Kev Ntsuam Xyuas Thiab Kev Tswj Xyuas Peritoneal Dysfunction

1. Mechanism thiab ua rau peritoneal dysfunction

Lub peritoneum yog tsim los ntawm ib txheej ntawm mesothelial hlwb thiab cov ntaub so ntswg sib txuas hauv qab. Hauv qhov chaw sib txuas no, muaj cov colloids, mucopolysaccharides, capillaries, lymphatic hlab ntsha thiab lymphocytes. Qhov zoo tshaj plaws tiv thaiv rau cov kuab tshuaj thiab cov kua dej thauj yog los ntawm capillaries thiab matrix nyob ib ncig ntawm lub capillary phab ntsa. Kev thauj mus los ntawm cov kuab tshuaj thiab cov kua dej los ntawm cov hlab ntsha mus rau hauv cov kab noj hniav yuav tsum dhau los ntawm cov kab mob sib kis, suav nrog cov kua dej hauv cov kab noj hniav hauv peritoneal capillary kab noj hniav, vascular endothelial hlwb, endothelial cell hauv qab daim nyias nyias, peritoneal stroma, mesothelial cell txheej, thiab peritoneal kua txheej. Lub peritoneal capillary phab ntsa yog qhov tseem ceeb ntawm kev thauj mus los, thiab kev thauj mus los ntawm cov kuab tshuaj thiab dej los ntawm phab ntsa capillary tau ua tiav nrog kev pab ntawm peb "qhov" ntawm qhov sib txawv.

Nyem rau Cistanche rau cov kab mob raum

Qhov poob ntawm peritoneal muaj nuj nqi feem ntau yog tshwm sim los ntawm plaub yam: ib qho yog siv bio-incompatible peritoneal dialysis kua; qhov thib ob yog qhov poob ntawm lub raum tsis ua haujlwm; qhov thib peb yog rov ua dua ntawm peritonitis; thiab qhov thib plaub yog qhov nce hauv lub hnub nyoog lim ntshav. Lub sij hawm ntev ntawm peritoneum mus rau lub siab-qab zib, ib puag ncig hyperosmotic tuaj yeem ua rau neovascularization, o, thiab fibrosis.

2. Kev txhais thiab kev faib tawm ntawm peritoneal dysfunction

Peritoneal dysfunction feem ntau yog tshwm sim raws li ultrafiltration tsis ua haujlwm. Xyoo 2021, International Society of Peritoneal Dialysis (ISPD) tau hloov lo lus "ultrafiltration tsis ua hauj lwm" mus rau "ultrafiltration insufficiency", tsom mus rau kev tshawb pom ntawm ultrafiltration peev xwm. Nws cov ntsiab lus tshwj xeeb yog: thaum lub net ultrafiltration ntawm 4-h peritoneal equilibrium test (PET) yog<400 mL (3.86% glucose/4.25% dextrose) or <100 mL (2.5% glucose/2.27% dextrose), ultrafiltration insufficiency should be suspected; and all patients who have difficulty maintaining adequate fluid removal.

Raws li kev tshawb pom ntawm peritoneal dysfunction los ntawm PET, peritoneal dysfunction tuaj yeem muab faib ua ob pawg: (1) Rapid peritoneal solute transfer rate (PSTR): suav nrog PSTR sai (tus neeg sib txawv muaj nyob rau thaum pib ntawm peritoneal dialysis) thiab tau txais peritoneal ultrafiltration. insufficiency (txog rau lub sij hawm ntev peritoneal dialysis, peritonitis, thiab lwm yam). (2) Tsawg cov piam thaj permeability (OCG): suav nrog kev ua haujlwm ntawm peritoneal ultrafiltration tsis ua haujlwm (qhov sib txawv ntawm tus kheej muaj nyob rau thaum pib ntawm peritoneal dialysis) thiab tau txais peritoneal ultrafiltration tsis ua haujlwm (txog rau kev mob peritoneal fibrosis, vascular puas, thiab lwm yam).

III. Cov kev ntsuas tseem ceeb thiab kev kuaj mob ntawm peritoneal dysfunction

1. Kev kuaj mob ceev ceev PSTR

Lub koom haum International Society of Peritoneal Dialysis (ISPD) cov lus qhia pom zoo tias 4-teev PET yuav tsum tau ua los ntawm kev siv tshuaj peritoneal dialysis kua nrog 2.5% / 2.27% lossis 4.25% / 3.86% dextrose / glucose, thiab creatinine yog siv los ua qhov ntsuas ntsuas los ntsuas PSTR. Nws yuav tsum tau ua thaum ntxov hauv kev kho ntshav lim ntshav (6-12 lub lis piam) thiab tom qab ntawd rov hais dua thaum kuaj pom, xws li thaum tus neeg mob cov kua dej tsis zoo lossis ultrafiltration hloov pauv loj.

PSTR feem ntau qhia txog kev ua haujlwm ntawm peritoneal diffusion thiab tuaj yeem qhia tau los ntawm huab hwm coj hloov chaw coefficient. Qhov tseem ceeb ntawm kev kho mob sai sai ntawm PSTR yog: (1) Nws cuam tshuam nrog kev muaj sia nyob qis hauv cov neeg mob peritoneal dialysis (1A). (2) Nws yog ib feem vim txo ultrafiltration thaum PSTR siab dua qhov nruab nrab. Nws tuaj yeem kho tau los ntawm kev ua kom lub sijhawm nyob ntawm cov kua qabzib peritoneal dialysis, siv icodextrin peritoneal dialysis kua thiab / lossis siv cov kua dej hauv lub cev nrog cov kua dej ntau dua (1A). (3) Muab piv nrog cov kua qabzib peritoneal dialysis, kev siv cov kua tshuaj icodextrin peritoneal dialysis tuaj yeem txhim kho tus neeg mob lub ntim ntim thiab txo qhov ntim ntau dhau (1A). (4) APD thiab icodextrin peritoneal dialysis kua tuaj yeem txo qhov kev pheej hmoo ntawm kev tuag cuam tshuam nrog ceev PSTR.

2. Kev kuaj mob ntawm ultrafiltration insufficiency

Ultrafiltration insufficiency yuav tsum xav tias nyob rau hauv cov xwm txheej hauv qab no: (1) Thaum lub net ultrafiltration ntawm 4 h PET yog<400 mL (3.86% glucose/4.25% dextrose) or <100 mL (2.27% glucose/2.% dextrose). (2) All patients who have difficulty maintaining adequate fluid removal. In addition to peritoneal dysfunction, ultrafiltration insufficiency may also be caused by mechanical problems, leakage, or reabsorption of peritoneal dialysis fluid.

Peritoneal osmotic conduction rau qabzib yog ib qho khoom siv ntawm lub peritoneum, uas qhia txog cov khoom siv ntawm lub peritoneum kom thauj cov dej hauv qab qhov kev txiav txim ntawm cov piam thaj siv lead ua osmotic gradient (ultrafiltration). OCG yog cov khoom lag luam ntawm ultrafiltration coefficient thiab kev cuam tshuam coefficient. Raws li qhov qis OCG, nws tuaj yeem muab faib ua qhov tsis txaus ntseeg ntawm peritoneal ultrafiltration insufficiency (tsawg OCG tshwm thaum pib ntawm peritoneal dialysis, uas tej zaum yuav muaj feem xyuam rau cov noob caj noob ces) thiab tau txais peritoneal ultrafiltration insufficiency (txog rau peritoneal raug mob thiab interstitial fibrosis). Tau txais peritoneal ultrafiltration insufficiency, sodium txawv<5 mmol/L or sodium sieving ratio <0.03, is a high risk factor for encapsulated peritoneal sclerosis.

3. Kev kuaj mob ntawm peritoneal ultrafiltration insufficiency (UF) tshwm sim los ntawm intrinsic peritoneal dysfunction (tso tawm raws li OCG qis)

Thaum UF xav tias, ntxiv rau 4 h PET. 3. Thaum cov sodium concentration txo qis dua lossis sib npaug li 5 mmol / L thiab / lossis sodium sieving piv Tsawg dua lossis sib npaug rau 0.03 ntawm 1 h, UF qhia.

IV. Kev cuam tshuam thiab kev tswj hwm ntawm peritoneal dysfunction

1. Siv peritoneal dialysis kua nrog zoo biocompatibility

Tam sim no, lactate dialysis kua nrog ntau cov piam thaj sib txawv raws li tus neeg sawv cev osmotic feem ntau siv hauv Suav teb. Lub peritoneum yog immersed nyob rau hauv peritoneal dialysis kua uas tsis muaj pH, siab qab zib, lactate thiab qabzib degradation khoom rau lub sij hawm ntev, uas hloov lub qub physiological lub xeev ntawm lub peritoneal kab noj hniav, txo cov kev tiv thaiv ntawm lub peritoneal kab noj hniav, thiab puas peritoneal mesothelial. cell, nws thiaj li ua rau qhov tshwm sim ntawm peritoneal fibrosis. Qhov loj dua cov tshuaj lim dej ntau dua thiab qhov siab dua cov piam thaj concentration, qhov pom tseeb dua qhov kev puas tsuaj no. Kev siv cov kua peritoneal dialysis nrog zoo biocompatibility, xws li icodextrin dialysis kua thiab nruab nrab pH peritoneal dialysis kua, yog haum rau kev tiv thaiv peritoneal muaj nuj nqi.

2. Tiv thaiv lub raum tsis ua haujlwm

Nrog rau qhov poob ntawm lub raum tsis ua haujlwm, qhov tshem tawm ntawm cov kua thiab dej los ntawm lub raum residual txo. Txhawm rau tswj hwm lub cev qhov ntim ntawm qhov sib npaug thiab kev tshem tawm cov co toxins txaus, cov kev kho mob feem ntau raug yuam kom nce cov koob tshuaj thiab cov kua dej lim ntshav, uas ua rau muaj kev puas tsuaj ntawm bio-incompatible dialysis kua rau lub peritoneum. Lub xub ntiag ntawm residual lub raum ua haujlwm tuaj yeem txo cov qib ntawm oxidative kev nyuaj siab hauv cov neeg mob ntshav qab zib peritoneal thiab txo cov cim ntawm lipid peroxides. Incremental peritoneal dialysis tuaj yeem siv tau. Ntau cov ntaub ntawv kho mob qhia tau hais tias raug hypertonic glucose peritoneal dialysis kua yog ib qho tseem ceeb ua rau peritoneal ultrafiltration tsis ua hauj lwm. Davies txoj kev tshawb fawb soj ntsuam tau pom tias cov neeg mob raug hypertonic qabzib muaj ultrafiltration tsis ua haujlwm 2 xyoos ua ntej pawg tswj hwm. Selgas kuj pom tias hypertonic qabzib peritoneal dialysis kua thiab ntshav qab zib yuav ua rau kom qhov tshwm sim ntawm ultrafiltration tsis ua haujlwm. Hypertonic qabzib tuaj yeem ua rau peritoneal oxidative kev nyuaj siab teb, yog li ua rau vascular hyperplasia thiab peritoneal fibrosis. Kev siv cov tshuaj antioxidants tuaj yeem txo qhov tshwm sim ntawm kev puas tsuaj. Thaum lub sij hawm kho peritoneal dialysis, lub hauv paus ntsiab lus ntawm kev nce koob tshuaj yuav tsum tau ua raws, uas yog, koob tshuaj me me yuav tsum tau muab thaum pib ntawm kev lim ntshav, thiab yuav tsum tau them nyiaj rau kev tswj hwm dej thiab ntsev. Tom qab ntawd, koob tshuaj lim ntshav yuav tsum maj mam nce ntxiv raws li qhov poob ntawm lub raum tsis ua haujlwm. Qhov no tuaj yeem txo qhov raug cov kua qabzib peritoneal dialysis kua, tiv thaiv lub raum tsis ua haujlwm, thiab tiv thaiv ultrafiltration ntau dhau.

3. Tsis txhob mob peritonitis

Kev mob tshwm sim tuaj yeem ua rau mob peritoneal fibrosis, angiogenesis, puas peritoneal muaj nuj nqi, thiab tuaj yeem ua rau peritoneal ultrafiltration tsis txaus.

4. Automated peritoneal lim ntshav

Automated peritoneal dialysis thiab icodextrin peritoneal dialysis kua tuaj yeem txhim kho qhov ntim ntawm PSTR peritoneal dialysis cov neeg mob, txo qhov ntim ntau dhau, thiab txo kev tuag. Cov kev tshawb fawb pom tau hais tias kev siv cov tshuaj icodextrin peritoneal dialysis kua tuaj yeem txhim kho cov xwm txheej ntim thiab txo qhov tshwm sim ntawm qhov ntim ntau dua piv nrog kev siv cov kua qabzib peritoneal dialysis.

5. Peritoneal so

Tso tseg peritoneal dialysis ib ntus rau ib lub sij hawm, feem ntau 2 mus rau 4 lub lis piam los yog ntev dua. Nyob rau lub sijhawm no, cov neeg mob yuav tsum tau hloov mus rau lwm yam kev kho rau lub raum xws li hemodialysis kom tso cai rau lub peritoneum kom tag nrho so thiab rov zoo.

Nws yuav tsum raug sau tseg tias txoj kev npaj tshwj xeeb rau peritoneal so yuav tsum tau hloov kho thiab ua raws li qhov xwm txheej ntawm tus neeg mob, raws li kev qhia thiab kev saib xyuas ntawm tus kws kho mob. Nyob rau tib lub sijhawm, tus kws kho mob tseem yuav tshuaj xyuas seb tus neeg mob puas tsim nyog rau rov pib kho peritoneal dialysis yav tom ntej thiab thaum twg yuav pib.

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V. Summary

Thaum kawg, xibfwb Chen Menghua tau xaus lus tias kev tiv thaiv kab mob peritoneal ua haujlwm tau zoo yog qhov tseem ceeb ua ntej rau kev txhim kho tus nqi ciaj sia ntawm peritoneal dialysis thev naus laus zis thiab tus neeg mob muaj sia nyob. Kev siv bio-incompatible peritoneal dialysis kua, hypertonic qabzib peritoneal dialysis kua, qabzib degradation khoom, residual lub raum tsis ua hauj lwm, peritonitis, thiab lwm yam yog lub ntsiab ua rau peritoneal muaj nuj nqi puas. Kev faib tawm thiab kev ntsuam xyuas ntawm peritoneal muaj nuj nqi raws li pathophysiology yog qhov tseem ceeb heev rau kev kho cov tshuaj peritoneal dialysis thiab prognosis.

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 rauraumnoj 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 qhov tsim ntawm pro-inflammatory cytokines thiab inhibit qhov kev ua ntawm txoj kev yuav tsum tau rau o, 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.