持续血液净化从肾脏替到多脏器功能支持的演变 ppt课件.ppt

* 可随时清除过多的液体 * 可随时清除过多的液体 * 可随时清除过多的液体 * 可随时清除过多的液体 -Landmark study by Ronco in a single-centre randomised trial: survival at 15 days was improved by increasing CRRT dose from 20 to 35 ml/Kg/hr -Concern about this study: Unblined single-centre, took 5-years to complete Sepsis contribute to 15% vs 50-60% incidence worldwide Cost assoc with intensifying the therapy and it is post-dilution technique Small sample size ( 425 patients) * * 可随时清除过多的液体 Very high volues are difficult to maintain over 24 hours Solute kinetics may render high volme useless after few hours Standard CVVH may contribute to maintain the effect of Pulse Sudden changes are cchievable without post treatment rebound 极高容量很难维持24小时以上溶质动力学可能会导致高容量在数小时后失效标准CVVH治疗可能有助于维持脉冲效应 突然变化是不会引起治疗后反跳 * * 可随时清除过多的液体 * -Blood is perfused through column which filled up with Polymyxin B that unites strongly with endotoxin. Endotoxins are toxins produced by Gram-negative bacteria and one of causative agents which induces Sepsis and Multiple Organ Failure by infection. After the therapy, blood pressure, the cardiac output, oxygenecity and more are improved. This therapy is applicable to an Endotoxemia, septic shock and serious infectious diseases doubted as the Gram-negative bacterium infection. （PMX-DHP: Polymyxin B immobilized fiber Direct Hemo-Perfusion） -64 patients from 10 Italian ICU -Underwent emergency OT for intra-abd sepsis -Treated with 2 sessions ( 2hrs each) of direct hemoperfusion with polymyxin (5mg polymyxin per gram polystyrene fiber) -First session within 24 hrs and the second session 24 hrs after after first session 实施CBP的时机? 肾脏疾病：不应等到肾衰才开始治疗，过迟开始CBP治疗会而影响患者的最终疗效 一般的指标：BUN、Cr浓度升高，高钾，酸中毒，液体过载等 肾外疾病：只要有一个重要器官功能出现严重损害，或严重代谢紊乱就可以开始CBP。提早开始CBP治疗，可能成为预防器官衰竭发生的手段，可能对整体病人的存活率有提高作用 Karvellas, et al. Critical Care, 2011; 15: R72 结论：对重症患者中的AKI更早开始RRT治疗， 可能有益于患者的存活 在进行CBP的同时，是否进行了有效的病因治疗 这是决定患者存亡的关键因素 CBP模式及相关参数的选择是否得当 CBP开始的时间：由什么决定？ CBP治疗的剂量：常规剂量，脓毒症剂量？ CBP模式的选择：单一，脉冲，还是杂合？ 滤器膜的性质：高通