腹膜透析充分性教案资料.ppt

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1、腹膜透析充分性TransportProcessesinPeritonealDialysisOsmosis（渗透）-Movementofwaterfromanareaofhigherconcentration(lowersoluteconcentration)toanareaoflowerconcentration(highersoluteconcentration)Diffusion（扩散）-MovementofsolutefromanareaofhigherconcentrationtoanareaoflowerconcentrationModelsofPer

2、itonealTransportThethreeporemodelThepore-matrixmodelThedistributedmodelThesemodelsarenotmutuallyexclusive;rathertheyshouldbeviewedascomplementarytooneanother.TransportAcrossthePeritonealEndothelium:TheThreePoreModel•Largepores(100-200Å)fewinnumber(3%ofSA)transportmacromoleculescleftsb

3、etweenendothelialcells•Smallpores(40-60Å)mostnumerous(95%ofSA)allowtransportofsmallsolutesandwaterpostulatedtobecleftsintheendothelium;havenotbeendemonstratedanatomicallyBasedTransportAcrossthePeritonealEndothelium:TheThreePoreModel(续)Ultrasmall(transcellular)pores(4-6Å)manyinnumber(b

4、utonly2%ofSA)transportwateronly(Nasieving)DemonstratedtobeAQP1（水通道蛋白）WaterTransportinAquaporin-1KnockoutMiceYangetal.AJP276:C76,1999问题：如果反复在90分钟放出腹透液，对病人电解质会产生什么影响？UltrafiltrationinPD:ThePore-MatrixModel多糖包被，细胞衣EffectivePeritonealSurfaceAreaIncreased“effective”peritonealsurfaceaream

5、ayoccur:DuringperitonitisAfterprolongedexposuretohighglucose-containingfluids这就是为什么腹膜炎时和长期透析后“PET"高转运的原因！Kt/V(HD)=‐ln(R‐.008xt)+(4‐3.5xR)x0.55UF/WAdequacyisaconcept,notanumber,andincludesmorethantheissueslistedabove.Funfact:UreawasdiscoveredbyHilaireRouellein1773.Itwasthefirstorganicc

6、ompoundtobeartificiallysynthesizedfrominorganicstartingmaterials,in1828byFriedrichWoehler.残肾GFR计算残肾GFR=（肾尿素清除率+肾肌酐清除率）/2；肾尿素清除率（ml/min）=（尿尿素／血清尿素）×24h尿量／1440肾肌酐清除率（ml/min）=（尿肌酐／血清肌酐）×24h尿量／1440尿尿素和血尿素的单位为mmol/L，尿肌酐和血肌酐的单位为μmol/L，尿量单位为ml。Kt/V计算每周总Kt/V＝（每日腹膜透析Kt/V+每日残肾Kt/V）×每周透析天数男性成年：V

7、=2.447-0.09516×年龄（yr）+0.1704×身高（cm）+0.3362×体重（kg）女性成年：V=-2.097+0.1069×身高（cm）+0.2466×体重（kg）Ccr的计算总Ccr=残肾Ccr+腹膜Ccr何谓“充分的”治疗避免过量水负荷血压控制良好保护残存肾功能营养良好控制血磷酸碱平衡纠正贫血清除足够的尿毒症毒素－没有尿毒症相关症状However,HongKongDatasuggest…45LoWK,etal,PDI1996;16:S163-166Withausualprescriptionof3x2liters,patientssurviva

8、lwase