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2010-7-9科内小儿crrt讲课 课件
Mobility 2010-4-21 儿科透析 HUS 体重22.5 kg 肖琪 Membrane fluxes in dialysis. Dialysis is the process of separating elements in a solution by diffusion across a semipermeable membrane (diffusive solute transport) down a concentration gradient. This is the principal process for removing the end-products of nitrogen metabolism (urea, creatinine, uric acid), and for repletion of the bicarbonate deficit of the metabolic acidosis associated with renal failure in humans. The preponderance of diffusion as the result of gradient is shown by the displacement of the arrow. Flux Measure of ultrafiltration capacity Low and high flux are based on the ultrafiltration coefficient (K uf ) Low flux: K uf 10 mL/h/mm Hg High flux: K uf 20 mL/h/mm Hg Permeability Measure of the clearance of the middle molecular weight molecule (eg, 2 -microglobulin) General correlation between flux and permeability Low permeability: 2 -microglobulin clearance 10 mL/min High permeability: 2 -microglobulin clearance 20 mL/min Efficiency Measure of urea clearance Definitions of flux, permeability, and efficiency. The urea value K o A, as conventionally defined in hemodialysis, is an estimate of the clear-ance of urea (a surrogate marker of low molecular weight uremic toxins) under conditions of infinite blood and dialysate flow rates. The following equation is used to calculate this value: Q b Q d 1-K d /Q b K o A= Q b -Q d ln 1-K d /Q d where K o = mass transfer coefficient A = surface area Q b = blood flow rate Q d = dialysate flow rate ln = natural log K d = mean of blood and dialysate side urea clearance As conventionally defined in hemodialysis, flux is the rate of water transfer across the hemodialysis membrane. Dissolved solutes are removed by convection (solvent drag effect). Effect of blood flow on clearance of various solutes, Fresenius F-5 membrane. The amount of solute cleared by a dialyzer depends on the amount delivered to the membrane. The usual blood flow is 300–400 mL/min, which is ad
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