【持续性肾脏替代治疗crrt英文精品课件】continuous renal replacement therapy(51p)

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1、ContinuousRenalReplacementTherapyAnnualRefresherCourseinCRITICALCAREMcGillCourseDirector:PeterGoldberg,MDDidierPayenCCDivision&DeptofAnesthesiology13/4/2000ContentPhysicalprinciplesDefinitionsTechniquesClinicalissuesSupportivetherapyoractivetherapy?SepsisanexampleWhy?Ho

2、w?Forwhatgoal?PHYSICALPRINCIPLES&DEFINITIONS<30000Da>30000Da<65000Da>65000DaPTMClearance=(Cuf/CI)*QufQuf=CH2OxSxPtmAllmoleculeslowerthanPorediamcrosstheMbneCONVECTION<30000Da>30000Da<65000Da>65000DaPTMClearance=(Cuf/CI)*QufQuf=CH2OxSxPtmAllmoleculeslowerthanPorediamc

3、rosstheMbneCONVECTION<30000Da>30000Da<65000Da>65000DaPTMClearance=(Cuf/CI)*QufQuf=CH2OxSxPtmAllmoleculeslowerthanPorediamcrosstheMbneCONVECTION<30000Da>30000Da<65000Da>65000DaPTMClearance=(Cuf/CI)*QufQuf=CH2OxSxPtmAllmoleculeslowerthanPorediamcrosstheMbneCONVECTION<30

4、000Da>30000Da<65000Da>65000DaCd<<30000Da<65000Da>65000DaCd<<

5、ysat=Pblood<30000Da>30000Da<65000Da>65000DaCd<30000Da<65000Da>65000DaCd

6、FUSIONPdialysat=Pblood<30000Da>30000Da<65000Da>65000DaFiltrationsubstitutionBloodFILTRATIONRATE0TO2L/HrSCUF&CVVHDEFINITIONSBELLOMOetal.AmJKidneyDis,28,(Suppl3)1996SCUF:UseonlyforfluidcontrolinoverhydratedstatusCVVH:Theultrafiltrateproducedduringmembranetransitisreplace

7、dinpartorcompletelytoachievebloodpurificationandvolumecontrol.UFisinexcessifweightlossismandatory:clearanceofsolutesequalsUFCVVHD:continuoushemodialysis.+countercurrentflowofdialysissolution.Bothdiffusion&convectionEfficiencyislimitedtosmallmolecules(lowPermfilter)CVVHD

8、F:same.Bothdiffusion&convectionbuthigherdialysateflow(HighPermfilter)SCUFSlowContinuousUltrafiltrationMaximum