CRRT治疗剂量课件.ppt

CRRT治疗剂量;CRRT概念;肾脏替代治疗 vs. 肾脏;超 滤;CRRT溶质清除机制;超滤率（UFR);滤过分数(FF);高通量滤器;超滤率的影响因素：TMP;超滤率的影响因素: 滤过分数;对流清除率;不同溶质的筛选系数;对流的清除与超滤量明显相关;什么是CRRT治疗剂量？;Effluent flow is commonly used as a measure of the “Dose” of renal replacement therapy administered and is reported as the effluent flow rate in milliliters per kilogram of body weight per hour.;治疗剂量通常是用单位公斤体重单位时间废液量来表示，单位为 ml/ kg.h ;Effect of different doses in continuous veno venous hemofiltration on outcomes of acute renal failure. ;;;CRRT治疗剂量;Summary of HVHF;Palevsky et al, NEJM 2008; 349: 7-20;NEJM 2009; 361: 1627-38;Prospective RCT, 18 ICUs in France, Belgium, Netherlands. 140 critically ill patients with septic shock and AKI for less than 24 h Patients randomized to receive high-volume (HVHF) with 70 mL/kg/h or standard-volume CVVH (SVHF) with 35 mL/kg/h for 96 h. Trial was stopped prematurely after enrolment of 140 patients (slow patient accrual and resources no longer being available);Nature Reviews Nephrology 2010; 6: 191;高容量血液滤过的弊端;目前CRRT剂量的共识;目前CRRT剂量的共识;CVVH后稀释UFR的计算;CVVH后稀释FF的计算;CVVH后稀释一定UFR,FF30%的血流速;CVVH前稀释UFR的计算;CVVH前稀释FF的计算;血流速率对前稀释CVVH中清除率的影响;CVVH前后稀释的比较;CVVH前稀+后稀UFR的计算; FF=(后稀置换液+每小时负平衡) /[60×BFR×(1-HCT)] FF=2100/[60×150×(1-30%)] =0.333 ;病例分析1;CVVH后稀释UFR计算;CVVH后稀释FF计算;如何调整;要使UFR达到35ml/kg.h需将置换液调到多少;CVVH后稀释FF计算;调整方案;病例分析2;CVVH前稀+后稀UFR计算;CVVH前稀+后稀FF计算;病例分析2;治疗剂量计算;总 结;