急性肾损伤概要.pptVIP

* Post dilution fluid replacement ensures that the patient receives the total electrolyte/buffer concentration contained in the fluid. As with Pre-dilution administration of replacement solution, the volume of fluid used is what drives the convective clearance. The benefits received from pre-dilution replacement are not present with post-dilution replacement. Therefore there may be a need to increase anticoagulation to prevent filter clotting. A benefit that post-dilution replacement fluid does offer is that the effluent (UF) chemistries truly reflect the plasma solute losses and thus filter efficiencies. The UF vs. plasma chemistry value is an important measure of filter efficiency. (Discuss FUN/BUN ratios if desired.) * Hemodiafiltration (HDF) is the most aggressive of the CRRT therapies. Hemodiafiltration is described as…. Read first bullet point. Hemodiafiltration incorporates the…. Read the second bullet point. We will see how utilizing all fluid paths available within the system will increase effectiveness of the treatment and allow us to control fluid and electrolyte balance based on individual patient needs. CVVHDContinuous Veno-Venous Hemodialysis P R I S M A S 连续静脉-静脉血液透析 血液回输 透析液 废液 血液流入 Therapy Options 治疗选项 对流作用 Convection 溶质随水流移动, “溶剂拖移” 溶质随水流动, “溶剂拖移” 对流作用清除溶质 对流作用清除溶质 通过对流作用置换所清除的溶质量取决于超滤出来的容量。 超滤容量 血液滤过 Hemofiltration (HF) 利用超滤清除比较大量的液体，结果，对流作用产生并同时清除溶质(以中大份子清除较明显) CVVHContinuous Veno-Venous Hemofiltration Therapy Options 治疗选项 连续静脉-静脉血液滤过 血液流入 血液回输 置换液 废液 Replacement (pre or post dilution) Access Return Effluent P R I S M A Replacement Access Return Effluent P R I S M A 置换液输注位置 滤器前稀释 pre-dilution 减低血液浓度，减少出现凝血，延长治疗时间 无抗凝血治疗首选 可用较高的超滤率(增加置换量) 滤出液化学检测数据不能正确代表真正血浆里离子成份 清除效率比后稀治疗低 15%左右 置换液输注位置 Replacement Access Return Effluent P R I S M A 滤器后稀释 post-dilution 滤器内血液浓缩，增加出现凝血，治疗时间短 只可用较低的超滤率(置换量较少) 需要抗凝血(使用抗凝血剂如肝素) 滤出液化学检测数据反影真正血浆里离子成份 清除效率比前稀治疗高15%左右 连续静静脉血液滤过(CVVH) 特点： 血流量控制精确而平稳 溶质清除更多 超滤量多, 需要置换液 血液透析滤过 Hemodiafiltration 结合了