blood purification is believed to be familiar to kidney friends who have been dialyzing for a long time. Some kidney friends have to undergo hemodialysis 2-3 times a week, but is blood purification a hemodialysis? Is there any other form of it? What are the differences between different forms?
Principles of blood purification
Two key factors in blood purification: 1. dialyzer (composed of semipermeable membrane, semipermeable membrane can filter substances of a certain molecular weight); 2. dialysate (dialysate can help patients remove toxins in the body). Blood purification uses the principle of semipermeable membrane to introduce the patient's blood and dialysate into the filter at the same time. The harmful substances in the blood are removed by ultrafiltration of , diffusion, convection, adsorption, etc., and then the removed blood is introduced back to the body, thereby achieving the purpose of treating the disease. As the name suggests, blood purification is to lead the blood from the patient's body out of the body and purify the blood through a purification device.
What are the common ways to clean blood?
Different blood purification methods, the principles of their functions and the substances they remove are different. According to the relative molecular weight, solutes can be divided into three types: small molecules, medium molecules, and macromolecular substances, , small molecule solutes such as urea , creatinine, uric acid, etc., and medium molecule solutes such as β2 microglobulin, etc. Common blood purification methods include hemodialysis, hemofiltration , hemodialysis filtration, continuous renal replacement therapy (CRRT), simple ultrafiltration, plasma replacement, plasma adsorption, blood perfusion, etc. We will introduce them one by one.
- Hemodialysis: uses the principle of diffusion and convection to remove metabolic waste, harmful substances and excessive water in the blood. It is one of the most commonly used renal replacement treatments for patients with end-stage renal disease.
- Hemofiltration: imitates the principle of normal human glomerular filtration and renal tubular reabsorption, and removes excessive water and uremia toxins in the body in the way of convection . Compared with hemodialysis, hemofiltration has the advantages of hemodynamic having a small effect on hemodynamic and high clearance rate of .
- Hemodialysis filtration: is a combination of hemodialysis and hemofiltration, with the advantages of two treatment modes. can remove more small and medium-sized toxins in the same time than hemodialysis or hemofiltration alone.
- Continuous renal replacement therapy (CRRT): is the general term for all continuous and slowly clearing water and solute treatment methods. Traditional CRRT should be treated for 24 hours, but the treatment time can be flexibly adjusted according to the patient's treatment needs and effects. This technology is not only limited to the function of replacing the kidneys, but is also often used for first aid for critical diseases, so it is also called continuous blood purification treatment.
- Simple ultrafiltration: A method to remove moisture from blood through a dialyzer. is conducive to removing excessive moisture in the body.
- Plasma replacement: is a method to remove macromolecular substances in the blood, lead the blood out of the body, separate the plasma from the whole blood, and then supplement with an equal amount of fresh frozen plasma or albumin solution to remove pathogenic factors in the blood (such as autoantibodies, immune complexes, toxins, etc.). It can be used to treat a variety of autoimmune diseases and poisoning. Plasma replacement only reduces the concentration of pathogenic factors in the body more quickly and effectively and reduces tissue damage. At the same time, active etiology treatment should be carried out to effectively control the disease.
- plasma adsorption: After the blood is drawn out, the blood formed components (hemocytos, platelets ) and plasma are separated, and the isolated plasma is then flowed into an adsorption column containing specific adsorption components (such as bilirubin , autoantibodies, etc.) to adsorb specific pathogenic substances, and finally the plasma from the separated formation components is injected back into the body. can effectively remove pathogenic substances in the blood and improve the immune status. Compared with and plasma replacement, no replacement solution is required.
- Hematoperfusion: introduces the patient's blood into a perfusion device equipped with solid adsorbents (activated carbon, resin and other materials). Through adsorption, a blood purification technology is used to remove exogenous or endogenous toxins, drugs or metabolic wastes that cannot be removed from the blood by dialysis. It is mainly used for rescue drugs and poison poisoning, and can also be used in rescue and treatment of various serious diseases such as severe infections, severe liver failure, uremia , and various autoimmune diseases.
Who and when do you need blood purification treatment?
end-stage renal disease patients, that is, what we usually call uremia patients, are the main population of blood purification. In addition, acute kidney injury , severe heart failure , severe drug poisoning, autoimmune system diseases, etc., all have indications for blood purification treatment. Different patients need different treatment methods, and they cannot be generalized. Experts should assist in assessing and formulating plans for whom and when and what kind of blood purification treatment should be performed.
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