Matsayin duniya na cututtukan koda na yau da kullun
Binciken da aka gudanar ya nuna cewa cutar koda ta zama daya daga cikin manyan cututtuka da ke barazana ga lafiyar jama'a a duniya.A cikin 'yan shekarun nan, kididdiga ta nuna cewa a cikin kasashen da suka ci gaba (kamar Amurka da Netherlands), kimanin kashi 6.5% zuwa 10% na yawan jama'a suna da nau'i daban-daban na cututtukan koda, wanda adadin ciwon koda a Amurka ya kasance. ya zarce miliyan 20, kuma asibitoci suna kula da masu cutar koda sama da miliyan 1 a kowace shekara.Jimillar masu fama da cutar koda na karshen zamani a kasar Sin ma na karuwa, kuma ana sa ran adadin masu fama da cutar koda a kasar Sin zai zarce miliyan 4 nan da shekarar 2030.
Hemodialysis (HD) yana ɗaya daga cikin maganin maye gurbin koda ga marasa lafiya da ke fama da gazawar koda mai tsanani.
Ƙirƙirar samun damar shiga jini mai tasiri shine abin da ake buƙata don ingantaccen ci gaba na hemodialysis.Ingantattun hanyoyin samun jijiyoyi kai tsaye yana shafar ingancin dialysis da rayuwar marasa lafiya.Yin amfani da kyau da kuma kariya mai kyau na samun damar shiga jini ba zai iya tsawaita rayuwar sabis na samun damar ba kawai ba, har ma ya tsawaita rayuwar marasa lafiya na dialysis, don haka ana kiran hanyar da ake kira "rayuwar rayuwa" na marasa lafiya na dialysis.
Clinical aikace-aikace na duban dan tayi a AVF
Kwararrun ƙungiyar samun damar jijiyoyin jini sun yi imanin cewa AVF ya kamata ya zama zaɓi na farko don samun damar jijiyoyin jini.Saboda rashin sabuntawa, iyakataccen adadin albarkatun jijiyoyi, kuma ba za a iya maye gurbinsu gaba ɗaya ba, don haɓaka rayuwar sabis na samun damar haƙuri, daidaitaccen amfani da kula da fistula arteriovenous, da kuma guje wa rikice-rikice masu alaƙa da huda. sun ja hankalin likitoci da ma'aikatan jinya.
Don tabbatar da kimantawa na jijiyoyin bugun jini na arteriovenous fistula (AVF)
1) Ko hanyoyin jini na al'ada ne: tortuosity, stenosis da dilatation
2) ko bangon jirgin ruwa ya yi santsi, ko akwai alamar karaya, ko aibu, ko kuma ya rabu.
3) ko akwai thrombi da sauran amsawa a cikin lumen
4) Ko cikar launin jini ya cika da kuma ko jagora da saurin kwararar jini ba su da kyau
5) Kiwon hawan jini
Hoton ya nuna Farfesa Gao Min yana jinyar mara lafiya a gefen gado
Kula da yoyon fitsari na ciki
Tun da kafa na ciki yoyon fitsari ga marasa lafiya shine mataki na farko na "dogon tafiya", AVF kafin amfani da ultrasonic auna diamita na jijiyoyin bugun gini da jini ya kwarara ta halitta, lokacin da tantance fistula iya, da balagagge matsayin, don auna ko marasa lafiya da fistula a cikin bayanai ta amfani da ma'auni, duban dan tayi ba shakka shine mafi mahimmanci kuma madaidaiciyar hanya.
Kulawar AVF: Ana yin sa ido na duban dan tayi sau ɗaya a wata
1) Gudun jini
2) Diamita na jirgin ruwa
3) Ko anastomosis yana da kunkuntar, ko kuma akwai thrombosis (idan akwai thrombosis, dole ne a ƙara balloon).
Balagagge hukunci na autogenous arteriovenous fistula
Ba tare da la'akari da lokacin shawarar da za a fara huda ba, abin da ake bukata dole ne ya kasance bayan yoyon fitsari na ciki ya balaga.
An yi imani da cewa balagagge na yoyon fitsari ya kamata ya dace da ma'auni "6" guda uku:
1) Gudun fistula na arteriovenous> 600ml/min (2019 ƙwararrun ƙwararrun Sinawa game da samun damar jijiya don maganin hemodialysis:> 500 ml / min)
2) diamita na huda jijiya> 6mm (2019 ƙwararrun ƙwararrun ƙwararrun Sinawa game da samun damar jijiya don maganin hemodialysis:> 5 mm)
3) Venous subcutaneous zurfin & LT;6mm, kuma yakamata a sami isasshen nisan huda jijiyar jini don saduwa da amfani da hemodialysis.
A mafi yawan lokuta, fistulas arteriovenous tare da jijiyoyin bugun jini da rawar jiki mai kyau na iya samun nasarar hudawa cikin makonni 4 da kafa su.
Kima da kiyayewa
Yana da matukar mahimmanci don kimantawa akai-akai da lura da alamun asibiti na ƙwanƙwasa arteriovenous da isasshiyar hemodialysis bayan aiki.
Kyakkyawan kimantawa da hanyoyin sa ido sun haɗa da
① Samun damar lura da kwararar jini: ana ba da shawarar saka idanu sau ɗaya a wata;
② Jarabawar jiki: ana ba da shawarar cewa a duba kowane dialysis, ciki har da dubawa, palpation da auscultation;
③ Doppler duban dan tayi: shawarar sau ɗaya kowane watanni 3;
④ Hanyar dilution ba urea an ba da shawarar don auna sake yin amfani da shi sau ɗaya kowane watanni 3;
⑤ Ana ba da shawarar gano matsa lamba kai tsaye ko kaikaice a tsaye sau ɗaya kowane watanni 3.
Lokacin da ba za a iya kafa AVF mai sarrafa kansa ba, zaɓi na biyu ya kamata a dasa fistula na ciki (AVG).Ko don kafa AVF ko AVG, duban dan tayi yana da mahimmanci don kimantawa kafin a fara aiwatar da tasoshin jini, jagorar aikin huda, kimantawa bayan tiyata da kiyayewa.
An yi PTA a ƙarƙashin jagorancin duban dan tayi
Rikicin da ba makawa na arteriovenous fistula shine stenosis.Gudun jini mai tsayi na dogon lokaci zai iya haifar da hyperplasia mai amsawa na venous intima na fistula na ciki, wanda zai haifar da jijiyar jijiyar jini da rashin isasshen jini, yana rinjayar tasirin dialysis, kuma yana haifar da occlusion na fistula, thrombosis da gazawar lokacin da stenosis ya yi tsanani.
A halin yanzu na al'ada aiki don lura da ciki fistula stenosis ga duban dan tayi shiryar arteriovenous fistula stenosis a keratoplasty (PTA), balloon fadada jiyya ta fata biopsy a marasa lafiya da fistula a cikin jini, a cikin catheter balloon fadada, a karkashin jagorancin duban dan tayi ga jijiyoyi stenosis fadada site, gyara kunkuntar sassa, mayar da al'ada diamita na jini, don tsawanta da sabis na marasa lafiya da arteriovenous ciki fistula.
PTA a karkashin jagorancin duban dan tayi, ya dace, babu lalacewar radiation, babu bambanci wakili lalacewa, zai iya nunawa da kuma cututtuka na occlusion na jijiyoyin jini a kusa da halin da ake ciki, ma'auni na jini da aka auna da kuma kimanta jinin jini, kuma zai iya zama nan da nan bayan nasara a matsayin mai jiwuwa. samun damar yin amfani da hemodialysis, ba sa buƙatar catheter na wucin gadi, tare da aminci, tasiri da halaye na ƙananan rauni, saurin dawowa, rage jin zafi na mai haƙuri, Tsarin aiki yana sauƙaƙe.
Clinical aikace-aikace na duban dan tayi a tsakiyar venous catheterization
Kafin kafa catheter na tsakiya, yakamata a yi amfani da duban dan tayi don tantance yanayin jijiyar jugular na ciki ko jijiya na mata, musamman ma marasa lafiya da ke da tarihin intubation na baya, sannan a yi amfani da duban dan tayi don bincika jijiyar stenosis ko rufewa.A karkashin jagorancin duban dan tayi, duban dan tayi, kamar yadda "ido na uku" na likita, zai iya gani sosai da gaske.
1) Auna diamita, zurfin da patency na huda jijiya
2) Ana iya ganin allurar huda a cikin jirgin jini
3) Nuna ainihin yanayin yanayin allura a cikin jini don guje wa rauni na ciki
4) Guji faruwar rikice-rikice (haɗuwar jijiya mai haɗari, samuwar hematoma ko pneumothorax)
5) Don haɓaka ƙimar nasara na huda na farko
Clinical aikace-aikace na duban dan tayi a cikin peritoneal dialysis catheterization
Ciwon peritoneal wani nau'i ne na maganin maye gurbin koda, wanda galibi yana amfani da yanayin peritoneum na kansa don gudanar da maganin maye gurbin koda.Idan aka kwatanta da hemodialysis, yana da halaye na aiki mai sauƙi, dialysis kai da matsakaicin kariya na ragowar aikin koda.
Zaɓin sanya catheter na peritoneal dialysis a saman jiki wani mataki ne mai matuƙar mahimmanci wajen samar da damar yin amfani da ƙwanƙwasa ƙwanƙwasa ba tare da toshewa ba.Domin kula da patency na peritoneal dialysis magudanun ruwa da kuma rage faruwa na catheterization rikitarwa, wajibi ne a san da tsarin jiki na gaban na ciki bango da kuma zabi mafi dace wurin shigar da peritoneal dialysis catheter.
Jeri percutaneous na peritoneal dialysis catheter a karkashin duban dan tayi jagora ne kadan cin zali, tattali, sauki aiki, mafi aminci, ilhama da abin dogara.
An yi amfani da SonoEye palmar ultrasonication don samun damar jijiyoyin jini
SonoEye mai ɗaukar nauyi ne kuma ƙarami, baya mamaye yankin gefen gado, yana da sauƙin dubawa, ana iya haɗa shi kai tsaye zuwa wayar ko kwamfutar hannu, buɗe aikace-aikacen a kowane lokaci.
Hoton ya nuna Farfesa Gao Min yana jinyar mara lafiya a gefen gado
Chison dabino duban dan tayi yana da hotunan ganowa kuma an sanye shi da fakitin auna kwararar jini na hankali, wanda ke yin ambulaf ta atomatik kuma yana ba da sakamakon kwararar jini.
Huda yoyon fitsari ta hanyar duban dan tayi na iya inganta yawan nasarar huda da kuma rage yawan rikice-rikice irin su hematoma da pseudoaneurysm.
Barka da zuwa tuntube mu don ƙarin ƙwararrun samfuran likitanci da ilimi.
Cikakken Bayani
Icy Yi
Abubuwan da aka bayar na Amain Technology Co., Ltd.
Mob/WhatsApp: 008617360198769
E-mail: amain006@amaintech.com
Mai haɗawa: 008617360198769
Lambar waya: 00862863918480
Lokacin aikawa: Nov-03-2022
