IN THE NAME OF GOD ﺍﻧﻮﺍﻉ

IN THE NAME OF GOD

ﺍﻧﻮﺍﻉ ﻭ ﺧﺼﻮﺻیﺎﺕ ﺻﺎﻓی ﻫﺎ ﻧﺎﺻﺮ ﻃﺒﺨی پﺎﻳﻴﺰ 8831

1 ﺷکﻞ ﺻﺎﻓی ﺍﻟﻒ: ﺻﺎﻓی ﺑﺎ ﺻﻔﺤﺎﺕ ﻣﻮﺍﺯی ) (Parallel Plate ﺏ : ﺻﺎﻓی ﺑﺎﻓیﺒﺮﻫﺎی ﺗﻮﺧﺎﻟی ) ( Hollow Fiber

ﺳﺎﺯگﺎﺭی ﺣیﺎﺗی ﺍیﺠﺎﺩ ﻋﺎﺭﺿﻪ ﻭﺍکﻨﺶ ﺍﻟﺘﻬﺎﺑی ﺑیﻦ ﺧﻮﻥ ﻭ ﺻﺎﻓی ﺑﻮیژﻪ ﺩﺭ ﺻﺎﻓی ﻫﺎی ﺳﻠﻮﻟﺰی کﻪ ﺩﺍﺭﺍی گﺮﻭﻩ ﻫیﺪﺭﻭکﺴیﻞ آﺰﺍﺩ ﻣی ﺑﺎﺷﻨﺪ. ﺑﺎﻋﺚ ﻓﻌﺎﻝ ﺷﺪﻥ کﻤپﻠﻤﺎﻧﻬﺎ ، آﺰﺍﺩ ﺷﺪﻥ ﺳیﺘﻮکیﻦ ﻭ ﺑﺎﻋﺚ ﺑﺮﻭﺯ ﻋﻼﺋﻢ ﺣﺴﺎﺳیﺘی ﺧﻔیﻒ ﺗﺎ ﺷﺪیﺪ ﺩﺭ ﺑیﻤﺎﺭﺍﻥ ﻣی ﺷﻮﺩ.

ﺳﻄﺢ ﺻﺎﻓی Surface Area ﺳﻄﺢ ﺻﺎﻓی ﻫﺎﻟﻮﻓﺎیﺒﺮ ﺳﻄﺢ ﺻﺎﻓی ﺗﻌﺪﺍﺩ ﻣﻮﺋیﻨﻪ ﻫﺎی ﺩﺭ ﺻﺎﻓی ﻫﺎی ﺗﻌﺪﺍﺩ ﺻﻔﺤﺎﺕ ﺩﺭ ﺻﺎﻓی ﻫﺎی پﻠیﺖ ﺻﺎﻓی ﻫﺎ ﺩﺍﺭﺍی ﺳﻄﻮﻉ ﻣﺨﺘﻠﻒ ﺍﺯ 4. 0ﻣﺘﺮ ﻣﺮﺑﻊ ﺗﺎ 3. 1ﻣﺘﺮﻣﺮﺑﻊ ﻣی ﺑﺎﺷﻨﺪ. ﻫﺮ چﻪ ﺳﻄﺢ ﺻﺎﻓی ﺑیﺸﺘﺮ ﺑﺎﺷﺪ ، ﺣﺠﻢ پﺮکﻨﻨﺪﻩ گی آﻦ ﺑیﺸﺘﺮ ﺍﺳﺖ.

Mass Transfer coefficient KOA یﺎ ﺿﺮیﺐ ﺳﻄﺢ ﺍﻧﺘﻘﺎﻝ ﺗﻮﺩﻩ ﺍی) ( Mass Transfer coefficient ﻣﻘﺪﺍﺭی کی ﺻﺎﻓی ﺧﺎﺻی ﺍﺳﺖ کﻪ ﺍﺯ ﻃﺮیﻖ ﻧﻔﻮﺫ پﺬیﺮی ، ﺿﺨﺎﻣﺖ ﻏﺸﺎﺀ ، ﺍﻧﺪﺍﺯﻩ ﻣﻮﺍﺩ ، ﻣیﺰﺍﻥ ﺟﺮیﺎﻥ ﺧﻮﻥ ﻭ ﻣﺎیﻊ ﺩیﺎﻟیﺰ ﻣﺸﺨﺺ ﻣی ﺷﻮﺩ. KOA ﻫﺮ ﺻﺎﻓی ﺑﺮﺍﺑﺮ ﺍﺳﺖ ﺑﺎ ﺣﺎﺻﻞ ﺿﺮﺏ ﺗﻮﺍﻧﺎیی آﻦ ﺻﺎﻓی ﺩﺭ کﻠیﺮﺍﻧﺲ یک ﻣﺎﺩﻩ ﺩﺭ ﺳﻄﺢ آﻦ ﺻﺎﻓی. KOA ﺍﺯ ﻧﻈﺮ ﺗﺌﻮﺭی ﺣﺪﺍکﺜﺮ کﻠیﺮﺍ ﻧﺲ ﺑﺮﺣﺴﺐ ﻣیﻠی ﻟیﺘﺮ ﺩﺭ ﺩﻗیﻘﻪ ﺑﺮﺍی یک ﻣﺎﺩﻩ ﺧﺎﺹ ﺩﺭ یک ﻣیﺰﺍﻥ ﺛﺎﺑﺖ ﺟﺮیﺎﻥ ﺧﻮﻥ ﻭ ﻣﺤﻠﻮﻝ ﺩیﺎﻟیﺰ ﺍﺳﺖ. KOA ﺑﺮﺍی ﺍﻭﺭﻩ ﻣﻌﻤﻮﻻ ﺩﺭ ﺻﺎﻓی ﻫﺎی ﻣﺘﻔﺎﻭﺕ ﺑیﻦ 002 ﺗﺎ 0011 ﻣی ﺗﻮﺍﻧﺪ ﻣﺘﻐیﺮ ﺑﺎﺷﺪ.

ﺣﺬﻑ یﺎ ﺟﺎﺑﺠﺎیی آﺐ ) Fluid Removal ( ﺗﻮﺍﻧﺎیی ﺻﺎﻓی ﺩﺭ ﻋﺒﻮﺭ آﺐ یﺎ ﻧﻔﻮﺫ پﺬیﺮی ﺻﺎﻓی ﻭﺍﺑﺴﺘﻪ ﺑﻪ : 1. ﻧﻮﻉ ﻋﻤﻠکﺮﺩ ﺩیﻮﺍﺭﻩ ﻏﺸﺎﺀ ﺻﺎﻓی 2. ﺳﺎیﺰ ﺳﻮﺭﺍﺧﻬﺎی ﻣﻮﺟﻮﺩ ﺩﺭ ﺟﺪﺍﺭ ﻣﻮﺋیﻨﻪ ﻫﺎ

KUF ﻧﻔﻮﺫ پﺬیﺮی ﺻﺎﻓی ﺑﻪ آﺐ ﺣﺠﻢ ﻣﺎیﻊ گﺮﻓﺘﻪ ﺷﺪﻩ ﺩﺭ ﻣیﻠی ﻟیﺘﺮ ﺑﺮ ﺳﺎﻋﺖ کﻪ ﺍﺯ ﺑیﻤﺎﺭ گﺮﻓﺘﻪ ﻣی ﺷﻮﺩ ﺑﻪ ﺍﺯﺍﺀ ) ( MM Hg ﻣیﻠی ﻣﺘﺮ ﺟیﻮﻩ ﻓﺸﺎﺭ ﺿﺮیﺐ ﺍﻭﻟﺘﺮﺍﻓیﺘﺮﺍﺳیﻮﻥ یﺎ KUF ﻧﺎﻣیﺪﻩ ﻣی ﺷﻮﺩ. KUF پﺎییﻦ یﻌﻨی ﻧﻔﻮﺫ پﺬیﺮی کﻤﺘﺮی ﻧﺴﺒﺖ ﺑﻪ آﺐ TMP KUF ﺑﺎﻻیﻌﻨی ﻧﻔﻮﺫ پﺬیﺮی ﺑیﺸﺘﺮ ﻧﺴﺒﺖ ﺑﻪ آﺐ TMP

High-Efficiency and High-Flux Hemodialysis

Definitions of flux, Permeability, and efficiency Flux ■ Measure of ultrafiltration capacity ■ Low and high flux are based on the ultrafiltration coefficient(Kuf) Low flux; Kuf < 10 ml/h/mm. Hg High flux; Kuf < 20 ml/h/mm. Hg Permeability ■ Measure of the clearance of the middle molecular weight molecule (eg, β 2 -microglobolin) ■ General correlation between flux and Permeability Low Permeability; β 2 -microglobolin clearance<10 ml/h/mm. Hg High Permeability; β 2 -microglobolin clearance<20 ml/h/mm. Hg Efficiency ■ Measure of urea clearance ■ Low and high efficiency are based on the urea Ko. A value Low efficiency; Ko. A <500 ml/min High efficiency; Ko. A <500 ml/min

Classification of High-Performance Dialysis v. High-Efficiency Low-flux hemodialysis v. High-Efficiency High-flux hemodialysis v. Low-Efficiency High-flux hemodialysis

Characteristics of High-Efficiency Dialysis ØUrea clearance rate is usually >210 ml/min ØUrea Ko. A of the dialyser is usually >600 ml/min ØUltrafiltration coefficient of the dialyser(Kuf) maybe high or low ØClearance of middle molecular weight molecules maybe high or low -------------------Ko- mass transfer coefficient; A- surface area

Differences between High and Low-Efficiency Hemodialysis High Efficiency, ml/min Low Efficiency, ml/min Dialyzer Ko. A ≥ 600 <500 Blood flow ≥ 350 <350 Dialysate flow ≥ 500 <500 Necessary optimal Bicarbonate dialysate Ko- mass transfer coefficient; A- surface area

Causes of High-Efficiency Dialysis Failure Access-related ■ Low blood flow rate ■ High recirculation rate Time-related ■ Patient not adherent to prescribed time ■ Staff not adherent to prescribed time ■ Failure to adjust time for conditions such as alarm, dialysate bypass, and hypotention

Benefits High-Efficiency Dialysis v Higher clearance of small solutes, such as urea, compared with conventional dialysis without increase in treatment time v Better control of chimistery v Potentially reduced morbidity v Potentially higher patient survival rates

Characteristics of High-Flux dialysis v. Dialyzer membranes are characterized by a high ultrafiltration coefficient(Kuf>20 ml/h/mm. Hg v. High clearance of middle molecular weight molecules occurs (eg, β 2 -microglobolin) v. Urea clearance can be high or low, depending on the urea Ko. A of the dialyzer v. High-flux dialysis requires an automated ultrafiltration control system

Technical requirements for High-Flux dialysis ü High-Flux dialyzers ü Automated ultrafiltration control system

Potential Benefits of High-Flux Dialysis q Delayed onset and risk of dialysis-related amyloidosis because of enhanced β 2 -microglobolin clearance q Increased patient survival resulting from higher clearance of middle molecular weight molecules q q q Reduced morbidity and hospital admissions Improved lipid profile Higher clearance of aluminum Improved nutritional status Reduced risk of infection preserved residual renal function

Limitation of High-Flux Dialysis üEnhanced drug clearance, requiring supplemental dose after dialysis üHigh cost of dialyzers

ﺍﻧﺘﺨﺎﺏ ﺻﺎﻓی ﻣﻨﺎﺳﺐ ﺟﻬﺖ یک ﺑیﻤﺎﺭ ﻣﻌﻤﻮﻻ ﺑﺎ کﻠیﺮﺍﻧﺲ ﻫﺪﻑ ﺗﻌییﻦ ﺷﺪﻩ ﺗﻮﺳﻂ پﺰﺷک ﺗﻌﺮیﻒ ﻣی ﺷﻮﺩ کﻪ ﻧﺘیﺠﻪ آﻦ ﺭﺳیﺪﻥ ﺑﻪ کﻔﺎیﺖ ﺩیﺎﻟیﺰ ﻣﻄﻠﻮﺏ ﻭ ﻣﻮﺭﺩ ﻧﻈﺮ ﺍﺳﺖ.

ﻣﺜﺎﻝ کﺎﺭﺑﺮﺩی: ﺑیﻤﺎﺭﺧﺎﻧﻤی 60 kg ﺑﺎ 160 cm ﻗﺪ ﻣی ﺑﺎﺷﺪ. 1 – ﻣﺤﺎﺳﺒﻪ ﺣﺠﻢ ) ،(V ﺩﺭ ﺍیﻦ ﻓﺮﺩ 23 ﻟیﺘﺮ یﺎ 00023 ﻣیﻠی ﻟیﺘﺮ 2 - ﻣﺤﺎﺳﺒﻪ ﺯﻣﺎﻥ ) 4 ، (T ﺳﺎﻋﺖ ﺩیﺎﻟیﺰ ﺑﺮﺍﺑﺮ ﺑﺎ 042 ﺩﻗیﻘﻪ 3 - ﺗﻌییﻦ K. T/V ﻫﺪﻑ ، K. T/V ﻣﻨﺎﺳﺐ ﺩﺭ یک ﺟﻠﺴﻪ ﺩیﺎﻟیﺰ=1/3 3/1 = • K. T/V 3/1 =00023 / )042. • ( K 371=042 / )00023. 3/1 ( = • K 371 = • K کﻠیﺮﺍﻧﺲ ﺍﻭﺭﻩ ﺻﺎﻓی 5 R ﺑﺎ ﻓﻠﻮی ﺧﻮﻥ 002 ﻣیﻠی ﻟیﺘﺮ ﺩﺭ ﺩﻗیﻘﻪ ﺣﺪﻭﺩ 071 ﻣیﻠی ﻟیﺘﺮ ﻣی ﺑﺎﺷﺪ ﻣی ﺗﻮﺍﻥ ﺑﺎ ﺍﻧﺘﺨﺎﺏ ﺍیﻦ ﺻﺎﻓی