Nhanganyaya
Mukurapa chirwere cheitsvo chekupedzisira (ESRD) uye kukuvara kweitsvo zvakanyanya (AKI),dhayirivha—inowanzonzi "itsvo yekugadzira" —ndiyo musimbotimudziyo wekurapainobvisa chepfu nemvura yakawandisa muropa. Inokanganisa zvakananga kushanda zvakanaka kwekurapa, mhedzisiro yemurwere, uye hupenyu hwake. Kune vanopa hutano, kusarudza dialyzer yakakodzera kunoenderana pakati pezvinangwa zvekurapa, kuchengetedzeka kwemurwere, uye mutengo. Kune varwere nemhuri, kunzwisisa mutsauko uripo pakati pemhando dzedialyzer kunovabatsira kutora chikamu mukuita sarudzo dzakafanana.
Chinyorwa chino chinoparura mapoka makuru ema dialyzer, maficha awo ehunyanzvi, uye nzira dzekusarudza dzinoshanda zvichibva pamirayiridzo yemazuva ano yakaita seKDIGO.
Kupatsanurwa Kwepakati KwemaDialyzer
Zvishandiso zvemazuva ano zve hemodialysis zvinogona kupatsanurwa nezvikamu zvina zvikuru: zvinhu zve membrane, dhizaini yemaumbirwo, hunhu hwekushanda, uye zvinhu zvinofungwa nemurwere.
1. Nezvinhu zveMembrane: Zvechisikigo vs. Zvekugadzira
Matumbu eCellulose (Echisikigo)
Zvazvinogadzirwa kubva muzvinhu zvinogadzirwa ne cellulose zvakaita se cuprophane kana cellulose acetate, ma membrane aya anodhura zvishoma uye anowanikwa zvakanyanya. Zvisinei, ane biocompatibility shoma, anogona kukonzera activation ye complement, uye anogona kukonzera fivha kana hypotension panguva ye dialysis.
Makenduru Ekugadzirwa (Anoshanda Zvakanyanya)
Yakagadzirwa nemapolymer emhando yepamusoro akadai sepolysulfone (PSu), polyacrylonitrile (PAN), kana polymethyl methacrylate (PMMA). Mamembrane aya anopa saizi yemasero akagadziriswa, kucheneswa kwemamorekuru epakati, uye kubatana kwakanaka, kuderedza kuzvimba uye kuvandudza kushivirira kwemurwere.
2. Nekugadzirwa Kwechivakwa: Hollow Fiber vs. Flat Plate
Madhayira eFiber asina Hollow(≥90% yekushandiswa kwemishonga iyi mukiriniki)
Ine zviuru zvema "capillary fibers" akapfava ane nzvimbo yakakura (1.3–2.5 m²) uye vhoriyamu shoma ye "priming" (<100 mL). Anopa kuchena kwakanaka uku achichengetedza kufamba kweropa kwakasimba.
Madhayira eFlat Plate
Hazviwanzo shandiswa mazuva ano, izvi zvine nzvimbo diki dze membrane (0.8–1.2 m²) uye huwandu hwakawanda hwe priming. Zvakachengeterwa nzira dzakakosha dzakadai se combined plasma exchange uye dialysis.
3. Nehunhu Hunoshanda: Kuyerera Kwakaderera vs. Kuyerera Kwakakwirira vs. HDF-Yakagadziridzwa
MaDialyzer eFlux Akaderera (LFHD)
Kushandiswa kweUltrafiltration coefficient (Kuf) <15 mL/(h·mmHg). Bvisa zvakanyanya zvinhu zvidiki zvinonyungudutsa (urea, creatinine) kuburikidza nekupararira. Zvinodhura zvishoma, asi zvine clearance shoma yepakati pemamorekuru (β2-microglobulin <30%).
MaDialyzer eFlux Akakwira (HFHD)
Kuf ≥15 mL/(h·mmHg). Inobvumira kuburitswa kwemamorekuru akakura, zvichideredza matambudziko akadai seamyloidosis inokonzerwa nedialysis uye kuvandudza mhedzisiro yemwoyo.
Zvishandiso zveHemodiafiltration (HDF)-Specific Dialyzers
Yakagadzirirwa kubvisa chepfu yepakati pemamorekuru neprotein, ichiwanzobatanidza mamembrane ekugadzira anopindira zvakanyanya ne adsorption layers (semuenzaniso, activated carbon coatings).
4. NeMurwere: Mukuru, Vana, Kutarisirwa Kwakakosha
Mamodheru eVakuru Akajairwa: 1.3–2.0 m² membranes kune varwere vazhinji vakuru.
MaModheru evana: 0.5–1.0 m² membranes dzine vhoriyamu shoma yepriming (<50 mL) kudzivirira kusagadzikana kwe hemodynamic.
Mhando dzeKuchengetedza Kwakakosha: Mapendi ekudzivirira ropa kubva muropa uye priming volume yakaderera (<80 mL) yekurapa itsvo kwenguva refu (CRRT) muvarwere veICU.
Dzidza Zvakadzama NezveMarudzi Makuru eDialyzer
Masero echisikigo
Zvimiro: Inodhura zvishoma, yakasimbiswa zvakanaka, asi haishande zvakanyanya mumuviri; njodzi huru yekubatwa nekuzvimba.
Kushandiswa Kwekiriniki: Yakakodzera rubatsiro rwenguva pfupi kana munzvimbo dzine mari yakawanda.
Makenduru Anoshanda Zvakanyanya
Polysulfone (PSu): Chinhu chinowanzo shandiswa pakugadzira dialyzer ine flux yakawanda, chinoshandiswa zvakanyanya mu high-flux hemodialysis neHDF.
Polyacrylonitrile (PAN): Inozivikanwa nekunyudzwa kwakasimba kwechepfu dzakasungwa nemapuroteni; inobatsira kune varwere vane hyperuricemia.
Polymethyl Methacrylate (PMMA): Kubviswa kwemunyu wakaenzana mumasero makuru, kunowanzoshandiswa muzvirwere zveitsvo zvine chirwere cheshuga kana zvirwere zvemapfupa nemaminerari.
Kuenzanisa Kusarudzwa kweDialyzer neZviitiko zveKliniki
Chiitiko 1: Kugadzirisa Hemodialysis muESRD
Zvinokurudzirwa: Dialyzer yakagadzirwa neflux yakawanda (semuenzaniso, PSu).
Chikonzero: Zvidzidzo zvenguva refu uye nhungamiro dzeKDIGO zvinotsigira ma membranes ane flux yakawanda kuti zvive nani pakubudirira kwemwoyo uye metabolic function.
Chiitiko chechipiri: Rutsigiro rweKukuvara kweItsvo Zvakakomba (AKI)
Zvinokurudzirwa: Cellulose ine flux shoma kana dialyzer yakagadzirwa nebhajeti.
Chikonzero: Kurapa kwenguva pfupi kunotarisa pakubviswa kwechinhu chisina kunyungudika uye kuenzana kwemvura; kushanda zvakanaka kwemari ndiko kwakakosha.
Kunze: Kana paine sepsis kana kuzvimba kweAKI, funga nezvekubvisa cytokine uchishandisa dialyzers dzine flux yakawanda.
Chiitiko chechitatu: Kuchenesa ropa kumba (HHD)
Zvinokurudzirwa: Chishandiso chedialyzer chine gomba repamusoro-soro chine priming inogadzirwa otomatiki.
Chikonzero: Kugadziriswa kuri nyore, zvinodiwa zvishoma zveropa, uye kuchengetedzeka kuri nani munzvimbo dzekuzvitarisira.
Chiitiko chechina: Kuchenesa ropa muvana
Zvinokurudzirwa: Zvishandiso zvekugadzira zve dialyzers zvine vhoriyamu shoma, zvinoenderana nehupenyu (semuenzaniso, PMMA).
Chikonzero: Kuderedza kushushikana kwekuzvimba uye kuchengetedza kugadzikana kwe hemodynamic panguva yekukura.
Chiitiko 5: Varwere veICU Vari Kurwara Zvakanyanya (CRRT)
Zvinokurudzirwa: Madialyzer ekugadzira ane anticoagulant, akagadzirwa nemuviri mudiki, akagadzirirwa kurapwa nguva dzose.
Chikonzero: Inoderedza njodzi yekubuda ropa uku ichichengetedza kubviswa kweropa kunoshanda muvarwere vasina kugadzikana.
Mafambiro Emangwana muTekinoroji yeDialyzer
Kushanda zvakanaka kwemuviri: Ma membrane asina chepfu uye machira e endothelial anofemerwa ne bio-inspired kuderedza kuzvimba uye njodzi yekugwamba kweropa.
Smart Dialyzers: Yakavakirwa mukati mekutarisa kubviswa kweropa online uye algorithm-based anticoagulation control yekuvandudza kurapwa kwenguva chaiyo.
Itsvo Dzekugadzira Dzinopfekwa: Matanda ane fiber inochinjika inogoneka kuburitsa masero mumuviri, ichibatsira murwere kufamba-famba, uye ichishandiswa dialysis kwemaawa makumi maviri nemana.
Zvinhu Zvisingakuvadzi Kuchengetedza Ruzivo: Kugadzira ma membrane anogona kuora (semuenzaniso, polylactic acid) kuderedza marara ekurapa.
Mhedziso
Kusarudza hemodialysis dialyzer hakusi kungosarudza chete—kusanganisa mamiriro emurwere, zvinangwa zvekurapa, uye kufunga nezvehupfumi. Varwere veESRD vanobatsirwa zvikuru ne dialyzers dzinoyerera zvakanyanya kuderedza matambudziko enguva refu. Varwere veAKI vanogona kukoshesa mutengo nekureruka. Vana nevarwere vanorwara zvakanyanya vanoda michina yakagadzirwa zvakanaka. Sezvo hunyanzvi huchifambira mberi, dialyzers dzemangwana dzichava dzakangwara, dzakachengeteka, uye dziri pedyo nekushanda kweitsvo kwechisikigo—zvichivandudza kurarama uye hupenyu.
Nguva yekutumira: Gunyana-08-2025