建立CRRT 的临床步骤幻灯片.pptVIP

建立CRRT 的临床步骤 血管通路 滤器选择 抗凝技术 置换液配方与液体管理 药物应用 血管通路 Vascular Access 中心静脉置管 股静脉 颈内静脉 锁骨下静脉 导管结构与特点 双腔导管Double-lumen catheters 1.Double -D 2.Double-O 双导管 Double-Catheters 1.Dual-Catheter 2.Split-Catheter 导管选择要点 能够提供的血流量； 导管材料； 导管型号 价格 血滤器 Hemofilters 种类 polysulfone polyacrylonitrile polyamide 溶质清除 血滤器可以自由清除分子量小于100道尔顿的溶质和毒素 (e.g. urea, creatinine, uric acid, sodium, potassium, ionized calcium and almost all drugs not bound to plasma proteins). 所有 CVVH血滤器不能通过白蛋白及其他超过 50,000 道尔顿的物质. 滤过分数 filtration fraction 滤过分数表示血液脱水的程度， filtration fraction (FF), which is the fraction of plasma water removed by ultrafiltration: FF(%) = (UFR x 100) / QP QP 为滤器血浆流量 ml/min. QP = BFR* x (1-Hct) *BFR:血流速 超滤率ultrafiltrate rate FF(%) = (UFR x 100) / QP QP = BFR* x (1-Hct) 例如 BFR = 100 ml/min Hct = 0.30 (i.e. 30%), QP = 70 ml/min. 滤过分数 30%滤器易凝血. 因此 the maximum allowable FF is set at 30%, a BFR of 100 ml/min yields a UFR = 21 ml/min. QP: the filter plasma flow rate in ml/min. 筛选系数与截留分子量 超滤系数与膜流量 Ultrafiltration coefficient K Uf Low flux membrane : 6 ml/h.mmHg.m2 = K Uf Mid flux membrane : 15 ml/h.mmHg.m2 = K Uf High flux membrane : 30 ml/h.mmHg.m2 = K Uf * * The hemofiltration membrane consists of relatively straight channels of ever-increasing diameter that offer little resistance to fluid flow. SIEVING COEFFICIENT 1.0 0 5600 inulin 11800 b2-m 21000 RBP 44000 orosomucoide 54000 a1 AT 66500 albumin MOLECULAR WEIGHT=SOLUTE SIZE DEFINITION:The cut-off point of a solute for any membrane is a sieving coefficient of 0.1 . This means that 10% of the molecules will pass and 90% will not pass . 0.5 60 urea Cut-off point O.1