肾替代性治疗--幻灯片.pptVIP

Renal Replacement Therapy(RRT)腎替代性治療 ;Acute Kidney Injury (AKI)[Acute Renal Failure ARF];;Prevention;Etiology Treatment;Evaluation of intravascular volume;Guide of Volume Expansion;Conservative Measurement;Uremia-nutrition Restriction protein but maintain caloric intake Carbohydrate ≥ 100gm/day to minimize ketosis and protein catabolism Drug Review all medication, Stop magnesium-containing medication Adjusted dosage for renal failure, Readjust with improvement of GFR ;Dietary modification;Renal Replacement Therapy;Indications for Renal Replacement Therapy;Methods for Renal Replacement Therapy;Mechanisms;Dialysis;Ultrafiltration ;Intermittent hemodialysis in ARF and critically ill patients;Peritoneal dialysis;Peritoneal dialysis;;Continuous renal replacement therapy (CRRT);急性腎衰竭仍是重症病患常見併發症之一，且死亡率極高( 50%) 重症病患常合併有低血壓，血行動力不穩，多重器官衰竭；且常需大量輸液 (升壓劑, 輸血) 合併急性腎衰竭需透析時常合併 (1) 血行動力不穩定 (2) 大量輸液無法依需要給予（如TPN) CRRT提供另類腎替代療法的選擇，並可避免傳統間歇性血液透析(intermittent hemodialysis, IHD)執行上的缺點;CRRT種類;;CAVH;CVVH;;;;;;CRRT的適應症;適應症;CRRT 的優點;CRRT的缺點;MMH CRRT Order; Predilution: run 999 cc/hr alternately as followed via artery end 1st bottle N/S 500cc + Sinca 1amp 2nd bottle N/S 500cc + 10% MgSO4 4cc 3rd bottle N/S 500cc  4th bottle D5W 500cc + NaHCO3 5amp Dialysate: 1.5% PD solution run 999 cc/hr Warm Predilution Dialysate to 37.0 ℃ Record I/O BP Q1H UF target: I-O = ( -40 )cc/hr Monitor: BUN, Cr, Na, K, Cl Q12H x 1 day and then QD Ca, P QD; Mg QW1,4 aPTT Q12H KCl supplement:;;MMH配方 (Predilution);;Dialysate(1.5% PD);CRRT結語 ;CRRT結語 ;CRRT結語;The End