课件：CRR技术进展forresiden协和.ppt

* Comparison of IHD and CRRTIf you think about it, we are very familiar with intermittent dialysis where using variable permeable membranes you are used to using blood flow rates which are less than the dialysate flow rates. As a consequence, the dialysate never gets saturated. The ultrafiltration rates depend upon what you are trying to achieve, but it is from 0 to 2 liters per hour. The dialysate base has 4 mg of acetate and 35 mg of bicarbonate per liter. There is no substitution fluid. You do this procedure over a few hours. The major force is diffusion with urea clearances of 180 to 200 ml/min. In contrast, amongst the CRRT techniques, one has to recognize that the operational characteristics will largely determine what you are going to see. If you use a hemofiltration technique, the only force for removing things is convection. As a consequence, it is the amount and composition of the substitution fluid which will influence your overall metabolic status. When you use a hemodialysis technique, such as CVVHD, diffusion is the main force; however, notice that the blood flow rate is significantly higher than your dialysate flow rate. As a consequence, your dialysate is saturated. And here most of the solutions used have been lactate, bicarbonate, or you can use citrate to provide the base. When you use a combination technique (such as CVV-HDF), you use both diffusion and convection in this method. * 增加血流量或Qf 可以提高小分子溶质的清除率 前稀释HDF容易达到较高的Qf，但联机HDF的置换液是从透析液中分流而出，过高的Qf虽可增加溶质对流清除率，但同时导致弥散清除率的减少。 * CVVH solute clearance and dialysate flowYou can see again the ratios for urea, creatinine, and phosphate all are relatively close to ...the ratios are relatively close to one, although there is a deviation. There is a splay here, as you can see. The larger the molecular weight species, the slightly lower the clearance will be. And beta-2 microglobulin, as a very large molecular weight species, has a markedly lower clearance. This is data from Brunet et. al. * U