腹膜透析初级基础.pptVIP

腹膜透析－ESRD治疗 中南大学湘雅医院 宁建平 How PD works  腹 透 原 理   What is the peritoneal membrane ? 腹膜是被覆于腹腔的光滑浆膜 脏层腹膜 壁层腹膜 腹膜凹陷 腹腔和腹膜腔 Role of the peritoneum 腹膜的功能 Protect peritoneal organs Prevent friction of moving organs Host defense mechanisms: Mesothelial cells, monocytesmacrophages, opsonins 支持、保护腹腔脏器 分泌滑液防止脏器移动时的摩擦 宿主的防御机制: 间皮细胞、单核巨噬细胞、调理素 Components of the peritoneum as a dialysis membrane 腹膜（做为透析膜）的组成 Removal of uremic toxins 尿毒症毒素清除  Small solutes Diffusion: Convective transport Middle or large solutes Peritoneal leak Diffusion 弥散 Definition: Solute movement due to concentration gradient of two solutes between components across a semi-permeable membrane Main driving force for small solute removal Factors involved in diffusion Size of solute Peritoneal surface area Hydrostatic pressure Electrical charge of solutes 定义: 溶质依靠溶液之间浓度梯度透过半透膜（腹膜）进行的转运 弥散是小分子溶质清除的主要机制 影响弥散的因素 溶质分子的大小 腹膜表面积 静水压 溶质的电负荷 Convective transport  对流转运 Solute transport along with fluid movement High during active ultrafiltration Terms used in convective transport Sieving coefficient: Ratio of solute being passed the barrier Reflection coefficient Ratio of solute being rejected by the barrier Sieving coefficient=1-reflection coefficient Factors involved in convective transport Size of solute Electrical charge of solutes 腹膜转运机理 小分子依靠弥散作用从毛细血管进入腹膜间质，再进入透析液中 透析液中的葡萄糖借助弥散作用从腹腔进入腹膜间质，加上弥散出来的小分子，使间质晶体渗透压升高，对毛细血管内水分形成超滤，水就从毛细血管移出； 毛细血管中水分的超滤对毛细血管中大分子又产生对流作用，大分子就进入间质，使局部胶体渗透压升高，水被进一步超滤，这样，水和大分子然后分别进入透析液当中； 葡萄糖不断进入间质和毛细血管使渗透梯度下降，水的超滤下降。 通过上述过程，毛细血管内的水被超滤出来，小分子和大分子毒素通过弥散和对流作用也被排出，从而实现水和毒素的清除，同时伴随着透析液葡萄糖被机体摄入。 PET: Protocol  PET：操作程序 1. Drain for at least 20min, ideally after an 8- to 12-hour overnight dwell using 2L of 2.5% dextrose solution 2. Weigh 2-L bag of warmed 2.5% dextrose solution 3. Infuse over 10min(at a rate of 200 ml/min). After each 400-ml infused, roll the patient from side to side. 4