【持续性肾脏替代治疗crrt英文精品课件】renal replacement therapy in perioperative medicine

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1、RenalReplacementTherapyinPerioperativeMedicineASArefreshercourses2006IntroductionThekidneyscontrol-fluidandelectrolytebalance-excretionofmetabolicbyproducts-productionofhemoglobin-activationofvitaminD“Renalreplacementtherapies(RRT)”-hemodialysis+itsprogeny(peritonealdialysis,continuous

2、hemofiltration,andcontinuoushemodiafiltration)Whatis“RenalFailure”?Surprisingly,thereisnouniversallyaccepteddefinitionforrenalfailureRenalfunctionisevaluatedbasedontwoseparatefunctions1)formationofconcentratedurine2)excretionofbyproductsofproteinmetabolismCreatinineclearance+urinaryout

3、put->renalfunction의측정도구로사용됨Whatis“RenalFailure”?Significantlimitations-fluctuationwithextracellularvolume,metabolicrate-신장의functionalreserve때문에fx의50%가소실될때까지serumcreatinine은상승하지않음-creatinineisactivelysecretedbynephron(overestimateGFR)CurrentcriteriaforthediagnosisofARF-serumcreatinineba

4、seline의3배이상증가-a75%decreaseinGFR(determinedbycreatinineclearance)-urinaryoutputoflessthan0.3ml/kgperhouroranuriafor12hoursWhataretheindicationsforRRTWhataretheindicationsforRRTProcessesofRenalReplacementTherapiesRRTusesanartificialkidneytoremovefluid(solvent)andsubstancesdissolvedintheb

5、lood(solute)Severalprocessesareusedtoproducehemofiltrate,usuallyincombination1.Ultrafiltration(한외여과)2.Convection(전달,운반)3.Diffusion(확산)4.MembraneAdsorptionProcessesofRenalReplacementTherapies1.Ultrafiltration2.Convection-"solventdrag"-removalofwaterandmiddlesizedmoleculesfromthebloodPro

6、cessesofRenalReplacementTherapies3.Diffusion-Smallermolecules(electrolytes,urea,andcreatinine)4.MembraneAdsorption-ArtificialMembranes(AN69)-ThistendencyisdeterminedprincipallybyporesizeandsurfaceareaTypesofRRTIntermittentRRT1.Intermittenthemodialysis(IHD)ThemostefficientmethodofRRTLar

7、geamountsoffluidcanberemovedandelectrolyteabnormalitiescanberapidlycorrectedoverarelativelyshortperiod“Dialysisdisequilibriumsyndrome"(투석불균형증후군)-많은osmoticshift로인하여ARF환자의20-30%에서저혈압-hemodynamicchangesmayworsenthepre-existingrenalinjuryIntermittentRenalReplacementTherapy1.Intermittenth