Hemodialysis is a common alternative treatment in modern medicine, and the main types are as follows: hemodialysis, hemofiltration, continuous arteriovenous hemofiltration, hemoperfusion, immunoadsorption, plasma exchange, and peritoneal dialysis.
I. Hemodialysis
It is the introduction of blood into the dialyzer, using the difference in solute concentration between the two sides of the semi-permeable membrane, through osmosis, diffusion and ultrafiltration, to achieve the purpose of removing metabolites and toxic substances, and correcting the disorder of water and electrolyte balance.
Indicated for.
1.Acute renal failure;
2, chronic renal failure;
3.Acute poisoning. There is no absolute contraindication to hemodialysis, but dialysis should be avoided in the following cases to avoid accidents: shock or hypotension, difficult to control bleeding, significant cardiac enlargement with severe myocardial damage, severe arrhythmia. Uncontrolled severe diabetes mellitus, cerebral hemorrhage, and elderly patients.
II. Hemofiltration
It is a simulated device designed in accordance with glomerular filtration function. Its characteristics are mainly as follows
1.The removal of small molecules such as urea nitrogen and creatinine is slightly inferior to hemodialysis, but the removal of medium molecules, correction of water, electrolytes and acidosis, treatment of pulmonary edema, pericarditis and cerebral edema is superior to hemodialysis.
2.It can significantly improve anemia and triglyceridemia, and make hypertension easy to control.
3.The combination of hemodialysis and filtration is called hemodialysis filtration, which can improve the efficiency of blood purification and shorten the dialysis time.
4.The disadvantage is that the input of large amount of replacement fluid is easy to contaminate and cause fever reaction and sepsis.
Continuous arteriovenous hemofiltration
It uses the normal pressure gradient difference between arterial and venous pressure to continuously pass the blood through a small filter to achieve the effect of hemofiltration. Its characteristics are: low filtration rate, no need to use hemofiltration machine and supplement a large amount of replacement fluid. Especially suitable for acute renal failure scene rescue.
Four, blood perfusion
It is to introduce the patient’s arterial blood into the blood perfusion device stored with adsorbent material, and purify the toxins and metabolites in it by contacting the blood, and then return it to the body. Blood perfusion can effectively remove creatinine, uric acid, middle-molecular substances, phenols, guanidine, indole, organic acids and many kinds of drugs from the blood, but it cannot remove water and electrolytes, so it should be used in combination with hemodialysis or hemofiltration when treating uremia.
V. Immunosorbent
It combines highly specific antigens, antibodies or certain substances with specific physicochemical affinity (ligands) with adsorbent materials (carriers) to make adsorbents (columns), which can selectively or relatively specifically remove endogenous pathogenic factors from patients’ blood by using their specific adsorption properties, thus achieving the purpose of blood purification and disease relief.
Mainly used in the following diseases.
1.Severe systemic lupus erythematosus.
2. Primary and recurrent focal segmental glomerulosclerosis.
3, anti-neutrophil cytoplasmic antibody-associated vasculitis.
4, neurological diseases: patients with myasthenia gravis have anti-acetylcholine receptor antibodies in the serum, which interfere with neuromuscular transmission and lead to muscle weakness, immunosorbent can remove the antibody and rapidly improve the symptoms of muscle weakness.
5, dilated cardiomyopathy: dilated heart disease patients have been detected in a variety of different autoantibodies: myocardial myosin antibodies, muscarinic M2 receptor antibodies, mitochondrial aconitic acid water and enzyme antibodies.
6. It can be used in the treatment of various autoimmune diseases such as anti-glomerular basement membrane disease, lipoprotein nephropathy, Wegener’s granulomatosis, type II cryoglobulinemia, rheumatoid arthritis, immune thrombocytopenic purpura, hemolytic uremic syndrome/thrombotic thrombocytopenic purpura (HUS/TTP), anti-coagulation factor antibody-mediated coagulation abnormalities, etc.
VI. Plasma exchange
It is to introduce the patient’s blood into the plasma exchange device, discard the separated plasma, and make up a certain amount of plasma, so as to remove the antibodies in the patient’s plasma and activate the mediators of immune response and immune complexes.
It is mainly indicated for.
(1) immune complex glomerulonephritis and anti-glomerular basement membrane glomerulonephritis, such as pulmonary hemorrhage-nephritis syndrome. Rheumatic diseases and systemic lupus erythematosus. Periarteritis nodosa and rheumatoid arthritis, etc.
(iii) Autoimmune hemolytic anemia, hemolytic uremic syndrome and thrombotic thrombocytopenic purpura, etc.
④Myasthenia gravis, Guillain-Barre syndrome.
⑤ Hepatic coma.
(6) Mushroom poisoning.
⑦Severe psoriasis.
⑧Acute rejection reaction after renal transplantation.
⑨ hyperlipidemia.
Seven, peritoneal dialysis
It uses the peritoneum as a semi-permeable membrane and instills the prepared dialysis solution into the peritoneal cavity of the patient through the catheter according to the principle of multi-south membrane equilibrium, and achieves the purpose of removing metabolites and toxic substances and correcting the disorders of water and electrolyte balance through the difference of solute concentration between the two sides of the peritoneum. The main indications are the same as those for hemodialysis.
There are no absolute contraindications, but abdominal dialysis is not recommended in the following cases.
(i) extensive peritoneal adhesions, trauma to abdominal viscera, recent major abdominal surgery, colostomy or fecal fistula, extensive abdominal wall infection or cellulitis, diffuse malignant tumors in the abdominal cavity or unknown lesions.
② diaphragmatic hernia, severe pulmonary lesions with respiratory distress.
③ Pregnancy.