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1、CRRT的概念與ICU應(yīng)用內(nèi)容提要CRRT的歷史CRRT的概念與基本原理CRRT的特點(diǎn)CRRT在ICU中的應(yīng)用指征CRRT在ICU中的應(yīng)用CRRTtherapyoverviewCRRT－用于ICU中ARF人工支持治療一種治療形式基本治療目標(biāo):消除體液過(guò)負(fù)荷清除廢物和炎癥因子糾正電解質(zhì)失常糾正酸堿平衡給予足夠的營(yíng)養(yǎng)支持CRRTUSEWesternEurope:200000Pts=82000Pts(41%penetration)NorthAmerica:155000Pts=29450Pts(19%pe
2、netration)Canada:11000Pts=4510Pts(41%penetration)Asia:80000Pts=14400Pts(18%penetration)Autralia:14000Pts=4900Pts(35%penetration)Japan:80000Pts=11200Pts(14%penetration)Row:75000Pts=16500Pts(22%penetration)LatinAmerica:40000Pts=2800Pts(7%penetration)200
3、3(195000pts):33%Total:650000PtsARFaredialysedofwhich165000ptsbyCRRT2000(AverageCRRTpenetration:25%)CRRTARF的一種主要治療選擇??AcuteRenalFailure治療選擇:藥物治療(fluids,diuretics)IntermittentHemodialysis(IHD)腹膜透析PeritonealDialysisContinuousRenalReplacementTherapies(CRR
4、T)CRRT在急性腎衰之外的適應(yīng)癥慢性心衰和水負(fù)荷過(guò)多多臟衰(MOF)ARDS燒傷的病人肝衰竭Sepsis內(nèi)容提要CRRT的歷史CRRT的概念與基本原理CRRT的特點(diǎn)CRRT在ICU中的應(yīng)用指征CRRT在ICU中的應(yīng)用CRRT水和溶質(zhì)清除原理超濾Ultrafiltration彌散Diffusion對(duì)流Convection吸附AdsorptionHollowfibrestructureFiltrateoutletFiltratecompartmentBloodinletHousingmaterial
5、PolycarbonateBloodInlet超濾UltrafiltrationPositivePressureNegativePressureOsmoticPressureBloodMembraneFiltrate??Convection????SCUF??SoluteMovementSmallmoleculeLargemoleculeBloodMembraneFiltrateDiffusion紅細(xì)胞RedBloodcell碳酸氫鹽Bicarbonate肌肝Créatinine氯Chlorure
6、鉀Potassium尿素UreaBloodMembraneFiltrateAssociatedwith??Dialysate??彌散Diffusion溶質(zhì)從高濃度(Blood)向低濃度(Dialysate)移動(dòng)對(duì)清除小分子物質(zhì)非常有效InHemodialysis….BFRdependentInCRRT….DialysateFlowDependentefficientforremovingsmallmolecules小分子物質(zhì)血液濃度高膜內(nèi)外濃度差大小分子物質(zhì)易于擴(kuò)散相同膜對(duì)小分子物質(zhì)阻力小對(duì)流Co
7、nvectionRedBloodCellBicarbonateCreatinineChlorurePotassiumUreaPositivePressureBloodMembraneFiltrateConvection溶質(zhì)伴隨水流清除，是依靠壓力梯度的溶質(zhì)拖拽適于清除大分子物質(zhì)血流速度越快，溶質(zhì)清除效果越好置換液必須是無(wú)菌的符合生理的吸附AdsorptionRedBloodcellCreatinineChlorurePotassiumUreaSangMembraneFiltrateInflamma
8、toryMediatorsSCUFCVVHCVVHDCVVHDFCRRT治療方式AccessReturnEffluentReplacement(preorpost dilution)AccessReturnEffluentAccessReturnEffluentDialysateReplacement(preor postdilution)IAccessReturnEffluentDialysate21ContinuousRenalReplacementTherapiesSCUFC
