【持续性肾脏替代治疗CRRT英文精品课件】Continuous Renal Replacement Therapy(51p).pptVIP

下载本文档

3
0
约1.09万字
约 51页
2018-06-06 发布于浙江
举报
版权申诉

【持续性肾脏替代治疗CRRT英文精品课件】Continuous Renal Replacement Therapy(51p).ppt

1、原创力文档（book118）网站文档一经付费（服务费），不意味着购买了该文档的版权，仅供个人/单位学习、研究之用，不得用于商业用途，未经授权，严禁复制、发行、汇编、翻译或者网络传播等，侵权必究。。
2、本站所有内容均由合作方或网友上传，本站不对文档的完整性、权威性及其观点立场正确性做任何保证或承诺！文档内容仅供研究参考，付费前请自行鉴别。如您付费，意味着您自己接受本站规则且自行承担风险，本站不退款、不进行额外附加服务；查看《如何避免下载的几个坑》。如果您已付费下载过本站文档，您可以点击这里二次下载。
3、如文档侵犯商业秘密、侵犯著作权、侵犯人身权等，请点击“版权申诉”（推荐），也可以打举报电话：400-050-0827(电话支持时间：9:00-18:30)。
4、该文档为VIP文档，如果想要下载，成为VIP会员后，下载免费。
5、成为VIP后，下载本文档将扣除1次下载权益。下载后，不支持退款、换文档。如有疑问请联系我们。
6、成为VIP后，您将拥有八大权益，权益包括：VIP文档下载权益、阅读免打扰、文档格式转换、高级专利检索、专属身份标志、高级客服、多端互通、版权登记。
7、VIP文档为合作方或网友上传，每下载1次，网站将根据用户上传文档的质量评分、类型等，对文档贡献者给予高额补贴、流量扶持。如果你也想贡献VIP文档。上传文档

【持续性肾脏替代治疗CRRT英文精品课件】Continuous Renal Replacement Therapy(51p)

Continuous Renal Replacement Therapy Annual Refresher Course in CRITICAL CARE McGill Course Director: Peter Goldberg, MD Didier Payen CC Division Dept of Anesthesiology 13/4/2000 Content Physical principles Definitions Techniques Clinical issues Supportive therapy or active therapy? Sepsis an example Why? How? For what goal? PHYSICAL PRINCIPLES DEFINITIONS DEFINITIONSBELLOMO et al. Am J Kidney Dis, 28, (Suppl 3) 1996 SCUF: Use only for fluid control in overhydrated status CVVH:The ultrafiltrate produced during membrane transit is replaced in part or completely to achieve blood purification and volume control. UF is in excess if weight loss is mandatory: clearance of solutes equals UF CVVHD: continuous hemodialysis. + countercurrent flow of dialysis solution. Both diffusion convection Efficiency is limited to small molecules (low Perm filter) CVVHDF: same. Both diffusion convection but higher dialysate flow (High Perm filter) EFFICIENCY CLINICAL ISSUES CLINICAL INDICATIONS IHD vs CRRT: no randomized trials but inferiority of IHD manisfests itself at many levels. Hemodynamic stability Hypotension, volume control Uremic control with CRRT than IHD (Clark et al JASNephrol, 1994) Metabolic control: metabolic acidosis; phosphate levels In ICU patients CRRT prevents the surge in ICP Cardiac disease restore dry body weight, improve V flow Cardiac surgical patients optimization between function and preload Sepsis and inflammatory patients CRRT AND INFLAMMATIONSepsis an example HYPOTHESIS FOR MODS PREVENTION Control of tissue edema EDTX adsorption Immunomodulation CAVH after Staph Aureus in swine(Lee PA et al; Crit Care Med 1993; 21: 914-924) Goals: 1) CAVH impact on morbidity and mortality 2) If UF contains mediators Design: prospective, randomized, controlled (n=65) Staph aureus (8 x 10 9 CFU) over 1 hr Part 1: Group 1: 5.5% plasma filtration fraction Group 2: 16.6% Group 3: 33.4%