血液净化进展ppt课件

江苏省人民医院 肾内科 Xing ChangyingXing Changying Department of NephrologyDepartment of Nephrology Jiangsu Province HospitalJiangsu Province Hospital Nanjing Medical UniversityNanjing Medical University Blood PurificationBlood Purification (2005-03-08)(2005-03-08) 江苏省人民医院 肾内科 1. 1. DefinitionDefinition 2. 2. Category & PrincipleCategory & Principle 3. 3. IndicationIndication 4. 4. Procedure of HDProcedure of HD 5. 5. ComplicationComplication 江苏省人民医院 肾内科 DefinitionDefinition 1. 1. Artificial EquipmentsArtificial Equipments 2. 2. Remove waste or bad materialsRemove waste or bad materials 3. 3. Supply useful materialsSupply useful materials 4. 4. Keep balanceKeep balance 江苏省人民医院 肾内科 1. 1. Hemodialysis (HD) Hemodialysis (HD) 血液透析血液透析 2. 2. Peritoneal Dialysis (PD) Peritoneal Dialysis (PD) 腹膜透析腹膜透析 3. 3. Continuous Renal Replacement Continuous Renal Replacement Therapy (CRRT)Therapy (CRRT)连续性肾替代疗法连续性肾替代疗法 4. 4. Plasma Exchange (PE) Plasma Exchange (PE) 血浆置换血浆置换 5. 5. HemoperfusionHemoperfusion (HP) (HP) 血液灌流血液灌流 6. 6. Lipid Separation Lipid Separation 血脂分离血脂分离 7. 7. Artificial Liver Artificial Liver 人工肝人工肝 CategoryCategory 江苏省人民医院 肾内科 Hemodialysis (HD) Hemodialysis (HD) 血液透析血液透析 Bicarbonate Bicarbonate Hemodialysis (BHD)Hemodialysis (BHD)血液透析血液透析 碳酸氢碳酸氢 钠血液透析钠血液透析 HemofiltrationHemofiltration（HF)HF) 血液滤过血液滤过 HemodiafiltrationHemodiafiltration (HDF) (HDF) 血液透析滤过血液透析滤过 Low-Flux Hemodialysis (LFD) Low-Flux Hemodialysis (LFD) 低流率血液透析低流率血液透析 High-Flux HemodialysisHigh-Flux Hemodialysis（HFD) HFD) 高流率血液透析高流率血液透析 On-line On-line HemodiafiltrationHemodiafiltration 联机血液透析滤过联机血液透析滤过 Single Single UltrafiltrationUltrafiltration 单纯超滤单纯超滤 CategoryCategory 江苏省人民医院 肾内科 江苏省人民医院 肾内科 江苏省人民医院 肾内科 DialyzersDialyzers PrinciplePrinciple 江苏省人民医院 肾内科 DialyzerDialyzer PrinciplePrinciple 江苏省人民医院 肾内科 DialyzerDialyzer PrinciplePrinciple 江苏省人民医院 肾内科 1. 1. DiffuseDiffuse 2. 2. ConvectionConvection 3. 3. AdsorptionAdsorption PrinciplePrinciple 江苏省人民医院 肾内科 Hemodialysis (HD) Hemodialysis (HD) 血液透析血液透析 Bicarbonate Bicarbonate Hemodialysis (BHD)Hemodialysis (BHD)血液透析血液透析 碳酸氢碳酸氢 钠血液透析钠血液透析 HemofiltrationHemofiltration（HF)HF) 血液滤过血液滤过 HemodiafiltrationHemodiafiltration (HDF) (HDF) 血液透析滤过血液透析滤过 Low-Flux Hemodialysis (LFD) Low-Flux Hemodialysis (LFD) 低流率血液透析低流率血液透析 High-Flux HemodialysisHigh-Flux Hemodialysis（HFD) HFD) 高流率血液透析高流率血液透析 On-line On-line HemodiafiltrationHemodiafiltration 联机血液透析滤过联机血液透析滤过 Single Single UltrafiltrationUltrafiltration 单纯超滤单纯超滤 CategoryCategory 江苏省人民医院 肾内科 Prepare dialysis machinePrepare dialysis machine PatientsPatients AcupunctureAcupuncture Connect tubeConnect tube AnticoagulateAnticoagulate Start pumpStart pump ObserveObserve EndEnd Procedure of HD 江苏省人民医院 肾内科 Procedure of HD Procedure of HD dialysis machinedialysis machine 江苏省人民医院 肾内科 Procedure of HD Procedure of HD water supplimentwater suppliment 江苏省人民医院 肾内科 Procedure of HDProcedure of HD dialysatedialysate 成成 分分 透析液配方（透析液配方（mmol/Lmmol/L） I II III 35 I II III 35倍稀倍稀释释释释液液 钠钠钠钠 钾钾钾钾 钙钙钙钙 镁镁镁镁 氯氯氯氯 碳酸碳酸 氢氢氢氢 根根 醋酸醋酸 盐盐盐盐 葡萄葡萄 糖糖 渗透渗透 浓浓浓浓 度度 142.0 135.0 140.2 132.0 142.0 135.0 140.2 132.0 2.0 2.0 2.0 1.3 2.0 2.0 2.0 1.3 0.25 1.25 1.88 2.2 0.25 1.25 1.88 2.2 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 121.0 111.0 108.0 100.0 121.0 111.0 108.0 100.0 30.0 8.3 30.0 8.3 33.0 29.3 40.0 33.0 29.3 40.0 11.1 11.1 11.1 10.0 11.1 11.1 11.1 10.0 307.9 293.9 301.3 285.2 307.9 293.9 301.3 285.2 江苏省人民医院 肾内科 Times of HDTimes of HD 1. 1. 45 hours per time45 hours per time 2. 2. 3 times per WEEK3 times per WEEK 3. 3. CRRT 8 to 24 hoursCRRT 8 to 24 hours 4. 4. PE, HP 24 hoursPE, HP 24 hours 江苏省人民医院 肾内科 Continuous Renal Replacement Therapy Continuous Renal Replacement Therapy (CRRT)(CRRT)连续性肾替代疗法连续性肾替代疗法 CategoryCategory 江苏省人民医院 肾内科 Continuous Renal Replacement Therapy (CRRT)Continuous Renal Replacement Therapy (CRRT) 连续性肾替代疗法连续性肾替代疗法 Continuous Arteriovenous HemofiltrationContinuous Arteriovenous Hemofiltration ( (CAVHCAVH) ) 连续性连续性动动静脉血液滤过静脉血液滤过 Continuous Continuous VenoVenoVenous Hemofiltration Venous Hemofiltration （ CVVH)CVVH)连续性连续性静静- -静脉血液静脉血液滤过滤过 Continuous Veno-Venous HemodiafiltrationContinuous Veno-Venous Hemodiafiltration (CVVHDF)(CVVHDF)连续性静连续性静- -静脉血液静脉血液透析滤过透析滤过 Continuous Continuous VenoVeno-Venous Hemodialysis -Venous Hemodialysis (CVVHD)(CVVHD)连续性静连续性静- -静脉血液静脉血液透析透析 Slow continuous Slow continuous ultrafiltrationultrafiltration Indication: Indication: Multiple Organ Dysfunction Multiple Organ Dysfunction SyndromeSyndrome CategoryCategory 江苏省人民医院 肾内科 Continuous Renal Replacement Therapy Continuous Renal Replacement Therapy (CRRT)(CRRT) 含链接 江苏省人民医院 肾内科ComplicationsComplications 1. 1. HypotensionHypotension/hypertens/hypertens ionion 2. 2. CrampsCramps 3. 3. Febrile reactionsFebrile reactions 4. 4. ArrhythmiaArrhythmia 5. 5. HemolysisHemolysis 6. 6. HypoxemiaHypoxemia 7. 7. BleedingBleeding 8. 8. Electrolyte Electrolyte abnormalitiesabnormalities 9. 9. DysequilibriumDysequilibrium syndromesyndrome 1. 1. Electrolyte abnormalitiesElectrolyte abnormalities 2. 2. AnemiaAnemia 3. 3. Hypertension/hHypertension/hypotensionypotension 4. 4. Renal Renal osteodystrophyosteodystrophy 5. 5. HypercalcemiaHypercalcemia 6. 6. Dialysis Dialysis amyloidamyloid syndrome syndrome 7. 7. HyperlipidemiaHyperlipidemia 8. 8. Aluminum toxicityAluminum toxicity 9. 9. Cardiac dysfunctionCardiac dysfunction 10.10. InfectionInfection Acute ChronicAcute Chronic 江苏省人民医院 肾内科 Peritoneal Dialysis (PD)Peritoneal Dialysis (PD)腹膜透析腹膜透析 Intermediate peritoneal dialysis (IPD) Intermediate peritoneal dialysis (IPD) 间隙性腹膜透析间隙性腹膜透析 continuous ambulatory peritoneal continuous ambulatory peritoneal dialysis (CAPD) dialysis (CAPD) 连续性非卧床腹膜透析连续性非卧床腹膜透析 automated peritoneal dialysis (APD ) automated peritoneal dialysis (APD ) 自动腹膜透析自动腹膜透析 tidal tidal peritoneal dialysis (TPD) peritoneal dial