Ukudla okungenamsoco kwe-hemodialysis nesifo sikashukela kuqeda ukusetshenziswa kwamafutha agcwele kanye nama-carbohydrate angagaya ukudla kalula. Lapho "isifo esimnandi" sithuthuka, sithinta cishe zonke izinhlaka zezitho, zidala izinkinga ezahlukahlukene.
Umphumela ovame kakhulu walesi sifo uthathwa njengokwehluleka kwezinso okungamahlalakhona, okuyimbangela ehamba phambili yokufa phakathi kwabanesifo sikashukela. Kwenzeka ngokumelene nesizinda sikashukela se-nephropathy - ukungasebenzi kwezinso.
Isifo sikashukela yi-pathology ehambisana nokuphazamiseka kwe-metabolic. Lapho imikhiqizo ye-metabolic nezinto ezinobuthi zibuthana egazini lomuntu ophilile, izinso zibhekana nokuhlungwa kwawo.
Kodwa-ke, ngesifo sikashukela, ukungasebenzi kahle kwesitho esibhanqiwe kuholela ekuqongeleleni kwezinto eziyingozi egazini ezifaka ubuthi emzimbeni. Ngakho-ke, odokotela bavame ukunquma inqubo yokuhlanzwa kwegazi okwenziwe. Ngabe kuhlobene kanjani i-hemodialysis kanye nesifo sikashukela? Hlobo luni lokudla okufanele ngilandele? Ake sizame ukuthola.
Ukusebenza kwezinso
Isitho esibhangqiwe siqukethe "ama-glomeruli" ayizinkulungwane eziyikhulu - izihlungi ezikhethekile ezikhipha igazi emikhiqizweni ye-metabolic kanye nobuthi obuhlukahlukene.
Lapho igazi lidlula emithanjeni emincane yalezihlungi, izinto eziyingozi zithunyelwa ezinsweni ziya kwesinye, futhi uketshezi nezinto ezibalulekile ziyabuyiselwa egazini. Ngemuva kwalokho, ngosizo lwe-urethra, yonke imikhiqizo edoti iyasuswa emzimbeni.
Njengoba ushukela ubonakala ngokuqukethwe kweglucose ekhulayo, umthwalo osendimeni ebhangqiwe ukhuphuka kakhulu. Ukususa ushukela omningi emzimbeni, izinso zidinga uketshezi olwengeziwe, ngenxa yalokho, ingcindezi ku-glomerulus ngayinye iyanda.
Izinqubo ezinjalo ze-pathogenic ngokuhamba kwesikhathi ziholela ekwehleni kwenani lokuhlunga okusebenzayo, okunomthelela ongaqondile ekuhlanzweni kwegazi.
Ngenqubo ende "yokugula okumnandi", izinso zincishisiwe kangangokuba kwehluleka ukwanda kwezinso. Izici zayo eziphambili yile:
- ikhanda kanye nokukhathala;
- isifo sohudo kanye nokuphefumula;
- ukushesha komoya ngisho nokuzivocavoca okuncane komzimba;
- isikhumba esikhanyayo;
- ukunambitheka kwensimbi;
- iminyakazo nemikhaba yemikhawulo engezansi, kubi kakhulu ebusuku;
- umoya omubi ovela emgodini womlomo;
- ukwehluleka nokukhohlisa.
Lesi simo sikhula ngemuva kweminyaka engu-15 ukuya kwengama-15 yokwelashwa kwesifo sikashukela okungasebenzi. Ukuhlola umsebenzi wezinso, udokotela angaqondisa ukuhlolwa komchamo noma kwegazi kwe-creatinine noma ukuhlolwa komchamo kwe-albhamuin noma i-microalbumin.
Lapho eqinisekisa ukutholwa, udokotela angakunquma inqubo yokuhlanza igazi. Ochwepheshe abaningi bayavuma ukuthi i-hemodialysis yesifo sikashukela idinga ukwelashwa okukhethekile. Ngakho-ke, iziguli zidinga ukushintshela kwirejimeni ekhethekile yokwelashwa kwe-insulin - imijovo ngama-insulin omuntu. Umnyombo walokhu kwelashwa ukukhansela imijovo ye-hormone yesikhathi esivamile ekuseni.
Ngaphezu kwalokho, akufanele sikhohlwe ngokuqapha njalo i-glycemia ukuze sigweme eminye imiphumela eyingozi ngokulinganayo.
Umnyombo wenqubo ye-hemodialysis
IHemodialysis inqubo eyengeziwe yokuhlanza igazi.
Idivaysi ekhethekile ihlunga igazi lesiguli nge-membrane, ngaleyo ndlela ihlanza ubuthi namanzi ahlukahlukene. Ngakho-ke, ucingo luvame ukubizwa ngokuthi "izinso zokwenziwa."
Umgomo wokusebenza kwensiza unje. Igazi eliphuma emthanjeni lingena ngaphakathi kulo, futhi inqubo yokuhlanzwa kwalo iyaqala.
Ngakolunye uhlangothi lwe-membrane ekhethekile, ukuphuma kwegazi, ngakolunye uhlangothi, ukudayela (isixazululo). Inezakhi eziheha amanzi ngokweqile kanye nobuthi obuhlukahlukene. Ukuqanjwa kwayo kukhethwe isiguli ngasinye.
"Izinso zokwenziwa" kunezenzo ezilandelayo:
- Iphelisa imikhiqizo yokubola. Kumele kuqashelwe ukuthi egazini lomuntu onesifo sikashukela ohlushwa yizinso, kugxilwa kakhulu ubuthi, amaprotheni, urea nezinye izinto. Noma kunjalo, azikho izinto ezinjalo ku-dialysate. Ngokusho kwemithetho yokuphambana, zonke izakhi ezivela koketshezi ezinokuqukethwe kwazo okuphezulu zihamba ku-ketshezi olunokuhlushwa okuphansi.
- Khipha amanzi ngokweqile. Lokhu kwenzeka ngokungenamkhawulo. Ngenxa yephampu, igazi lidlula esihlungini ngaphansi kwengcindezi, futhi kuflash eliqukethe idayari, ingcindezi iphansi. Njengoba umehluko wokucindezela mkhulu impela, uketshezi olwedlulele lungena kusisombululo se-dialysis. Le nqubo ivimbela ukuvuvukala kwamaphaphu, ubuchopho kanye nokuhlangana, futhi futhi kususa uketshezi oluqongelela inhliziyo yonke.
- Ijwayelekile i-pH. Ukuze uzinze ibhalansi ye-acid-base, kufakwa isikhombi esikhethekile se-sodium bicarbonate solution. Ingena kuyi-plasma, bese ingena emangqamuzaneni abomvu egazi, ithuthukisa igazi ngezisekelo.
- Ijwayelekile amazinga we-electrolyte. Ukuze ungasusi igazi lezinto ezidingekayo ezinjengo Mg, K, Na no Cl, ziqukethwe inani elifanayo njengengxenye ye-dialysate. Ngakho-ke, ukweqiwa kwama-electrolyte kudlulela kusisombululo, futhi okuqukethwe kwabo kuvamile.
- Ivimbela ukuthuthukiswa kwe-embolism yomoya. Lesi senzo sinesizathu sokuba khona "kogibe lomoya" kwi-tube, elibuyisela igazi emthanjeni. Ngokudlula kwegazi, ingcindezi engemihle idalwa (kusuka ku-500 iye ku-600 mm Hg). Idivaysi ithatha ama-bubble air bese ibavimbela ukuthi bangangeni egazini.
Ngaphezu kwalokho, ukusetshenziswa kwinso lokufakelwa kuvimbela ukwakheka kweziqalo zegazi.
Ngenxa ye-heparin, ephathwa kusetshenziswa iphampu, ukuhlangana kwegazi akwenzeki.
I-Hemodialysis: izinkomba kanye nokuphikisana
Le nqubo yenziwa izikhathi ezingama-2-3 ezinsukwini eziyi-7.
Ngemuva kokuthola i-hemodialysis, amaphesenti wokusebenza kokuhlunga kwegazi, noma kunalokho, ehlisa ukuqoqwa kwe-urea, anqunywa.
Lapho inqubo yenziwa kathathu ngesonto, khona-ke le nkomba kufanele okungenani ibe ngu-65%. Uma i-hemodialysis yenziwa kabili ngesonto, khona-ke iphesenti lokuzihlanza kufanele libe cishe yi-90%.
Ukwelashwa kweHemodialysis kufanele kwenziwe kuphela ngemuva kokunqunywa kokuxilongwa kanye nesivumelwano nodokotela abakhona. Inqubo yokuhlanza igazi ichazwe ezimweni ezilandelayo:
- ekwehlulekeni kwe-renal acute okubangelwa i-glomerulonephritis eyingozi, i-pyelonephritis kanye nokuphazamiseka kwendlela yokuchama;
- ukwehluleka okungapheli kwezinso;
- ngobuthi bezidakamizwa (ama-antibhayirasi, ama-sulfonamides, amaphilisi okulala, ama-sedatives nabanye);
- ukudakwa nezibazi (i-paleadstool noma i-arsenic);
- ukudakwa nge-methyl alcohol noma i-ethylene glycol equkethwe ngotshwala;
- nge-hyperhydration (uketshezi olwedlulele emzimbeni);
- ukudakwa ngezidakamizwa ze-narcotic (morphine noma i-heroin);
- uma kwenzeka kungalingani kokuqukethwe kwe-electrolyte ngenxa yokuvinjwa kwamathumbu, i-cystic fibrosis, ukuphuma komzimba, ukushiswa, i-peritonitis noma izinga lokushisa lomzimba eliphakeme.
Kodwa-ke, ukusetshenziswa kwe- "izinso zokwenziwa" noma ngabe ikhona enye yalezi zindlela zokuxhumana akusadingekile ngaso sonke isikhathi. Isifo sikashukela noma isiguli esinezinga le-glucose ejwayelekile sinqunywa i-hemodialysis uma:
- Umthamo wansuku zonke womchamo obunjiwe ungaphansi kwamalitha ayi-0,5.
- Izinso zenza umsebenzi wazo nge-10-15% kuphela futhi zihlanza igazi ngokungaphansi kwama-200 ml ngomzuzu owodwa.
- Okuqukethwe kwe-urea ku-plasma yegazi kungaphezu kuka-35 mmol / L.
- Ukuhlushwa egazini le-potassium kungaphezu kuka-6 mmol / l.
- I-bicarbonate ejwayelekile yegazi ingaphansi kwama-20 mmol / L.
- I-plasma creatinine iqukethe ngaphezu kwe-1 mmol / L.
- Ukudumba kwenhliziyo, amaphaphu nobuchopho akunakuqedwa ngemithi.
Kwezigaba ezithile zeziguli, i-hemodialysis ingahle ihlulwe. Akuvunyelwe ukusebenzisa insiza yokuhlunga igazi kumacala alandelayo:
- lapho ungenwe izifo;
- ngokwakhiwa kwe-psychologies yengqondo (i-schizophrenia, i-psychosis noma isifo sokuwa);
- ngokwanda okuqhubekayo kwengcindezi yegazi;
- ngemuva kokushaywa unhlangothi noma i-myocardial infarction;
- ngamathumba amabi;
- ngokwehluleka kwenhliziyo;
- ngesifo sofuba nesifo sikashukela;
- ngezifo zegazi (i-leukemia ne-aplastic anemia);
Ngaphezu kwalokho, i-hemodialysis ayisetshenziswa eminyakeni engaphezu kwengu-80.
Izici zomsoco kushukela kanye ne-hemodialysis
Umuntu onesifo sikashukela onokwehluleka kwezinso kufanele abonane nodokotela ngokudla.
I-yokudla, icubungula izinga ushukela, ukuba khona noma ukungabikho kwezinkinga, isikhathi sokwelashwa, isisindo nobudala, kuthuthukisa uhlelo lokudla okunempilo.
Ukuze ulondoloze amazinga e-glucose ajwayelekile futhi uvikele ukuwohloka kokusebenza kwezinso, isiguli kufanele silandele yonke imiyalo kadokotela obonayo.
Imithetho eyinhloko yokudla okondlayo kwe-hemodialysis kanye "nesifo esimnandi" imi ngalendlela elandelayo:
- Ukwanda kokudla kwamaprotheni ku-1,2 g nge-1 kg yesisindo somzimba. Ingxenye le itholakala emaqanda, inhlanzi enamafutha aphansi, inyama nemikhiqizo yobisi.
- Inani lemikhiqizo esetshenzisiwe akufanele yedlule i-2500 kcal. Le yindlela yokugaywa kwemvelo yamaprotheni engaqinisekiswa ngayo.
- Ukuvinjwa kokudla kwamanzi. Esikhathini esiphakathi nezinqubo zokuhlanza igazi, kwenqatshelwe ukusebenzisa uketshezi olungaphezulu kuka-5% ngesisindo sesiguli.
Ukudla okulinganiselayo kuqeda ukudla okwamafutha. Ngakho-ke, kuzodingeka ulahle ingulube, iwundlu, i-mackerel, i-tuna, i-herring, i-sardines kanye ne-salmon. Ngaphezu kwalokho, awukwazi ukudla imifino ecebiswe nge-oxalic acid (rhubarb, isipinashi, isilimo esidliwayo esinamagatsha anamanzi, isithombo, u-anyanisi oluhlaza kanye ne-isitshalo seqanda). Kufanele ukhohlwe amasoseji, amasoseji, inyama ebhemayo nokudla okusemathinini. Yebo, futhi-ke, zenqabe imithombo yama-carbohydrate agayekayo, okungukuthi, ushukela, ushokoledi, namakhekhe nezinye amaswidi.
Esikhundleni salokho, udinga ukudla izithelo ezingafakwanga njengamawolintshi, ama-apula aluhlaza, amaplamu, ulamula nokuningi. Thuthukisa ukudla ngemifino emisha (utamatisi, ukhukhamba) nezinhlamvu ezinempilo (ibhali, i-buckwheat ne-oatmeal).
Kuvunyelwe ukudla inyama nenhlanzi (i-veal, inkukhu, i-hake) nemikhiqizo yobisi oluncane.
Ukudla inombolo yesi-7 kwe-hemodialysis
Ukudla okunjalo kwabashukela abethembele nge-insulin kusetshenziselwa i-hemodialysis ukuze kulinganiselwe ukondleka futhi kuvikele ukukhula kwemiphumela emibi ngenxa yenqubo yokuhlunga kwegazi.
Imvamisa, ekudleni # 7 kubizwa nge- "renal."
Umgomo wayo oyinhloko wukunciphisa umkhawulo wokudla nsuku zonke kwe-potassium, amaprotheni namanzi.
Kunezinhlobo eziningi zokudla, kepha konke akubeki ukusetshenziswa kokudla okubandakanya i-potassium, nezitsha ezinokuqukethwe okunosawoti okuphezulu. Kodwa-ke, izinongo ezithile nososo kuvunyelwe ukunxephezela ukuntuleka kosawoti.
Ngokusho kokudla No. 7, ukudla okulandelayo nezitsha kuvunyelwe:
- isobho lezithelo nemifino ngokufakwa kwamazambane, i-dill, iparsley, ibhotela, u-anyanisi (abilisiwe noma oyisitshulu);
- isinkwa, ama-pancake namapancake ngaphandle kosawoti;
- inyama yenkomo enamafutha amancane, ingulube ecijile, i-veal, unogwaja, ikalikuni, inkukhu (ingabhakwa noma ibilisiwe);
- inhlanzi enamafutha amancane ngefomathi ebilisiwe, ungaba nefry kancane noma ubhake;
- i-vinaigrette ngaphandle kosawoti, amasaladi avela kuzithelo nemifino emisha;
- amasoso nezinongo - utamatisi, ubisi, izithelo nososo wemifino, usinamoni, uviniga;
- amaqanda athambile abilisiwe kabili ngosuku, ngesimo sama-omelet, izikhupha ekwakhiweni kwezitsha;
- izithelo ezingafakwanga ezinjeng peach, i-orange, ulamula, ama-apula aluhlaza;
- okusanhlamvu - ibhali, ummbila;
- ubisi, ukhilimu, ukhilimu omuncu, ushizi we-cottage shizi, izitsha ze-curd, ubisi olubilisiwe olubhakiwe, i-kefir ne-yogurt;
- i-tee ngaphandle koshukela, ama-jusi angenakuthunyelwa kuwo, ama-decoctions ama-rose okhalweni;
- uwoyela wemifino.
Ngaphezu kokubuka izondlamzimba ezikhethekile, kuyadingeka ukuthi uguqule umsebenzi ngokuphumula okuhle. Ukucindezelwa okungokomzwelo nakho kudlala indima ebalulekile ekusebenzeni kwezinso noshukela wegazi.
Ngesikhathi sokudla, iziguli zidinga ukulandela zonke izincomo zikadokotela ukuvimbela ubunzima obuhlukahlukene. Kulokhu, ukuzelapha kungavunyelwe ngokuphelele, ngoba isiguli singazilimaza kuphela.
Ividiyo ekulesi sihloko iveza umsebenzi wezinso kushukela.
