连续性肾替代治疗CRRT.ppt

* There are a number of key scientific principles used to accomplish the goals of CRRT. They are listed here and before we discuss the individual therapies, I would like to review them. Understanding the principles of diffusion, ultrafiltration, convection and adsorption will clarify which therapy will best produce the desired outcome whether used alone or in combination. * This slide illustrates the process of ultrafiltration. We now have two cups of fluid. Each cup contains two compartments separated by a semipermeable membrane. The cup on the left illustrates how the exertion of a positive pressure on the left compartment will PUSH fluid from that compartment to the one on the right. Similarly, looking at the cup on the right side of the slide, a negative pressure applied to the right compartment will PULL fluid from the compartment on the left into that on the right. How does this work in continuous therapies? * To illustrate the principle of diffusion, picture a cup of water as seen here on the slide. In the cup on the left, a quantity of salt is poured. The salt gradually diffuses through the water from the high salt concentration area to the low salt concentration area until it is evenly distributed. A uniformly salty solution is created as seen in the cup on the right. * To illustrate convection, we go back to the use of the cups. The cup now has a concentrated solution on one side of the semipermeable membrane. As fluid moves (by ultrafiltration), solutes small enough to pass through the pores of the membrane move along with the fluid. Change in blood concentration of a specific solute is dependent on the fluid volume removed. * ，其优点为连续性治疗，可缓慢、等渗地清除水和 溶质，容量波动小，净超滤率明显低，胶体渗透压变化程度 小，基本无输液限制，能随时调整液体平衡，从而一般对血流 动力学影响较小，更符合生理情况 连续性治疗，可缓慢、等渗地清除水和 溶质，容量波动小，净超滤率明显低，胶体渗透压变化程度 小，基本无输液限制，能随时调整液体平衡，从而一般对血流 动力学影响较小，更符合生理情况 * * 易出现气胸、血胸、臂丛神经损伤等。 包括： 血流速度 置换途径 置换液流量 超滤率 超滤量 置换液的配置 抗凝 监测方案 治疗处方 例1： 王某，女，87岁，诊断：1、肺部感染 感染性休克 2、肾功能不全 尿毒症 3、冠心病 心功能不全