透析机功能组件的临床使用.ppt

Biofeedback modules and Haemodialysis * FMCAP/Medical * During HD with UF two potentially conflicting physiological responses are at play. Normal resting energy expenditure generates heat. REE may also be increased as a consequence of the inflammatory responses to the membrane and dialysate contaminants. Perception of the tendency for body temperature to rise leads to the need to dissipate heat through increased skin perfusion which lowers peripheral vascular resistance. In response to UF and fall in blood volume numerous physiological responses are invoked. Most important to the maintenance of adequate perfusion pressure and blood flow is the closing or constriction of peripheral blood vessels to non-vital organs, including the skin. The conflict is obvious: heat dissipation requires a well perfused skin: hemodynamic stability requires a poorly perfused skin. The net status of skin perfusion will depend upon the relative strengths and priorities to the body of the homeostasis of these two competing systems. As we shall see, it seems that the priority of thermal homeostasis may have been underestimated in the past. Biofeedback modules and Haemodialysis * FMCAP/Medical * The data presented here from an actual dialysis session monitored by BVM, BTM and BPM will be described in detail during presentation. Biofeedback modules and Haemodialysis * FMCAP/Medical * If patient warming is a problem for hemodynamic stability, why not just routinely dialyse patients with cool dialysate? In fact, such an approach is used by numerous clinicians attempting to improve hemodynamic stability for hypotension prone patients. For reasons we will examine, results are unreliable and unpredictable. Biofeedback modules and Haemodialysis * FMCAP/Medical * Tattersall from the Lister Unit, UK accurately recorded the pre-dialysis body temperature of 25 patients. Most patients had temperature recorded on more than one occasion. Normal body temperature in these patients ranged in a normal distrib