CRRT医学知识基础.pptxVIP

2024/3/311CRRT(连续性肾替代治疗〕

ContinuousRenalReplacementTherapiesTechnicalandPracticalAspects技术原理与临床应用

2024/3/312普通血液净化治疗

2024/3/313ICU的治疗环境

2024/3/314内容1根底理论2开始治疗3应用4管理

2024/3/315根底理论

2024/3/316ICU中CRRT指征急性肾损伤，尤其是伴有血流动力学不稳定，高代谢，多脏器衰竭等的病例利尿剂抵抗的水钠潴留需要全静脉营养但伴有少尿或无尿钾代谢异常钠代谢异常去除毒素及炎症介质(内毒素、前列腺素、白介素等)

2024/3/3171977 Krameretal.Reportforthefirsttimeoncontinuousarterio-venoushemofiltration(CAVH)1981 Bischoffdevelopsapump-drivenprocedureascontinuousveno-venoushemofiltration(CVVH)1985 Geronemusfurtherdevelopscontinuousarterio-venoushemodialysis(CAVHD)1987 Uldallintroducescontinuousveno-venoushemodialysis(CVVHD)历史回忆

2024/3/318CRRT持续不卧床腹膜透析(CAPD)持续循环腹膜透析(CCPD)连续缓慢超滤(SCUF)连续动静脉血滤(CAVH)连续动静脉血液透析(CAVHD)连续动静脉血液透析滤过(CAVHDF)连续静静脉血液滤过(CVVH)连续静静脉血液透析(CVVHD)连续静静脉高流量血液透析(CVVHFD)连续静静脉血液透析滤过(CVVHDF)腹膜透析(IPD)血液灌流(HP)血液浓缩血浆治疗(PEX,PAP)血液透析(HD)血液滤过(HF)血液透析滤过(HDF)连续治疗间歇治疗ICU中血液净化技术

2024/3/319H2OwatersolublemoleculesFmmHgmmHgBBBDBDmmHgBmmHgDBDlow-fluxhigh-fluxhigh-flux弥散弥散/对流吸附HDHFHDF对流吸附不同治疗模式的物质去除(1)

弥散－Diffusion

对流－Convection

吸附－Adsorption

2024/3/31130408012010102103104105ureacreatinineVit.B12?2-Malbumineclearanceml/minMWdaltonHFHDHDFKidneyCut-offIL-1TNF不同治疗模式的物质去除(2)IL-6IL-8

2024/3/3114AVheparinUFhigh-fluxCAVHContinuousarterio-venoushemofiltration

肝素血路管动脉端PV静脉压监测PA动脉压检测UF超滤液R置换液BLD漏血监测SAD气泡检测加热器高通滤器连续性静静脉血液滤过CVVHContinuousVeno-VenousHemofiltration血泵血路管静脉端←－－－－－－－－－－

连续性静静脉血液透析CVVHD

ContinuousVeno-VenousHemodialysisPV静脉压力检测PA动脉压力检测BLD漏血监测SAD气泡检测加热器高通滤器肝素D透析液血泵D＋UF透析液超滤液血路管动脉端血路管静脉端

连续性静静脉高通量血液透析，CVVHFD

continuousveno-venoushighfluxdialysis

PV静脉压力检测PA动脉压力检测BLD漏血监测SAD气泡检测加热器高通滤器血路管动脉端肝素D透析液血泵D＋UF透析液超滤液血路管静脉端

连续性静静脉血液透析滤过CVVHDFContinuousVeno-VenousHemodiafiltration血路管静脉端PV静脉压监测PA动脉压检测R置换液BLD漏血监测SAD气泡检测加热器高通滤器血路管动脉端肝素←－－－－－－－－加热器D＋UF透析液超滤液D透析液血泵

缓慢持续血液滤过SCUFSlowContinuousUltrafiltrationBLD漏血监测高通滤器血路管静脉端PV静脉压监测SAD气泡检测PA动脉压检测肝素UF超滤液血泵血路管动脉端

2024/3/3120CVVHFD的治疗机制

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