血液透析治疗模式的选择及评价课件

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1、血液透析治疗模式的选择和评价基本原理溶质清除机制弥散﹙diffusion﹚溶质浓度梯度—成正比溶质分子大小—成反比对流﹙convection﹚随溶剂的跨膜运动而转运溶质分子大小成反比超滤率及筛选系数决定转运速率吸附﹙absorption﹚水份清除机制超滤系数﹙Kuf﹚跨膜压(TMP)ClassificationofartificialmembranesusedforbloodpurificationtherapyWaterpermeabilitySolutepermeabilityBiocompatibilityMateria

2、l/PolymerRegeneratedcelluloseModifiedcelluloseSyntheticLow-flux﹙Kuf<15ml/mmHg·hr﹚High-flux﹙Kuf>15ml/mmHg·hr﹚Forsmallsolute→KoA﹙e.g.BUN﹑Scr﹑UA﹚Forlargersolute→SC﹙e.g.β2-MG﹚Qualitativemeasures1970swasonenhancingthesolutediffusiveandwaterremovingpropertiesofthemembranes1

3、980stheemphasishasbeenonconvectivetransport,absorption,andbiocompatibilityHistoricalOverviewEFFICIENCYBIOCOMPATIBILITYTechnologiesConvectionDiffusionDiffusion+ConvectionMembranesModifiedCelluloseCelluloseSyntheticLong-termresultsinhaemodialysistherapy(Relationshipbetw

4、eenmembranes,technologies,efficiencyandbiocompatibility)CRRTcontinuousambulatoryperitonealdialysis(CAPD)continuouscyclicalperitonealdialysis(CCPD)slowcontinuousultrafiltration(SCUF)continuousarterio-venoushemofiltration(CAVH)continuousarterio-venoushemodialysis(CAVHD)

5、continuousarterio-venoushemodiafiltration(CAVHDF)continuousvono-venoushemofiltration(CVVH)continuousvono-venoushemodialysis(CVVHD)continuousveno-venoushigh-fluxdialysis(CVVHFD)continuousvono-venoushemodiafiltration(CVVHDF)BloodPurificationProcedurescontinuousintermitt

6、entIRRTintermittentperitonealdialysis(IPD)hemoperfusion(HP)hemoconcentrationplasmapheresishemodialysis(HD)hemofiltration(HF)hemodiafiltration(HDF)水分迅速减少组织器官血供障碍血浆渗量骤然下降血压不平稳或诱发肺水肿生理代偿机制加重或诱发心衰血/膜反应SIRSIRRT对血流动力学影响CRRT与IRRT比较改善心血管稳定性维持脑灌注控制高分解代谢维持水电解质和酸碱平衡为营养支持创造条件重症AR

7、F已首选CRRTH2OwatersolublemoleculesHFBHDBDBDHDFmmHgBBF,Dlow-fluxFilterhigh-fluxorFilterdiffusionconvectiondiffusion/convectionmmHgBmmHgmmHgFDmmHgmmHgHFHDHDFKidney104ß2-MGC3a、C5aIT-1TNFVit.B12LipidABunCrUAclearance﹙ml/min﹚12080400101031020MW﹙Da﹚105AlbLpsMethodologiesPatie

8、ntMaterials“Ancillary”therapyCost？FactorsaffectingrenaldialysistherapyresultsheparinAVPVPADUFDBLDSADheaterlow-fluxHDheparinA