5.周树生——血浆置换在重症患者中的应用(周树生).pptVIP

血液净化的医学历史与起源 不同的透析器 血浆置换基本概念和理论 血浆置换在重症患者临床中的应用 三、血浆置换---管路连接 三、血浆置换---管路连接 Anatomy of a Plasmafilter 血浆滤过量与血流量成正比，与血球压积成反比 受跨膜压(TMP)的影响：血浆滤过率随 TMP增加而升高，但 TMP增至一定程度，血浆滤过率不再增加并维持平台效应，继续增加TMP则有可能导致破膜漏血。 目前的研究认为：PE能更有效清除血浆中与蛋白质结合的毒素，如内毒素和免疫复合 物等中大分子物质，改善生理参数，降低死亡率。 Plasma exchange as rescue therapy in multiple organ failure 76 patients (41 male and 35 female) with DIC and MODS (including ARF) 回顾性对照研究，器官衰竭评分5，（range 1~6） 预计存活率为20% Plasma exchange was performed until DIC was reversed 结果：实际有82% 存活 Ann Thorac Surg.2004 May;77(5):1839-41 血浆置换有效治疗甲状腺风暴 第IV类：对照的临床研究证实PE无效。如肾移植排斥反应等。 美国血液分离学会（American Society for Aphesis）将血浆置换的 疗效分为四类： 血浆置换在重症患者临床中的应用 血浆置换在脓毒血症和多脏器功能障碍综合症的应用 Plasma concentrations of endotoxin significantly decreased (p .001). Serum concentrations of TNF-a significantly decreased (p .05). Serum concentrations of IL-6 decreased significantly (p .05). Crit Care Med. 1998 May;26(5):873-6 PE-sepsis and septic:PE能有效清除炎症介质 BMC Anesthesiol.2014 Apr 7;14(1):24 去甲肾上腺素剂量 before,during and after first therapeutic TPE in non-survivors and survivors Therapeutic?plasma?exchange?as?rescue?therapy?in?severe?sepsis?and?septic?shock:? retrospective?observational single-centre?study?of?23?patients TPE as rescue therapy in 23 patients with severe sepsis or septic shock from 2005 to 2012 BMC Anesthesiol. 2014 Apr 7;14(1):24 Therapeutic?plasma?exchange?as?rescue?therapy?in?severe?sepsis?and?septic?shock:? retrospective?observational single-centre?study?of?23?patients TPE as rescue therapy in 23 patients with severe sepsis or septic shock from 2005 to 2012 Net fluid balances as surrogate marker of septic vascular permeability are presented relating to the time of first TPE BMC Anesthesiol. 2014 Apr 7;14(1):24 Therapeutic?plasma?exchange?as?rescue?therapy?in?severe?sepsis?and?septic?shock:? retrospective?observational single-centre?study?of?23?patients TPE as rescue therapy in 23 patients with severe sepsis or septic shock from 2005 to 2012 PE may be an important adj