Yuav Ua Li Cas Tiv Thaiv Ntshav Coagulation Thaum Hemodialysis Hemoperfusion?

Qhov tseeb, hais txog tus txheej txheem ua ntej dej ntws tawm ntawm cov khoom siv hemoperfusion, muaj ib tshooj tshwj xeeb hauv 2014 tsab ntawm "Hemodialysis Specialty Nursing Operation Guidelines" muab tso ua ke los ntawm Hemodialysis Professional Committee ntawm Tuam Tshoj Nursing Association uas piav qhia txog cov txheej txheem kev khiav hauj lwm rau hemoperfusion. . Yog lawm, nws yog nplooj ntawv 67 ntawm phau ntawv hauv qab no, uas feem ntau yog qhia txog qhov zoo li qub heparinization ntawm cov khoom siv perfusion + pre-flushing ntawm cov khoom siv perfusion thiab dialyzer, nrog rau cov txheej txheem dej ntws los ntawm kev siv lub raj sib txuas.

Nyem rau Cistanche rau mob raum

Cov hemoperfusion ua ke nrog hemodialysis (HP + HD) hom kev kho mob tau nce zuj zus thiab siv. Lub tshuab hemoperfusion yog txhawm rau tso tus neeg mob cov ntshav los ntawm lub cev mus rau sab nraud ntawm lub cev los ntawm cov khoom siv adsorbent ntawm cov khoom siv perfusion kom nqus thiab tshem tawm cov co toxins, tshuaj, metabolites, thiab lwm yam. cov tshuaj lom metabolites.

Yog li, hom series feem ntau yog siv rau kev lim ntshav perfusion. Lub extracorporeal ncig tsub kom lub ntim ntawm perfusion ntaus ntawv. Thaum muaj qhov tshwm sim ntawm coagulation tshwm sim, cov ntshav ntau ntxiv tuaj yeem raug muab pov tseg, uas ua rau muaj kev pheej hmoo ntawm kev lim ntshav, ua rau muaj kev cuam tshuam ntawm kev tswj ntshav qab zib thiab coagulation kev pheej hmoo rau cov neeg mob, thiab tseem ua rau muaj kev puas siab puas ntsws ntawm cov neeg mob.

1 Yuav ua li cas pre-flushing lub perfusion ntaus ntawv raws li tus qauv?

Cov kev paub tam sim no thiab cov kev cai ntawm ntau lub chaw qhia tau hais tias nyob rau hauv tus txheej txheem ntawm hemodialysis kev saib xyuas, lub ntsiab pre-flushing txoj kev rau lub hemoperfusion ntaus ntawv yog static heparinization + ntws pre-flushing tso pa tawm, thiab ntws pre-flushing tso pa + heparin saline kaw circulation. Lub ntim ntim ua ntej ntawm cov khoom siv hemoperfusion ua ke nrog cov hemodialyzer tseem yuav tsum yog 2000ml. Raws li kev xaiv thiab siv cov dej ntsev thiab qabzib, thov mus saib hauv phau ntawv qhia khoom. Hauv kev kho mob, feem ntau ntawm lawv yuav tsum tau ua ntej yaug nrog saline.

Thawj txoj kev ua ntej ua ntej: static heparinization + ntws ua ntej yaug

Thawj kauj ruam yog twv yuav raug hu yuav ua li cas ua haujlwm zoo li heparinization.

Raws li kev soj ntsuam ntawm ib lub chaw, xa mus rau qhov kev coj ua ntawm "Standardized Operating Procedures for Hemoperfusion" thaum pib ntawm tsab xov xwm, lub perfusion ntaus ntawv yog qhib ua ntej lub pre-flushing ntawm lub perfusion ntaus ntawv thiab lub dialyzer, thiab ib tug 2-5 ml syringe yog siv los kos 1 heparin txhaj tshuaj, 100mg, thiab txhaj rau hauv lub tshuab perfusion. Thaum txhaj tshuaj heparin, koj yuav tsum xyuam xim xaiv sab nrog roj ntau kom tsis txhob poob siab thiab heparin splashing, ua rau cov tshuaj heparinization tsis txaus. Yog tias qhov no tsis tuaj yeem lav tau, koj tuaj yeem xaiv ua ntej aspirate ib feem ntawm cov kua hauv lub tshuab perfusion thiab muab pov tseg, thiab tom qab ntawd aspirate cov tshuaj heparin rau kev txhaj tshuaj. Tom qab txhaj tshuaj heparin, cov cuab yeej perfusion tuaj yeem tig thiab nqis 180 degree kom faib cov heparin. Thaum kawg, sau cia lub sij hawm so ntawm heparin thiab muab tso rau hauv ib lub tais uas tsis muaj menyuam rau kev tos tos.

Hauv cov txheej txheem no, nws yog ib qho tseem ceeb kom tsis txhob muaj heparin splashing vim kev txhaj tshuaj, ua tib zoo saib xyuas cov kev ua haujlwm aseptic, qhwv nws hauv lub sijhawm tom qab ua tiav thiab muab tso rau hauv lub tais kev kho mob rau standby. Lub sij hawm nqus dej yuav tsum yog 20-30 feeb. Cov lus qhia ua haujlwm pom zoo kom sawv ntsug li 30 feeb.

Qhov thib ob kauj ruam yog yuav ua li cas rau pre-flushing lub perfusion ntaus ntawv.

Hemoperfusion tuaj yeem ua tiav ib leeg. Muaj cov tshuab hemoperfusion tshwj xeeb. Cov tshuab lim dej zoo tib yam tuaj yeem siv los txuas lub raj lim dej mus rau cov khoom siv perfusion (tsis muaj dialyzer) rau kev kho mob. Tom qab ntawd, lub pre-flushing ntawm lub perfusion ntaus ntawv yuav ua tau los ntawm kev txuas lub perfusion ntaus ntawv mus rau lub extracorporeal ncig Circuit Court ib leeg. Thaum ua hemoperfusion ua ke nrog hemodialysis, koj tuaj yeem txiav txim siab ua ntej yaug lub tshuab perfusion ua ntej thiab tom qab ntawd ua ntej yaug lub lim dej kom tsis txhob muaj kev cuam tshuam ntau ntxiv thiab cov kauj ruam txuas ntxiv. Koj tuaj yeem xaiv ua ntej yaug cov khoom siv perfusion thiab dialyzer hauv koob. Feem ntau ntawm peb cov chaw zov me nyuam xaiv series pre-flushing, thaum cov lus qhia ua haujlwm pom zoo kom cais ua ntej yaug.

Nws yuav tsum tau muab sau tseg tias pre-flushing lub perfusion ntaus ntawv ua ntej thiab ces txuas lub dialyzer rau pre-flushing yuav txo tau cov huab cua nyob rau hauv lub dialyzer thiab ua tau ib tug ceev pre-flushing pa nyhuv, tab sis qhov no kuj ua rau kom lub sij hawm ntawm kev twb kev txuas thiab disconnection. .

Ib lo lus nug tseem ceeb yog yuav ua li cas xaiv cov ntshav ntws thiab ntim ua ntej.

Hauv txoj kev xav, tsis muaj qhov sib txawv ntawm qhov ua ntej dej ntws tawm ntawm cov cuab yeej hemoperfusion thiab cov dej ntws ua ntej ntawm lub hemodialyzer. Txawm li cas los xij, tus kws sau ntawv ntseeg tias yog ① cov khoom siv perfusion yog pre-flushed ua ntej, qhov siab txaus ntawm 200ml / min tuaj yeem xaiv rau cov pa tawm sai. Ntau qhov kev ua haujlwm tau lees paub tias cov kauj ruam no tuaj yeem ua kom tiav hauv lub sijhawm luv luv ntawm ib zaug, thiab 500ml ntawm cov kua qaub ib txwm siv tau; ② thaum lub dialyzer yog pre-flushed nyob rau hauv series, lub dialyzer pre-flushing specification yuav tsum tau ua raws li tag nrho, thiab daim nyias nyias pre-flushing ntawm 80-100ml / min yuav siv tau kom tag nrho humidify thiab tso lub dialysis membrane. 500ml ntawm ib txwm saline yuav siv tau nyob rau hauv cov kauj ruam no; ③ thaum lub tshuab ua tiav kev ntsuas tus kheej thiab hla lub membrane rau kev tso dej ua ntej sab nraud ntawm daim nyias nyias, 200-300ml / min tuaj yeem siv rau trans-membrane pre-flushing. Lub sijhawm no, cov nyhuv ua ntej dej ntws tawm ntawm lub tshuab perfusion thiab lub tshuab lim dej tuaj yeem kuaj xyuas; ④ Thaum kawg, 500ml ntawm high-flow rate pre-flushing yog siv los tso cov npuas seem thiab cov khoom.

Dab tsi yuav tsum tau muab sau tseg rau hauv cov txheej txheem no yog tias "Hemodialysis Specialist Nursing Operation Guidelines" qhia meej meej tias thaum cov ntshav perfusion yog siv nrog rau lwm cov kev kho ntshav purification, cov ntshav perfusion yuav tsum tau yaug ua ntej thiab tom qab ntawd txuas nrog lwm cov dialyzers; Txoj kev no muaj ntau qhov kev sib txuas ntawm kev sib txuas, yog li cov dej ntws tawm yog nruj me ntsis txwv tsis pub, thiab ceev faj kom tsis txhob nthuav tawm rau saum huab cua ntev ntev. Qhov no yog tus qauv kev ua haujlwm tshwj xeeb, thiab tus sau xav kom cov neeg nyeem ua raws nws ntau li ntau tau, txawm hais tias tus sau tus kheej tsis pom zoo vim tias muaj ntau qhov kev sib txuas tsis sib xws thiab raug.

Txoj kev thib ob ua ntej dej ntws: ntws ua ntej dej ntws tawm + heparin saline kaw ncig

Txoj kev no tshem tawm cov txheej txheem heparinization thiab ua ntej yaug dej:

① Txuas cov cuab yeej perfusion thiab lub raj xa dej lim dej, ua kom muaj dej ntws / qis qis ua ntej dej ntws tawm, thiab ua kom tiav cov pa tawm ntawm 500ml pre-flushing ntim;

② Siv tus choj txuas txuas mus rau qhov kawg ntawm lub raj xa dej lim ntshav los tsim lub kaw lus kaw, siv lub koob txhaj tshuaj 2-5 ml los kos heparin los ntawm lub lauj kaub venous lossis lwm qhov chaw infusion, tig lub twj tso kua mis los ua cov tshuaj heparin saline. kaw kev ncig ntawm cov ntshav khiav ntawm 100ml / min, thiab raws li cov chaw tsim khoom cov kev taw qhia, kaw heparin saline ncig tuaj yeem ua tiav 10- Ua tiav hauv 20 feeb, tshem tawm cov hlab ntsha kawg thiab rov qab los;

③ Pre-flushing lub perfusion ntaus ntawv thiab dialyzer nyob rau hauv series, xa mus rau lub pre-flushing specifications ntawm lub hemodialysis txheej txheem kev khiav hauj lwm cov txheej txheem, pre-flushing daim nyias nyias ntawm 80-100ml / min kom tag nrho humidify thiab tso tawm lub dialysis membrane, thiab 500ml ntawm ib txwm saline yuav siv tau nyob rau hauv cov kauj ruam no;

④ Thaum lub tshuab ua tiav qhov ntsuas tus kheej, 200-300ml / min tuaj yeem siv rau trans-membrane pre-flushing tom qab bypassing daim nyias nyias, thiab cov nyhuv ua ntej dej ntws tawm ntawm lub tshuab perfusion thiab dialyzer tuaj yeem tshawb xyuas qhov no sij hawm;

⑤ Thaum kawg, siv 500 ml ntawm kev txhim kho siab-kawg tus nqi ua ntej yaug kom tso cov npuas seem thiab cov khoom seem.

Nws yuav tsum tau muab sau tseg tias thawj lub ntsiab lus tseem ceeb yog tib yam li saum toj no, thawj perfuse pre-flushing thiab ces series pre-flushing. Lwm lub ntsiab lus tseem ceeb yog txo lub sij hawm raug cuam tshuam ntawm kev sib txuas. Nws raug nquahu kom siv lub raj xa dej ntau rau kev sib txuas ua ntej dej ntws. Ntawm no, tus editor kuj ntseeg hais tias cov khoom siv sib txuas ntau lub raj yuav tsum hloov cov raj ncaj qha los ntawm kev sib txuas rau kev siv tshuaj kho mob thoob plaws. Txawm hais tias kev ua haujlwm yuav yog me ntsis cumbersome, nws kuj yog qhov yooj yim heev tom qab ua tiav. Nws tsis tsuas yog txo lub sijhawm cuam tshuam ntawm kev sib txuas, tab sis kuj txo qhov kev pheej hmoo ntawm perfusion to tom qab kev kho mob.

2 Vim li cas cov xwm txheej perfusion coagulation ib txwm tshwm sim?

Tus kws kho mob ntseeg hais tias kev tsom xam ntawm coagulation ua rau yog sib cais los ntawm peb yam: txaus dej ua ntej, tsim nyog anticoagulation, thiab txaus ntshav txaus.

Qhov tseem ceeb 1: Yuav ua li cas ua ntej dej ntws

Cov lus teb los ntawm thoob plaws lub ntiaj teb no nthuav heev. Tom qab lub membrane pre-flushing tiav nrog 500ml ntawm ib txwm saline, daim nyias nyias pre-flushing yog ua sab nraum lub membrane siv lub voj voog kaw. Lub ntim ua ntej dej ntws tawm yog 500ml, uas yog lub hemodialysis pre-flushing; muaj hemoperfusion pre-flushing, lub ntim ntim ua ntej yog 1000ml, series pre-flushing, 500ml perfusion thiab dialyzer tso pa, 500ml high-flow transmembrane pre-flushing; vim muaj kev txwv kev tuav pov hwm kho mob, cov kua qaub ib txwm tsis tuaj yeem tshaj tus qauv, thiab muaj kev phom sij txog kev nyab xeeb ...

Qhov teeb meem tseem ceeb 2: Kev siv cov tshuaj anticoagulants

Muaj tus cwj pwm dav dav tias hemodiafiltration (HDF) thiab hemoperfusion (HD + HP) yuav tsum tau nce koob tshuaj anticoagulants los tiv thaiv cov ntshav txhaws. Tus kws kho mob tsuas tuaj yeem hais ncaj ncees, "Peb ob hom tsis tau nce koob tshuaj tiv thaiv coagulants, uas tsis txawv ntawm hom hemodialysis, thiab yeej tsis tau muaj qhov tshwm sim ntawm cov ntshav txhaws thiab cov hlab ntsha txhaws." Hehe, kuv tsis paub tias peb cov kws kho mob xav li cas thaum lawv pom. Ntawm no, tus kws kho mob ntseeg tias ntau cov ntaub ntawv yuav tsum tau sau thaum lub sijhawm ua haujlwm laus. Cov khoom sib txawv muaj qhov sib txawv. Yog tias muaj ntau tus kheej thiab muaj kev nyab xeeb anticoagulant koob tshuaj tuaj yeem muab tau, nws kuj tau txais. Tsis tas li ntawd, cov ntsiab lus no suav nrog tus neeg mob cov xwm txheej hypercoagulable, thiab cov neeg mob hypercoagulable xav tau kev tiv thaiv zoo dua.

Qhov teeb meem tseem ceeb: ntshav ntws

Kuv nyuam qhuav hais ib rooj plaub ntawm coagulation tshwm sim los ntawm cov ntshav tsis zoo tom qab lub perfusion raj tau muab tso rau hauv lub tshuab vim mus rau hauv chav dej hauv nruab nrab ntawm cov txheej txheem. Kuj tseem muaj qhov pheej hmoo ntawm kev ua tsis zoo thiab cov ntshav ntws; tib neeg feem ntau nug seb cov ntshav ntws npaum li cas yog siv rau kev kho ntshav perfusion. Qhov no yuav tsum muaj qhov hnyav ntawm cov nyhuv adsorption ntawm cov ntshav perfusion thiab cov ntshav txaus kom ntseeg tau tias muaj kev tiv thaiv zoo. Peb tau ua cov ntshav perfusion ntawm 150ml / min, thiab cov pa 230ml / min. Tsuas yog ob qhov xwm txheej saum toj no, tsis tau muaj qhov tshwm sim coagulation raws li kev kho mob ib txwm muaj.

Thaum kawg, kuv tus cwj pwm yeej ib txwm ua: yog tias koj tsis muaj txoj hauv kev zoo dua los daws qhov teeb meem lossis muaj pov thawj txaus los kho cov txheej txheem, ces cov txheej txheem kev saib xyuas kev noj qab haus huv tshwj xeeb yog txoj kev qhia zoo tshaj plaws. Ua raws li cov txheej txheem kev khiav haujlwm (SOP) tsawg kawg yog kev nyab xeeb. Txawm hais tias muaj teeb meem, kuv txoj haujlwm muaj kev nyab xeeb thiab tuaj yeem ua raws.

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 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.