txiaj ntsig qhia tau tias qhov sib txawv tsis yog qhov tseem ceeb. Txawm li cas los xij, kev lim ntshav yuav ntxiv qhov tshwm sim ntawm cov kab mob plawv thiab kev tuag ntawm cov neeg mob ntshav qab zib. Raws li cov lus qhia tshiab tshaj tawm los ntawm KDOQI, kev kho mob ntshav qab zib yuav tsum pib thaum eGFR ze li 10 ml / (min·1.73m2).

2. Kev lim ntshav txaus txaus

Kev lim ntshav txaus muaj feem cuam tshuam nrog cov teeb meem nyuaj thiab kev tuag, thiab ntau cov pov thawj qhia tau hais tias cov neeg mob ntshav lim ntshav txaus muaj cov neeg tuag tsawg dua. Kev lim ntshav txaus nyob ntawm cov koob tshuaj lim ntshav, uas yog sib npaug rau lub sijhawm lim ntshav sib npaug los ntawm kev lim ntshav. Hauv kev xyaum kho mob, qhov yooj yim tshaj plaws los kho yog lub sijhawm lim ntshav. Raws li EDTA cov ntaub ntawv, kev tuag ntawm cov neeg mob nrog lub sij hawm lim ntshav tsawg dua 12 h / W yog qhov siab dua li cov neeg mob uas lub sij hawm lim ntshav ntau dua 12 h / W. Tsis tas li ntawd, tseem muaj cov ntaub ntawv qhia tias qhov kev pheej hmoo ntawm kev tuag ntawm cov neeg mob uas dialyze 3 × 3.5 teev hauv ib lub lis piam yog ob zaug ntawm 3 × 4 teev.

Qhov teeb meem tam sim no rau cov neeg mob lim ntshav hauv kuv lub tebchaws yog tias thaum lawv tus mob zoo dua me ntsis, lawv yuav tsum tau txo cov kev lim ntshav. Nyob rau tib lub sijhawm, kuj tseem muaj cov xwm txheej uas lawv raug yuam kom txo tus naj npawb ntawm kev lim ntshav vim yog kev lag luam. Qhov no ua rau kev lim ntshav tsis txaus mus ntev, uas cuam tshuam rau cov neeg mob lub neej zoo thiab ua rau muaj kev tuag ntau ntxiv. Yog li no, los xyuas kom meej meej ntawm lim xyeem thiab txhim kho lub neej ntawm cov lim ntshav, thiab lub sijhawm lim ntshav txaus yuav tsum tsis pub dhau los ntev dua 12 teev toj ib asthiv.

Dialysis efficiency yog txiav txim los ntawm dialyzer cheeb tsam, dialyzer kev ua tau zoo tsis, dialysate flow thiab ntshav txaus. Ntawm lawv, thaj chaw dialyzer yog lub hauv paus ntawm kev lim dej kom zoo; Qhov kev ua haujlwm tsis zoo ntawm lub tshuab lim dej txiav txim siab qhov kev tshem tawm cov ntsiab lus thiab yog qhov tseem ceeb cuam tshuam rau kev lim ntshav. Cov kua dej ntshiab thiab ultrafiltration tus nqi ntawm lub dialyzer nce nrog nce ntshav txaus thiab dialysate txaus. Txoj kev npaj lim ntshav zoo tshaj plaws yuav tsum suav nrog kev siv thaj chaw loj, lub tshuab lim dej kom siab, nrog rau cov ntshav khiav ceev ntawm 250 txog 300 ml / min thiab tsis pub tsawg dua 200 ml / min. KDOQI cov lus qhia pom zoo tias cov qauv tshuaj hemodialysis tsawg kawg yog Kt/V Ntau dua lossis sib npaug rau 1.2 thiab URR Ntau dua lossis sib npaug li 65%. Txhawm rau tiv thaiv cov koob tshuaj hemodialysis kom tsis txhob ncav cuag qhov tsawg kawg nkaus pom zoo koob tshuaj, cov phiaj xwm ntsuas qhov tseem ceeb tau pom zoo kom Kt / V Ntau dua lossis sib npaug rau 1.3 thiab URR Ntau dua lossis sib npaug li 70%.

High-flux hemodialysis is a better blood purification technology. In recent years, high-flux dialysis has been widely used. Dialyzers or hemofilters with ultrafiltration coefficients >14 ml / (h·mmHg) los yog loj dua yog siv rau kev lim ntshav niaj hnub, uas ua rau kom tshem tawm cov kua nruab nrab thiab loj molecular thiab hloov cov kev thauj mus los ntawm kev yooj yim diffusion. Hloov mus rau hauv dispersion + convection thiab adsorption. Thaum hais txog qhov kev daws teeb meem, qhov ntim tshem tawm kuj tseem ceeb heev. Kev txiav txim siab ntawm lub cev qhuav dej thiab kev hloov kho raws sij hawm kom tsis txhob muaj dej tuav yog qhov tseem ceeb ntawm kev lim ntshav txaus, nrog rau cov kauj ruam tseem ceeb hauv kev txo cov neeg tuag thiab txhim kho lub neej zoo.

Tsis tas li ntawd, txhawm rau txhim kho lub neej zoo ntawm cov neeg mob ntshav qab zib nephropathy ntawm kev lim ntshav, yuav tsum tau ntsuas cov hauv qab no: (1) Txhim kho dialytic hypotension. (2) Tswj ntshav siab. (3) Txhim kho kab mob plawv. (4) Txhim kho hypoglycemia. (5) Txhim kho kev tsis txaus noj haus. (6) Ua kom vascular nkag mus sai li sai tau.

Cistanche kho mob raum li cas?

Cistancheyog ib hom tshuaj suav tshuaj ntsuab siv rau ntau pua xyoo los kho ntau yam mob, suav nrograumkab mob. Nws yog muab los ntawm qhuav stems ntawmCistanchedeserticola, ib tsob nroj nyob rau hauv cov suab puam ntawm Tuam Tshoj thiab Mongolia. Lub ntsiab active Cheebtsam ntawm cistanche yogphenylethanoidglycosides, echinacoside cov tshuaj, thiabacteoside, uas tau pom tias muaj txiaj ntsig zoo rau lub raum kev noj qab haus huv.

Kab mob raum, tseem hu ua kab mob raum, hais txog ib yam mob uas lub raum ua haujlwm tsis zoo. Qhov no tuaj yeem ua rau muaj cov khoom pov tseg thiab cov co toxins hauv lub cev, ua rau muaj ntau yam tsos mob thiab teeb meem. Cistanche tuaj yeem pab kho mob raum ase los ntawm ntau lub tswv yim.

Ua ntej, cistanche tau pom tias muaj cov nyhuv diuretic, txhais tau tias nws tuaj yeem ua rau cov zis ntau ntxiv thiab pab tshem tawm cov khoom pov tseg ntawm lub cev. Qhov no tuaj yeem pab txo lub nra ntawm lub raum thiab tiv thaiv kev tsim cov co toxins. Los ntawm kev txhawb nqa diuresis, cistanche kuj tseem tuaj yeem pab txo qis ntshav siab, ib qho teeb meem ntawm cov kab mob raum.

Ntxiv mus, cistanche tau pom tias muaj cov teebmeem antioxidant. Kev ntxhov siab oxidative, tshwm sim los ntawm qhov tsis sib xws ntawm kev tsim cov dawb radicals thiab lub cev tiv thaiv antioxidant, ua lub luag haujlwm tseem ceeb hauv kev mob raum. ies pab neutralize dawb radicals thiab txo Oxidative kev nyuaj siab, yog li tiv thaiv lub raum los ntawm kev puas tsuaj. Cov phenylethanoid glycosides pom hauv cistanche tau tshwj xeeb hauv kev tshem tawm cov dawb radicals thiab inhibiting lipid peroxidation.

Tsis tas li ntawd, cistanche tau pom tias muaj cov tshuaj tiv thaiv kab mob. Kev mob yog lwm yam tseem ceeb hauv kev loj hlob thiab kev loj hlob ntawm cov kab mob raum. Cistanche's anti-inflammatory zog pab txo cov zus tau tej cov pro-inflammatory cytokines thiab inhibit qhov ua kom o yuav tsum tau txoj kev, yog li alleviating o nyob rau hauv lub raum.

Tsis tas li ntawd, cistanche tau pom tias muaj cov teebmeem immunomodulatory. Hauv kab mob raum, lub cev tiv thaiv kab mob tuaj yeem ua rau tsis zoo, ua rau muaj kev mob ntau dhau thiab cov ntaub so ntswg puas. Cistanche pab tswj lub cev tiv thaiv kab mob los ntawm kev hloov kho kev tsim khoom thiab kev ua haujlwm ntawm lub cev tiv thaiv kab mob, xws li T hlwb thiab macrophages. Txoj cai tiv thaiv kab mob no pab txo qhov mob thiab tiv thaiv kev puas tsuaj ntxiv rau lub raum.

Ntxiv mus, cistanche tau pom los txhim kho lub raum kev ua haujlwm los ntawm kev txhawb nqa kev tsim kho ntawm lub raum hlab nrog cov hlwb. Lub raum tubular epithelial hlwb ua lub luag haujlwm tseem ceeb hauv kev pom thiab rov nqus cov khoom pov tseg thiab electrolytes. Hauv kab mob raum, cov hlwb no tuaj yeem raug puas tsuaj, ua rau lub raum ua haujlwm puas. Cistanche lub peev xwm los txhawb kev tsim kho ntawm cov hlwb no pab kho lub raum kom zoo thiab txhim kho lub raum tag nrho.

Ntxiv nrog rau cov kev cuam tshuam ncaj qha rau lub raum, cistanche tau pom tias muaj txiaj ntsig zoo rau lwm yam kabmob thiab lub cev hauv lub cev. Txoj hauv kev zoo rau kev noj qab haus huv no tseem ceeb tshwj xeeb hauv cov kab mob raum, vim tias tus mob feem ntau cuam tshuam rau ntau lub cev thiab lub cev. che tau pom tias muaj kev tiv thaiv rau lub siab, lub plawv, thiab cov hlab ntsha, uas feem ntau cuam tshuam los ntawm kab mob raum. Los ntawm kev txhawb nqa kev noj qab haus huv ntawm cov kabmob no, cistanche pab txhim kho lub raum tag nrho thiab tiv thaiv kev mob ntxiv.

Hauv kev xaus, cistanche yog cov tshuaj suav tshuaj ntsuab siv rau ntau pua xyoo los kho mob raum. Nws cov active Cheebtsam muaj diuretic, antioxidant, anti-inflammatory, immunomodulatory, thiab regenerative teebmeem, uas pab txhim kho lub raum ua haujlwm thiab tiv thaiv ob lub raum los ntawm kev puas tsuaj ntxiv. , cistanche muaj txiaj ntsig zoo rau lwm yam kabmob thiab lub cev, ua rau nws txoj hauv kev zoo rau kev kho mob raum.