(精选)【持续性肾脏替代治疗CRRT英文精品课件】CRRT Protocol-Continuous Renal Replacement Therapy (44p)教学课件.pptVIP

Hemofiltration withpredilution or postdilution ultrafiltrate Postdilution Predilution anticoagulant FILTRE Arterial flow Venous flow Predilution : Injection before the filter Postdilution : Injection after the filter Double lumen : Re-circulation rate 250cc/min blood flow Subclavian , internal jugular vein 3% Catheter length Femoral vein 24cm : 10% 15cm : 18% 400 c.c/min blood flow 38% in the femoral vein American Journal of Kidney disease , 1996 Double lumen : Re-circulation rate 298 c.c/min blood flow Femoral vs Subclavian : 16.1% vs 4.1% Femoral cath 13.5 cm vs 19.5 cm : 22.8 ±3.0% vs12.6 ±1.7% American Journal of Kidney disease, 1996 Choice of replacement fluid Acetate-Based fluids Hyperacetatemia?peripheral vasodilator, myocardial depressant effect Acetate metabolism ? ?oxygen consumption Bicarbonate-Based fluid ?SVR, ?CI Lactate-Based fluid ? lactate : ? protein catabolism ?ADP level and impair oxygen delivery and ventricular function (myocardial depression) Excessive accumulation of D-lactate ? ?IICP American Journal of Kidney disease, 1996 Effects of bicarbonate and lactate-buffered replacement fluids on cardiovascular outcome in CRRT patients Bicarbonate Replacement Fluid : recommended in patients with lactic acidemia and severe liver failure Improve cardiovascular outcome in critically ill patients with acute renal failure International Society of Nephrology 2000 CRRT ProtocolContinuous Renal Replacement Therapy 台大外科部 護理師 蔡壁如 Outline History Indication CRRT Method Ultrafiltration rates Choice of replacement fluid Set-up protocol 1861 Thomas Graham, etc. use a semi-permeable membrane to diffuse urea 1924 George Haas dialyse a patient during 15 minutes 1927 Heparin,an anticoagulant, is available 1937 Production of cellophane for filters 1943 Willem Kolff makes a rotating drum dialyser 1970 First artificial membrane 1975-1985 Development of new techniques, i.e. adsorption, plas