最新血液透析治疗模式的选择及评价课件PPT文档.ppt

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1、基本原理 溶质清除机制 弥散diffusion 溶质浓度梯度成正比 溶质分子大小成反比 对流convection 随溶剂的跨膜运动而转运 溶质分子大小成反比 超滤率及筛选系数决定转运速率 吸附absorption 水份清除机制 超滤系数Kuf 跨膜压(TMP),Classification of artificial membranes used for blood purification therapy,Water permeability,Solute permeability,Biocompatibility,Material/Polymer,Regenerated cellulose

2、 Modified cellulose Synthetic,Low-fluxKuf 15 ml/mmHghr,For small solute KoA e.g.BUNScrUA For larger solute SC e.g.2-MG,Qualitative measures,1970s was on enhancing the solute diffusive and water removing properties of the membranes1980s the emphasis has been on convective transport,absorption,and bio

3、compatibility,Historical Overview,EFFICIENCYBIOCOMPATIBILITY,TechnologiesConvectionDiffusionDiffusion+Convection,MembranesModified CelluloseCelluloseSynthetic,Long-term results in haemodialysis therapy,(Relationship between membranes,technologies,efficiency and biocompatibility),CRRT,continuous ambu

4、latory peritoneal dialysis(CAPD)continuous cyclical peritoneal dialysis(CCPD)slow continuous ultrafiltration(SCUF)continuous arterio-venous hemofiltration(CAVH)continuous arterio-venous hemodialysis(CAVHD)continuous arterio-venous hemodiafiltration(CAVHDF)continuous vono-venous hemofiltration(CVVH)c

5、ontinuous vono-venous hemodialysis(CVVHD)continuous veno-venous high-flux dialysis(CVVHFD)continuous vono-venous hemodiafiltration(CVVHDF),Blood Purification Procedures,continuous,intermittent,IRRT,intermittent peritoneal dialysis(IPD)hemoperfusion(HP)hemoconcentrationplasmapheresishemodialysis(HD)h

6、emofiltration(HF)hemodiafiltration(HDF),水分迅速减少 组织器官血供障碍 血浆渗量骤然下降 血压不平稳或诱发肺水肿 生理代偿机制 加重或诱发心衰 血/膜反应 SIRS,IRRT对血流动力学影响,CRRT与IRRT比较,改善心血管稳定性 维持脑灌注 控制高分解代谢 维持水电解质和酸碱平衡 为营养支持创造条件 重症ARF已首选CRRT,HF,B,HD,B,D,B,D,HDF,mmHg,B,B,F,D,low-flux,Filter,high-flux or Filter,diffusion,convection,diffusion/convection,mmH

7、g,B,mmHg,mmHg,F,D,mmHg,mmHg,HF,HD,HDF,Kidney,104,2-MGC3a、C5aIT-1TNF,Vit.B12LipidA,BunCrUA,clearance ml/min,120,80,40,0,10,103,102,0,MWDa,105,AlbLps,Methodologies,Patient,Materials,“Ancillary”therapy,Cost,？,Factors affecting renal dialysis therapy results,A,V,PV,PA,low-flux,HD,heparin,A,V,PV,PA,high-

8、flux,HF,Predilution,Postdilution,A,V,PV,PA,high-flux,High-flux HD,V,V,PV,PA,high-flux,HDF,Postdilution,Predilution,Replacement Solution,Continuous,Intermittent,Dialysis Treatment,RRT的抗凝,低分子肝素的优势,低分子肝素1长固定高无需低小,抗 Xa:IIa 活性比值血浆半衰期清除率生物利用度需 aPTT 监测对 PF4 的敏感性对血小板抑制作用,普通肝素=1短不固定低需要高大,低分子肝素对血透中的影响,Heparin

9、isation in RRT,Complications,VC,Kd+KrC,G,堆积产生清除,摄入产生,堆积分布,其中:G-尿素产生的速率 V-体内尿素的分布容积 C-血液尿素的浓度 Kd-透析器的廓清率 Kr-残存肾功能的廓清率,清除,PCRnPCR,BUN,Kt/VURR,血液透析动力学模型综合评价,80 60 40 20 0,120100,SUN MON TUE WEN TUE FRI SAT SUN,BUN/dL,week,nPCR,KtV,TAC,Delivered:3 times/week Td4hrs U.F.0.05Wt,Targe:Kt/V1.2 nPCR1.1g/day TAC50/dL,SurvivalMorbidityNutritional StatusMetabolic AlterationsHospitalization Time,Evaluation,Long-term results in haemodialysis therapy,summary,谢！,