CRRT治疗参数及模式选择医学课件.ppt

continuous ambulatory peritoneal dialysis (CAPD) continuous cyclical peritoneal dialysis (CCPD) slow continuous ultrafiltration (SCUF) continuous arterio-venous hemofiltration (CAVH) continuous arterio-venous hemodialysis (CAVHD) continuous arterio-venous hemodiafiltration (CAVHDF) continuous vono-venous hemofiltration (CVVH) continuous vono-venous hemodialysis (CVVHD) continuous veno-venous high-flux dialysis (CVVHFD) continuous vono-venous hemodiafiltration (CVVHDF) CRRT 的定义 持续的血液净化→治疗时间(24hr) 缓慢的血液净化 尽可能地模仿肾脏清除功能 CRRT在重症ARF中的应用 ARF伴有心血管功能衰竭 ARF合并脑水肿 ARF伴有高分解代谢 CRRT在非肾脏疾病中的应用 已发现CRRT能清除大量炎症介质和维持 体液平衡 对SIRS、ARDS、MODS和急性坏死性胰腺 等疾病的病理、生理产生影响 扩大CRRT临床应用范围 CRRT适应症!？ 预见性－疾病演变→不良 前瞻性－治疗时机→早期 国内目前市售CRRT机 理想的CRRT机（Ⅰ） Inexpensive / user friendly / flexible Accurate / dedicated pumps Accurate scales Blood flows 5-500mls/min increments of 5 ml/min Continuous independent flow measurements Server controlled Thermoregulation Full range of safety features 理想的CRRT机（ Ⅱ） Safety features Audible / visual alarms with over-ride Air / clot detectors Blood leak detectors Continuous display of circuit pressures Continuous Uf urea concentration Continuous circuit Hct Minimal alarms - maximum patient safety 理想的CRRT机（ Ⅲ） The Ideal Circuit for CRRT Minimal priming volume / low resistance Easy priming / recirculation procedure Exchangeable components Biocompatible Non inflammatory Hemodynamic stability Non thrombogenic CRRT机技术参数 血液参数 血流量及范围 QB（ml/min) 体液参数 体外液 透析液流速 QD(ml/h) , 与小分子清除效率相关 体内液 置换液流速 QE(ml/h), 决定治疗效率, 尤中、大分子清除 净超滤率 QR(ml/h), 决定治疗时间 平衡系统称重范围 应能达20Kg以上 Clinical Forms for CRRT CVVH conventional, spc. acute on acute pts. CVVHD conventional, acute on chronic pts. SCUF spc. heavy edema pts. with HF…… CVVHFD recent Tech., spc. the critical pts. in ICU CVVHDF a little,complex,expensive Plasmapheresis PA,PE,PS…… CRRT Dialyser High-flux ( Kuf 20 ml/mmHg/hr ) Filter Replacement /Dialysate Fluid for CRRT 市售 自配 On-lin