接續上一篇,這些尿都積在體內,一開始可能症狀還不明顯,但是當開始出現症狀的時候,或腎臟功能真的快不行了的時候,腎臟科醫生就會說:該作準備了!
喂!不是要你為後事作準備,而是要準備幫你的腎臟找個代班的了啦,就像老師生病請假,也要找個代課老師一樣。
有三種代班腎臟的方式可以選擇,用台語來說最貼切清楚:洗血(台語)、洗巴肚(台語)、換腰子(台語)。標準醫學名詞叫做:”血液透析“、“腹膜透析“、或”腎臟移植“。我們常聽到的”洗腎”,實在不如說:洗血(台語)、洗巴肚(台語)更接近事實。這三種腎臟的代班方式中,腎臟移植對身體最好,但是最難,難在要有人捐腎臟,難在患者要乖乖服用抗排斥藥,難在患者一定要好好配合醫囑回診抽血,難在一有風吹草動都有可能人仰馬翻等等。
還記得前一篇講到逆滲透濾水器嗎?既然,逆滲透濾水器和腎臟這麼像,可不可以把血液抽出去,經過濾水器洗一洗阿?阿你說對啦,洗血(台語),顧名思義就是把體內的血液,藉由管子抽出體外,在體外經過人工腎臟的淨化後,再返回體內。這個人工腎臟,還真的有點像逆滲透的濾心那樣的感覺。
人工腎臟 逆滲透的濾心
還記得上一篇提到(請參照:洗腎是在洗甚麼?(簡述腎臟功能)),人的腎臟是每分每秒都在製造尿液,洗血(台語)要天天洗嗎?要洗多久?要怎樣才算洗的夠乾淨?
這個問題的答案,在透析的標準裡面,洗的”足夠”就是好。換句話說,只要達到60分及格,大家都是好學生。以一般成年人來說,這個可接受的標準答案是:一週三次,一次四個小時。用醫學術語來說,要達到 kT/V > 1.2, URR >65%。
什麼?不曉得kT/V、URR是多少?請向照顧你的腎臟科醫師詢問吧!
{2147300:PNU8IMDP}pediatricsdefaultascno422%7B%22status%22%3A%22success%22%2C%22updateneeded%22%3Afalse%2C%22instance%22%3A%22zotpress-10e508762fc2abc9c3f59a4aa1fbee66%22%2C%22meta%22%3A%7B%22request_last%22%3A0%2C%22request_next%22%3A0%2C%22used_cache%22%3Atrue%7D%2C%22data%22%3A%5B%7B%22key%22%3A%22PNU8IMDP%22%2C%22library%22%3A%7B%22id%22%3A2147300%7D%2C%22meta%22%3A%7B%22creatorSummary%22%3A%22Clearinghouse%22%2C%22numChildren%22%3A1%7D%2C%22bib%22%3A%22%3Cdiv%20class%3D%5C%22csl-bib-body%5C%22%20style%3D%5C%22line-height%3A%201.35%3B%20%5C%22%3E%5Cn%20%20%3Cdiv%20class%3D%5C%22csl-entry%5C%22%20style%3D%5C%22clear%3A%20left%3B%20%5C%22%3E%5Cn%20%20%20%20%3Cdiv%20class%3D%5C%22csl-left-margin%5C%22%20style%3D%5C%22float%3A%20left%3B%20padding-right%3A%200.5em%3B%20text-align%3A%20right%3B%20width%3A%201em%3B%5C%22%3E1.%3C%5C%2Fdiv%3E%3Cdiv%20class%3D%5C%22csl-right-inline%5C%22%20style%3D%5C%22margin%3A%200%20.4em%200%201.5em%3B%5C%22%3EClearinghouse%20TNNK%20and%20UDI.%20Hemodialysis%3A%20Dose%20and%20Adequacy.%20Accessed%20February%2027%2C%202015.%20%3Ca%20href%3D%27http%3A%5C%2F%5C%2Fkidney.niddk.nih.gov%5C%2FKUDiseases%5C%2Fpubs%5C%2Fhemodialysisdose%5C%2F%23hope%27%3Ehttp%3A%5C%2F%5C%2Fkidney.niddk.nih.gov%5C%2FKUDiseases%5C%2Fpubs%5C%2Fhemodialysisdose%5C%2F%23hope%3C%5C%2Fa%3E%3C%5C%2Fdiv%3E%5Cn%20%20%3C%5C%2Fdiv%3E%5Cn%3C%5C%2Fdiv%3E%22%2C%22data%22%3A%7B%22itemType%22%3A%22webpage%22%2C%22title%22%3A%22Hemodialysis%3A%20Dose%20and%20Adequacy%22%2C%22creators%22%3A%5B%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22The%20NIDDK%20National%20Kidney%20and%20Urologic%20Diseases%20Information%22%2C%22lastName%22%3A%22Clearinghouse%22%7D%5D%2C%22abstractNote%22%3A%22Explains%20the%20formulas%20used%20to%20determine%20whether%20a%20hemodialysis%20dose%20is%20adequate.%22%2C%22date%22%3A%22%22%2C%22url%22%3A%22http%3A%5C%2F%5C%2Fkidney.niddk.nih.gov%5C%2FKUDiseases%5C%2Fpubs%5C%2Fhemodialysisdose%5C%2F%23hope%22%2C%22language%22%3A%22en%22%2C%22collections%22%3A%5B%5D%2C%22dateModified%22%3A%222015-02-27T13%3A13%3A40Z%22%7D%7D%5D%7D The image is cited from Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014“. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. – Own work