建立的临床步骤.ppt

1,建立的临床步骤,2,血管通路VascularAccess,中心静脉置管股静脉颈内静脉锁骨下静脉,3,导管结构与特点,双腔导管Double-lumencatheters1.Double-D2.Double-O双导管Double-Catheters1.Dual-Catheter2.Split-Catheter,4,导管选择要点,能够提供的血流量；导管材料；导管型号价格,5,血滤器Hemofilters,种类polysulfonepolyacrylonitrilepolyamide,Thehemofiltrationmembraneconsistsofrelativelystraightchannelsofever-increasingdiameterthatofferlittleresistancetofluidflow.,6,溶质清除,血滤器可以自由清除分子量小于100道尔顿的溶质和毒素(e.g.urea,creatinine,uricacid,sodium,potassium,ionizedcalciumandalmostalldrugsnotboundtoplasmaproteins).所有CVVH血滤器不能通过白蛋白及其他超过50,000道尔顿的物质.,7,滤过分数filtrationfraction,滤过分数表示血液脱水的程度，filtrationfraction(FF),whichisthefractionofplasmawaterremovedbyultrafiltration:FF(%)=(UFRx100)/QPQP为滤器血浆流量ml/min.QP=BFR*x(1-Hct)*BFR:血流速,8,超滤率ultrafiltraterate,FF(%)=(UFRx100)/QPQP=BFR*x(1-Hct)例如BFR=100ml/minHct=0.30(i.e.30%),QP=70ml/min.滤过分数30%滤器易凝血.因此themaximumallowableFFissetat30%,aBFRof100ml/minyieldsaUFR=21ml/min.QP:thefilterplasmaflowrateinml/min.,SIEVINGCOEFFICIENT,1.0,0,5600inulin,11800b2-m,21000RBP,44000orosomucoide,54000a1AT,66500albumin,MOLECULARWEIGHT=SOLUTESIZE,DEFINITION:Thecut-offpointofasoluteforanymembraneisasievingcoefficientof0.1.Thismeansthat10%ofthemoleculeswillpassand90%willnotpass.,0.5,60urea,Cut-offpoint,O.1,筛选系数与截留分子量,10,超滤系数与膜流量,UltrafiltrationcoefficientKUfLowfluxmembrane:6ml/h.mmHg.m2=KUfMi