腹膜透析终末期肾病治疗方式的选择

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1、腹膜透析终末期肾病治疗方式的选择血液透析腹膜透析肾移植Transplantation移植AdvantagesMostlikeyourownkidneyNodialysisneededNoaccessneededNormalDiet(-sodium)More“normal”lifestyle优点与自己的肾脏功能相似不需透析不需要通路正常饮食（钠）生活方式更接近正常DisadvantageRisksofmajorsurgeryRiskofbodyrejectingkidneyPossiblesideeffectsofdrugsLo

2、werresistancetoillnessBodyimagechanges.缺点手术风险排异反应药物的副作用抵抗力低下体形改变Patient'sKidneyTransplantKidney(extra-peritoneally)Bladder病肾移植肾膀胱Whocannotdonateakidney?哪些人不可捐献肾？HIVorAIDS-relatedinfectionHepatitisBorCinfectionMajorheartorbreathingproblemsDiabetesExtremeobesitySignif

3、icantkidneydiseaseMostcancersIVdrugabusePregnancyHighBPHavingonlyonekidneyEvidenceoffinancialornon-financialcoercionInabilitytogiveinformedconsent/psychiatricdisordersHIV或AIDS相关感染乙肝或丙肝感染严重心肺疾病糖尿病过度肥胖明显的肾脏疾病大多数癌症静脉吸毒妊娠高血压仅有一个肾有经济或非经济利益企图的证据无法做到知情同意或有精神障碍Indicationsfo

4、rdialysisinitiation开始透析的指征肾小球滤过率10-15ml/min/1.73m²尿毒症症状尿毒症导致营养不良有计划地开始透析对于患者非常重要，应尽量避免“急诊透析”！GFR10-15ml/min/1.73m²UremicsymptomsMalnutritionHemodialysis血液透析Theprocessofseparatingchemicalsubstancesfrombloodthroughasemi-permeablemembrane通过透析器半透膜从血液中分离化学物质的过程ToxinRemov

5、al清除毒素Removaloftoxinsfromthebloodisaccomplishedby:清除血液中毒素是通过：Diffusion弥散Convection对流Adsorption吸附Blood血Blood血液Dialysate透析液Salt盐Toxin毒素Semi-permeableMembrane半透膜在血透治疗中，绝大部分清除毒素作用是通过弥散实现弥散清除与下列因素相关：浓度梯度，分子大小，膜表面积ConcentrationGradient-FlowGeometry浓度梯度-液流动力影响BloodIn血液入口Bl

6、oodOut血液出口DialysateIn透析液入口DialysateOut透析液出口CounterFlow反向液流Temporaryvs.Permanent临时通路或永久通路TemporaryAccessUsedforafewhourstoseveralweeksUsuallypercutaneousinsertionofacannulaintoalargeveinSurgicalimplantationofpairedtubesintoanarteryandveinwereusedanumberofyearsago;fai

7、rlyobsoletenowForpatientswithacuterenalfailure,chronicrenalfailurewithoutpermanentaccess,peritonealdialysis(PD)ortransplantpatientsfortemporaryhemodialysisPermanentForperiodsrangingfrommonthstoyearsOptionsSub-cutaneousanastomosisofarterytoveinSub-cutaneouspositionin

8、gofa“tube”graftbetweenanarteryandveinImplantationofacuffeddual-lumencatheterintoavein临时通路使用几小时到数周通常经皮穿刺大静脉，留置导管。外瘘（动静脉各植入一根临时导管）现在已经基本不再使用