连续性血液净化治疗.pptVIP

So to summarize, let’s quickly compare and contrast the four basic CRRT therapies. SCUF is the most simple therapy, its purpose that of patient excess fluid removal. Blood enters the PRISMA extracorporeal circuit through an access line, passes through the hemofilter, and returns to the patient circulation via the return line. As the blood passes through the filter, ultrafiltration takes place and effluent collects in the effluent bag. Effluent is any fluid that exits the hemofilter and is delivered to a waste bag. Pumps control blood flow and fluid removal rates. CVVH adds use of pumped replacement fluids, either pre or post filter, to enhance middle molecule clearance. CVVHD does not use replacement fluids, but incorporates use of pumped dialysate to enhance small molecule clearance. CVVHDF is the therapy that combines the benefits of CVVH and CVVHD with use of both replacement fluids and dialysate to achieve optimal benefits for the ARF patient. * 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 （CVVHDF) 结合了弥散清除(血液透析)和对流清除 (血液滤过 ) 滤器液腔需要透析液流动，而血液管路需要置换液输注 血液透析滤过 弥散 + 对流清除  Urea K Cr H2O PO4 MEDIATORS Urea H2O K H2O Cr.H2O PO4 H2O BLOOD 血 Replace- ment 补充液/置换液 Replace- ment 补充液/置换液 Dialysate 透析液 Ultrafiltrate 超滤液 - 弥散与对流的连合功效 combined effects of diffusion and convection - 超滤液率 透析液率 Ultrafiltrate flow rate dialysate flow rate - 比较复杂的技术 Technically more complex - 需更多资源More resource intensive 介质 CVVHDFContinuous Veno-Venous Hemodiafiltration P R I S M A S 連續靜脈-靜脈血液透析 血液回輸 透析液 廢液 血液流入 置換液 Therapy Options 治療選項 连续动静脉血液透析滤过(CVVHDF) 特点： 溶质清除多 超滤量最大 可以清除大分子，中分子和小分子 吸附 溶质吸附在滤器膜的表面、或滤器中的活性炭及吸附树脂上，从而达到清除的效果 应用于血液灌流等模式中 全血吸附 血浆吸附 吸附的清除率 对某些溶质或特定溶质起作用 与溶质浓度关系不大 与溶质和吸附物质的化学亲和力及吸附面积有关 吸附作用 Adsorption 有些膜材料带有吸附特性: (例如AN69