FundamentalKnowledgeofDialysis.ppt

Nissen Fundamental Knowledge of Blood Purification(DCC, Evaluation and Control) By Henry Service Team * Contents Definition Clinical meanings Fundamental principle Classification of Dialysis Critical control Effectiveness evaluation Prospective * Blood purification is the artificial removal of waste products from an individual‘s blood. Definition mmHg B mmHg D B D * 1.急性肾功能衰竭：高钾血症、严重水肿、尿毒症症状出现时 （血肌酐、尿素氮升高，少尿或无尿，代谢性酸中毒） 2.慢性肾功能衰竭 3.急性药物或毒物中毒 4.严重水肿 5.肝胆疾病：如肝功能衰竭，肝硬化腹水等 6.水电解质代谢异常：严重的高钾血症、 高钙血症、低钠血症等 When do patients need blood purification? * Bone Structure Vitamin DActivation骨质代谢 CalciumBalance钙平衡 Cardiac Activity PotassiumBalance钾平衡 Acid-base balance Recovery ofBicarbonate 调节酸碱 Blood Pressure Water Balance 调节水份控制血压 SodiumRemoval清除钠 Metabolic End Products Removal of Urea, Creatinine etc. 清除代谢废物 Clinical meanings（For what?） Substitution of Kidney * 开始时: 膜两侧浓度有差别 结束时: 膜两侧浓度相同 弥散是小分子物质随机的运动可导致均匀分布的结果。 Fundamental principle of blood purification Diffusion * Ultrafiltration 压力差 开始时: 结束时: 运用压力的作用将水份从膜一侧推到另一侧，膜孔够大时溶质也可以被挤出 Fundamental principle of blood purification * Hemodialysis Peritoneal Dialysis KidneyTransplantation Dialysis is the most popular therapy Classification of Kidney substitution * Hemodialysis Hemodialysis血液透析 HD Hemofiltration血液滤过 HF Hemodiafiltration血液透析滤过 HDF Classification * H2O water soluble molecules F mmHg mmHg B B B D B D mmHg B mmHg D B D low-flux低通透析器 high-flux高通透析器 high-flux高通透析器 Hemodialysis血液透析 Hemofiltration血液滤过 Hemodiafiltration血液透析滤过 弥散原理 对流 超滤 弥散 对流 超滤 Classification * Clearance in HD, HF and HDF各治疗模式的清除率 0 40 80 120 10 102 103 104 105 Urea 尿素氮 Creatinine 肌酐 Vit. B12 ?2-Microglob. Albumine Clearance清除率 ml/min MG Dalton道尔顿 HF HD HDF Kidney肾脏 * Semipermeable Membrane半透膜 Virus病毒 Bacteria细菌 Medium sizedmolecules, e.g.b2-Microglobulin b2-微球蛋白 Water flow iseasily possible 水最容易通过 Erythrocyte,red blood cell红血球 Albumin, asexample of a bigprotein molecule 白蛋白等大蛋白分子 Electrolytes电解质 半透膜就是性能良好的筛网，仅有小于筛孔的物质可以通过 * Dialyzate select