【持续性肾脏替代治疗crrt英文精品课件】crrt prescription-dialysis course 2012

《【持续性肾脏替代治疗crrt英文精品课件】crrt prescription-dialysis course 2012》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

1、CRRTPrescription:DialysisCourse2012Dr.AndrewHouseSiteChiefUHDivisionofNephrologyModalitiesConventionalIntermittentHemodialysis(IHD)Sustainedlow-efficiencydialysis(SLED)ContinuousRenalReplacementTherapies(CRRT)Slowcontinuousultrafiltration(SCUF)Continuoushemofil

2、tration(CVVH)Continuoushemodialysis(CVVHD)Continuoushemodiafiltration(CVVHDF)Highcutoff(HCO)hemofiltrationordialysisHemoadsorptionandplasmatherapyPLEX,plasmapheresis,coupledplasmafiltration-adsorptionUltrafiltrationMovementofFluidthroughasemipermeablemembraneca

3、usedbypressuregradient(TMP)ApositiveandnegativepressurerequiredUltrafiltration(UF)inCRRTcircuitsuchasPrismaflex®Positivepressureinbloodcompartmentwill“push”fluidthroughthemembraneNegativepressureinfluidcompartmentwill“pull”plasmawaterthroughthemembraneNon-perme

4、ablesolutescreateanosmoticpressure,movingwaterfromtheareaofhighwaterconcentrationtotheareaoflowerconcentration.BloodoutBloodinEffluentHIGHPRESLOWPRESDiffusionThemovementofsolutesfromanareaofhigherconcentrationtoanareaoflowersoluteconcentration.Diffusion/dialysi

5、sinCRRTcircuitsuchasPrismaflex®MovementofsolutesbaseduponaconcentrationgradientSoluteremovaldependson:SolutesizeBloodflowrate(BFR)DialysateflowrateConcentrationgradientbetweenthebloodandthedialysateDialysateinBloodinBloodoutUFandDialysateConvectionThemovementof

6、membrane-permeablesolutesdraggedalongwiththemovementofasolvent;allowssievingoflargermoleculesPositivepressureNegativepressureHemofiltrationinCRRTcircuitsuchasPrismaflex®PlasmawaterwithsolutesisremovedasUFatsetreplacementrateReplacementsolutionisinfusedintoblood

7、flowpathatthesamerateastheUFpumpisremovingNofluidbolusforpatientUnwantedsolutesarenotreplaced(e.g.BUN)Wantedsolutes(e.g.HC03)&fluidarereplacedReplacementBloodinBloodoutPrePostUFout“HemofiltrationisUltrafiltrationwithReplacement”CVVHDFPre-filterreplacementConsid

8、erations:LowershematocritdilutesbloodpassingthroughthefilterHigherUFcapabilitiesLessefficientclearancethenpost-filterreplacementPre-filterReplacementPre-filterReplacementorA