血液透析與腹膜透析之使用方法

《血液透析與腹膜透析之使用方法》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、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10/3/20211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,CAVHDFRenalreplacementtherapy10/3/20212PICUTrainingCourseSlide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;CVVHD10/3/20213PICUTra

2、iningCourseSlideIndicationsforAcuteDialysis(1)SymptomaticfluidoverloadHyperkalemia(K+≧7.0mEq/L)Symptomaticuremiaand/orBUN>150-175mg/dLSevereintractableacidosis(pH≦7.1)NonobstructiveanuriaOliguriawithrapidprogressionofrenalinsufficiencySeverehyponatremiao

3、rhypernatremia10/3/20214PICUTrainingCourseSlideIndicationsforAcuteDialysis(2)SeverehyperphosphatemiaandhypocalcemiaInadequateurineoutputwithobligatoryIVfluidrequirementsPotentiallyharmfullevelsoftoxins.poisons.ordrugs(hemodialysisorhemoperfusion)Tumorlys

4、issyndrome(uricacid>20mg/dL)Hyperammonemiaininbornerrorsormetabolism(hemodialysis)10/3/20215PICUTrainingCourseSlide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10/3/20216PICUTrai

5、ningCourseSlideAcutePeritonealDialysisinChildrenPDismoreefficientininfantsandchildrenPeritonealsurfaceareainchildren:twicethanthatofadultperkgbodyweightTheultrafiltrationrateperKgBW:higherinsmallerpediatricpatientsshortdialysatedewelltimesareusedPediatr

6、ichemodialysis:technicalchallengesandrequiresspeciallytrainedpersonnel10/3/20217PICUTrainingCourseSlideTechnicalConsiderationofPDSingle(orTwo)cuffTenckhoffcatheterInsertion:SurgicalinsertionorPercutaneousinsertionInsertionSite:10/3/20218PICUTrainingCours

7、eSlideTenckhoffPDcatheter10/3/20219PICUTrainingCourseSlideTenckhoffPDcatheter-2cuff10/3/202110PICUTrainingCourseSlide10/3/202111PICUTrainingCourseSlide10/3/202112PICUTrainingCourseSlide10/3/202113PICUTrainingCourseSlide10/3/202114PICUTrainingCourseSlide1

8、0/3/202115PICUTrainingCourseSlide該如何開立腹膜透析處方?10/3/202116PICUTrainingCourseSlideAcuteperitonealdialysisorderDialysatesolution%(1.5%,2.5%4.25%)Exchangevolume:initial20ml/kgandgraduallyupto40~50ml/kgduringoneweekWarmdialysate