持续性肾脏替代治疗CRRT英文ppt课件.ppt

Azotemia Control Profiles Liao et al. Artif Organs 27:802-802 (2003) ?2M Concentration Profiles Liao et al. Artif Organs 27:802-802 (2003) 3. Dos determinanter vid olika CRRT modaliteter 1. Diffusion - Konvektion Diffusion is solute transport across a semi-permeable membrane - molecules move from an area of higher to an area of lower concentration Convection is a process where solutes pass across the semi-permeable membrane along with the solvent (“solvent drag”) in response to a positive transmembrane pressure Best for small molecule clearance Effectiveness less dependent on molecular size 2. DilutionsmodeSolute Clearance vid CVVH Post-Dilution CVVH K = S ? QUF*  Pre-Dilution CVVH K = S ? QUF ? *S = Koncentration i filtrat CE Koncentration i blod CA QBW QBW + QR ) ( ) CE CA ? QUF Blood Flow Rate Requirements in Post-Dilution CVVH: Filtration Fraction = 0.30*  Filtration Fraction = Weight (kg) 60 80 100 120 *Dose: 35 mL/hr/kg QB (Hct=0.30) 167 222 278 333 QB (Hct=0.35) 180 240 299 359 QUF QP Blood Flow Rate Requirements in Post-Dilution CVVH: Filtration Fraction = 0.40*  Filtration Fraction = Weight (kg) 60 80 100 120 *Dose: 35 mL/hr/kg QB (Hct=0.30) 125 167 208 250 QB (Hct=0.35) 135 180 224 269 QUF QP Impact of Blood Flow Rate on Clearance in Pre-Dilution CVVH  QBW + QR QBW Dilution Factor = QB (mL/min) 208 150 225 300 Assumptions: 75 kg; Hct = 0.30; dose = 35 mL/hr/kg (post) Dilution Factor Post (1.00) 0.77 0.83 0.87 KUrea (mL/min) 43.8 33.7 36.5 38.1 Qr = 35 ml/kg ? min Qbw Qbw + Qr Qb Qb + Qr ~ Blodfl?deshastighet Ultrafiltration Hematokrit Plasmaproteinkoncentration 3. Secondary membrane Boundry layer Effect of Protein Adsorption on Solute Rejection by a Polyamide Membrane Feldhoff et al, Artif Organs 8:166-192, 1984 % Rejection Log [Molecular Weight] 2000 3000 5000 10000 Plasma Saline Maltodextriner med en kontinuerlig f?rdelning molekylvikter mellan 340 och 120.000 Da Solute Clearances in High-Volum