Chronic renal failure is the end stage of many chronic kidney diseases, mainly manifested by the retention of metabolic wastes in the body, causing a series of symptoms and metabolic disorders. Renal replacement therapy is its main treatment method, including: hemodialysis, peritoneal dialysis, colonic dialysis, and renal transplantation. The efficacy of clinical hemodialysis, peritoneal dialysis and kidney transplantation is relatively certain, but the high technical content, many complications, expensive, as well as a series of problems such as rejection and limited sources of transplanted kidneys limit their wide clinical application. Since its clinical application in the 1970s, colonic dialysis can be used as a supplement to the above renal replacement therapy and has a very broad application prospect in the treatment of early and middle stage of chronic renal failure.
1.Research history
The research history of colon dialysis can be traced back to the 1930s. 1932, Pendlefon and west confirmed that intestinal mucosa can remove urea, creatinine and some nitrogen metabolites, and in the state of uremia, the intestinal clearance rate is significantly increased, and can remove some medium molecular materials, thus becoming the physiological basis of colon dialysis. In general, the length of the colon in adults is nearly 2 meters, and the colonic mucosa is rich in blood flow, and its mucosal hill skin cells have a wide area, which can produce a very wide effective dialysis area, thus laying the foundation for the deconvolution of colonic dialysis. Therefore, eliminating toxins from the body through the colonic route is a proven treatment with clinical practical value and is a new idea for clinical treatment.
2.Principle
The human colon has excretory and absorptive functions, and the colonic mucosa is similar to the peritoneum in that it is a biological semi-permeable membrane characteristic, which can selectively absorb and secrete. Using the different ion concentrations in the dialysis fluid, different ion gradients across the colonic mucosa are established, so that the toxic metabolites retained in the blood circulation move across the colonic mucosa and enter the dialysis fluid, and at the same time, the substances in the dialysis fluid that are useful to the body are absorbed into the blood. In addition, there are colonic pockets in each section of the colon, and the dialysis fluid enters the colon and forms many small dialysis pools in the intestinal cavity with the curvature of the intestinal cavity, which, together with the frequent peristalsis of the colon, brings the dialysis fluid into full contact with the colonic mucosa, accelerates the exchange of water and solutes between the intestinal cavity and the blood, eliminates water and toxic substances from the body, and reduces or relieves the edema of peritoneal tissues and renal vascular endothelial cells and renal interstitium. Colonic dialysis can make the patient’s blood urea nitrogen decrease, serum creatinine stabilize or decrease, acid-base disorder and electrolyte disorder correct, and urea increase. Colon dialysis is designed by using the physiological characteristics of the colon, using the human body’s own intestinal wall as the dialysis membrane and imitating the principle of peritoneal dialysis to eliminate the metabolic wastes accumulated in the body, correct the disorder of electrolyte balance, eliminate the excess water in the body, improve the disorder of the patient’s internal environment and reduce the treatment purpose of pulmonary and cardiovascular complications through diffusion and osmosis.
3.Operating method
Colon dialysis machine enema method: Colon dialysis by colon pathway therapy machine is different from the traditional colon method in the past, it uses a special catheter to insert into the intestinal cavity in a deeper position and can warm the injected solution, injecting a fast flow rate and a large amount of solution for irrigation, fully expanding the filtration area of the colonic mucosa, changing the shortcomings of the traditional enema with a small dialysis area and poor absorption capacity, enabling the injected drug to be retained in the intestine for a longer period of time. It can make the injected drugs remain in the intestine for a longer time, which can better adjust the water, electrolyte and acid-base balance, and also can make the toxins precipitated from the colonic mucosa to be discharged out of the body in time. Step 1 intestinal cleansing: through the instrument, the colon will be cleared of the residual stool and intestinal toxins, and a better internal environment will be established for the next step of colon dialysis and drug enema. Intestinal cleansing can effectively remove intestinal toxins and feces, thus establishing a more effective environment for colon dialysis and drug enemas, which is more effective for treatment. Step 2 Colon Dialysis: Under the condition of clean intestinal tract, effective colon dialysis is performed using dialysis solution to further eliminate toxins from the body. This step makes use of the characteristics of large colonic mucosa and rich blood flow, which can be used as semi-permeable membrane, similar to the principles of hemodialysis and peritoneal dialysis, and uses dialysis fluid similar to hemodialysis to perform colonic dialysis, using instruments and special pipes to fill the colon with dialysis fluid and keep the dialysis fluid in the colon for the necessary time for adequate dialysis, and then excrete the dialysed toxins out of the body in time, repeatedly several times, thus It can further remove toxins from the body and better adjust the body’s water, electrolyte and acid-base balance. If high depth fluid is used, it can also reverse the discharge of water overload in the body, thus treating hypervolemia, hypertension and swelling. Step 3 Retention enema: On top of the above two steps, a Chinese medicine retention enema is performed. Therefore, the whole colon is in a clean state and the Chinese medicine solution can enter the deep part of the colon. Diseases that cannot be solved by the traditional low retention enema method will be better treated, and the area of action of the colonic mucosa can be greatly expanded. The use of our different symptoms with different drugs for intestinal retention enema, using the absorption function of the intestinal mucosa to fully adsorb the Chinese medicine, and effectively regulate the internal environment of the body. Specific method: Before the treatment, the patient is asked to defecate by himself, take the left side lying position, after the negative anal finger diagnosis, the special probe is connected to the catheter and coated with liquid paraffin, and slowly sent into the intestinal cavity about 2250px through the anus, the treatment time is set for 30min, the injection time is 60s, and the waste liquid is discharged from the other tube of the probe by itself. Treatment parameters such as treatment time, dialysis fluid injection time, interval time and total amount of dialysis fluid can be set according to the patient’s condition under computer regulation. The completion of enema requires you to lie on your right side which is conducive to the flow of drugs to deep structures, prolonging the time of drug flow to sigmoid structures and delaying the time of timely appearance of defecation, thus prolonging the retention time of Chinese medicine in the intestine and increasing the amount of drug absorption.
4.Clinical application
In China, colonic dialysis therapy is mainly used for patients with acute and chronic renal failure is treatment, and has achieved better efficacy. Especially for patients with mild or moderate renal failure (blood creatinine <600mmol/L) who do not yet need hemodialysis or abdominal dialysis (blood creatinine >600mol/L); patients whose physical conditions are not suitable for hemodialysis or abdominal dialysis; patients who do not want to do hemodialysis or peritoneal dialysis; in addition, it can also be used with hemodialysis to further stabilize the patient’s internal environment and gradually reduce their hemodialysis frequency. Colonic dialysis therapy can automatically adjust the injection volume, pressure, temperature and insertion depth of the drug, which can directly act on the intestinal lesions, fully absorb the drug through the colonic mucosa, antibacterial and anti-inflammatory, promote the repair and healing of the intestinal mucosa, and achieve the purpose of treating chronic intestinal disorders. As the third dialysis method after hemodialysis and peritoneal dialysis, colonic dialysis is increasingly accepted by clinicians.
Advantages.
It is possible to perform whole colon cleansing at the same time as treatment, which completely and thoroughly cleanses the colon of feces and toxins, and reduces the reabsorption of toxic substances in the intestine by the colonic mucosa and reduces the burden on the kidneys.
The large area of colonic mucosa allows for rapid absorption of drugs and large absorption volume. Drug delivery through the colonic route avoids the first-pass effect of the liver and maximizes the therapeutic effect of the drug. The colon route treatment machine adopts a computer-controlled program with an automatic detection system, which ensures the safety and effectiveness of clinical treatment.
5. Indications for colonic dialysis treatment.
(1) Acute and chronic glomerulonephritis.
(2) Acute and chronic renal insufficiency in early stage.
(3) Acute and chronic enteritis, ulcerative colitis, etc.
6, contraindications to colonic dialysis treatment.
(1) artificial anus.
(2) colon and rectum seven days after surgery.
(3) Anal fistula.
(4) Severe internal and external hemorrhoids.
(5) Patients with inflammation, edema, and active bleeding in the anal canal mucosa.
(6) Patients with rectal stenosis due to rectal or anal tumors; (7) Pregnant women or patients with active bleeding
(7) Prohibited for pregnant women or as directed by a physician.
(8) Severe heart disease.
7.What preparatory work should be done before the patient is treated by the colon route?
Generally, there is no need to fast, but do not eat spicy and stimulating food, do not eat too much before cleansing, and try to choose a high quality low protein diet. It is necessary to have a bowel movement before cleansing to empty the rectum, which can save time and facilitate cleansing to avoid blockage, and it is also necessary to empty the bladder.
8.Is there any pain in colon route treatment?
Normally, there is no pain, but some people may feel uncomfortable. Common reasons are: physicians due to internal resistance to fire tension; secondly, there is a large amount of gas in the colon or the colon is severely blocked; thirdly, the cleaning process is a sudden contraction of the colon muscles in the elimination of a large amount of liquid and waste sometimes part of the liquid into the cecum, may produce spasms, and the feeling of urgency to excrete.