GEMODIALIZ

GEMODIALIZ (az gemo… va yun. dialysis – tajziya, judo shudan), usuli berun az gurda toza namudani khun. G.-ro hangomi illati shadid va muzmini gurdaho, zahroludi az spirt, doru va moddahoi khimiyavi (agar az membranai gemodializi guzarand), ikhtiloli tarkibi elektrolizii khun va g. kor mefarmoyand. Hangomi A. az organizm mahsuli zararnoki mubodilai moddaho khorij va muvozanati obu elektrolitho barqaror karda meshavad.
Masalai toza namudani khun az zamonhoi qadim malum ast. Tabiboni guzashta sababi bisyor bemorihoro natijai makhlut gashtani moeoti badan mehisobidand. Baroi toza kardani onho az jushobi rastani va mineralhoi gunogun istifoda meshud. Bo vujudi in, muolija samarai dilkhoh namedod va hatto baroi salomatii mariz khavfnok bud.
Asri 19 barobari rivoju ravnaqi biokhimiya masalai toza namudani khun to hadde halli kheshro yoft. S. 1854 olimi shotlandi T. Grekh ba G. asosi fiziki guzosht. u dar kitobi «Nerui osmosi» baroi avval oidi az pergamenti makhsusi nimnufuzpazir ibrozi aqida namud. Usuli mazkur baroi judo namudani mahlulhoi kolloidi va kristalloidi imkonpazir gasht. T. Grekh qonunhoi diffuziya va osmosro isbot namuda, jarayoni diffuziyai mahlulhoi kristalloidiro ba tavassuti kogazi pergamenti dializ nomid.
Pas az 50 sol J.J. Abel apparati az khun judo kardani moddahoi halshudaro ikhtiro namud. Tadqiqot dar saghoi gurdaashon burida girifta guzaronida shud. Malum gasht, ki az tarkibi khun dur kardani moddahoi nitrogenii bo safedaho payvastnabuda imkon dorad. Hurdii sathi membrana imkon nadod, ki apparat baroi toza kardani khuni odam niz istifoda gardad. Ba sifati vositai peshgirii lakhtabandii khun hangomi az apparat guzashtani on girudin (antikoagulyante, ki az shulluk megirand) kor farmuda meshud. Binobar samarai kam doshtani girudin orizahoi jiddii suddabandi rukh menamudand.
G.-i nakhustini odam s. 1924 dar Germaniya az jonibi dukhtur G. Haas guzaronda shudaast. Ba sifati antikoagulyant girudini toza istifoda gasht. Hosiyathoi antigenii on imkon namedod, ki dializ ziyoda az 30 – 60 daqiqa guzaronda shavad. S. 1927 dar mavridi G. bori avval ba sifati antikoagulyant geparin istifoda gasht. Hamin tavr, G. Haas nakhustin olime bud, ki kambudihoi G.-ro bartaraf sokht.
3 sent. s. 1945 bori avval dar jahon bo rohi G. bemor az igmo (koma)-i uremiyavi barovarda shud (dukhturi gollandi V. Kolf). Dar natijai bo gemodializator toza kardani khun konsentratsiyai karbamid dar tarkibi on past gasht. S. 1946 V. Kolf bori avval dar jahon dasturamalero oid ba muolijai bemoroni uremiya bo rohi G. ba tab rasond.
Dar mavridi G. moddahoi tarkibi khun bo rohi diffuziya va konveksiya dur karda meshavand. Diffuziya ba tavassuti membranai suni surat megirad; dar yak tarafi membrana khuni patsient, dar tarafi digar – mahluli dializi joygir ast. Vobasta ba masomahoi membrana az khun moddahoi massai mollekulaashon gunogun – az natriy, kaliy va karbamid to safedaho (V2 – mikrobulin) khorij karda meshavand. Ba khuni patsient az mahluli dializi metavonand elektrolitho (natriy, kaliy, kalsiy, khlorid) va moddahoi kalonmolekula roh yoband. Binobar in dar tarkibi mahluli dializi konsentratsiyai muayyani elektrolitho vujud dorad, ki baroi nigoh doshtani muvozanati elektoliti dar organizmi patsient peshbini shudaand; mahlul ba tavri makhsus toza karda meshavad, to in ki zahri bakteriyaho yo moddahoi khimiyavi ba khuni patsient roh nayoband. Hangomi diffuziya az khun moddahoi zahrnoki bo safedaho payvast va gidrofobi amalan judo nameshavand.
Konveksiya niz ba tavassuti hamon membranai gemodializi binobar tafovuti bayni fishori khun va mahluli dializi surat megirad; on imkon medihad, ki az tarkibi khun moddahoi zahrnoki gidrofobi khorij karda shavand. Nig. niz Gurdai suni.