【持续性肾脏替代治疗CRRT英文ppt课件】Renal Replacement Therapy in Perioperative Medicine.pptVIP

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【持续性肾脏替代治疗CRRT英文ppt课件】Renal Replacement Therapy in Perioperative Medicine.ppt

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【持续性肾脏替代治疗CRRT英文ppt课件】Renal Replacement Therapy in Perioperative Medicine

代理报关委托书委托报关协议关于审理城镇房屋租赁合同纠纷案件司法解释有关劳务派遣制度设计及对劳务派遣行业的影响分析糖皮质激素在呼吸系统疾病中的合理应用严重脓毒症导致急性肺损伤病人自发利尿现象的观察分析 Renal Replacement Therapy in Perioperative Medicine ASA refresher courses 2006 Introduction The kidneys control - fluid and electrolyte balance - excretion of metabolic byproducts - production of hemoglobin - activation of vitamin D “Renal replacement therapies (RRT)” - hemodialysis + its progeny (peritoneal dialysis, continuous hemofiltration, and continuous hemodiafiltration) What is “Renal Failure”? Surprisingly, there is no universally accepted definition for renal failure Renal function is evaluated based on two separate functions 1) formation of concentrated urine 2) excretion of byproducts of protein metabolism Creatinine clearance + urinary output - renal function? ?? ??? ??? What is “Renal Failure”? Significant limitations - fluctuation with extracellular volume, metabolic rate - ??? functional reserve ??? fx? 50%? ??? ? ?? serum creatinine? ???? ?? - creatinine is actively secreted by nephron (overestimate GFR) Current criteria for the diagnosis of ARF - serum creatinine baseline? 3? ?? ?? - a 75% decrease in GFR (determined by creatinine clearance) - urinary output of less than 0.3 ml/kg per hour or anuria for 12 hours What are the indications for RRT What are the indications for RRT Processes of Renal Replacement Therapies RRT uses an artificial kidney to remove fluid (solvent) and substances dissolved in the blood (solute) Several processes are used to produce hemofiltrate, usually in combination 1. Ultrafiltration (????) 2. Convection (??, ??) 3. Diffusion (??) 4. Membrane Adsorption Processes of Renal Replacement Therapies 1. Ultrafiltration 2. Convection - solvent drag - removal of water and middle sized molecules from the blood Processes of Renal Replacement Therapies 3. Diffusion - Smaller molecules (electrolytes,