血液透析与腹膜透析之使用方法

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1、血液透析與腹膜透析之使用方法小兒部腎臟科林廣彥醫師7/25/20211血液透析(H/D)腹膜透析(PD)慢性連續性腎臟替代療法(Slowcontinuerenalreplacementtherapy):CVVH,CAVH,CVVHD,CAVHD,CVVHDF,CAVHDFRenalreplacementtherapy7/25/20212PICUTrainingCourseSlide何時該介入腎臟替代療法?該如何選擇何種腎臟替代療法?H/D;P/DorCVVH;CVVHD7/25/20213PICUTrainingCourseSli

2、deIndicationsforAcuteDialysis(1)SymptomaticfluidoverloadHyperkalemia(K+≧7.0mEq/L)Symptomaticuremiaand/orBUN>150-175mg/dLSevereintractableacidosis(pH≦7.1)NonobstructiveanuriaOliguriawithrapidprogressionofrenalinsufficiencySeverehyponatremiaorhypernatremia7/25/20214PICU

3、TrainingCourseSlideIndicationsforAcuteDialysis(2)SeverehyperphosphatemiaandhypocalcemiaInadequateurineoutputwithobligatoryIVfluidrequirementsPotentiallyharmfullevelsoftoxins.poisons.ordrugs(hemodialysisorhemoperfusion)Tumorlysissyndrome(uricacid>20mg/dL)Hyperammonemia

4、ininbornerrorsormetabolism(hemodialysis)7/25/20215PICUTrainingCourseSlide血液透析與腹膜透析之比較溶質由腹膜清除率或體內生化環境較穩定中分子及大分子清除率較每週三次的HD好對於hemodynamicunstablepatient(Shock;ICH;CADect.)較適合P/D水分與鉀離子之移除率:H/D較P/D好7/25/20216PICUTrainingCourseSlideAcutePeritonealDialysisinChildrenPDismore

5、efficientininfantsandchildrenPeritonealsurfaceareainchildren:twicethanthatofadultperkgbodyweightTheultrafiltrationrateperKgBW:higherinsmallerpediatricpatientsshortdialysatedewelltimesareusedPediatrichemodialysis:technicalchallengesandrequiresspeciallytrainedpersonnel

6、7/25/20217PICUTrainingCourseSlideTechnicalConsiderationofPDSingle(orTwo)cuffTenckhoffcatheterInsertion:SurgicalinsertionorPercutaneousinsertionInsertionSite:7/25/20218PICUTrainingCourseSlideTenckhoffPDcatheter7/25/20219PICUTrainingCourseSlideTenckhoffPDcatheter-2cuff7

7、/25/202110PICUTrainingCourseSlide7/25/202111PICUTrainingCourseSlide7/25/202112PICUTrainingCourseSlide7/25/202113PICUTrainingCourseSlide7/25/202114PICUTrainingCourseSlide7/25/202115PICUTrainingCourseSlide該如何開立腹膜透析處方?7/25/202116PICUTrainingCourseSlideAcuteperitonealdial

8、ysisorderDialysatesolution%(1.5%,2.5%4.25%)Exchangevolume:initial20ml/kgandgraduallyupto40~50ml/kgduringoneweekWarmdialysate