crrt讲稿.ppt

,CRRT进展及其临床应用广东省人民医院血液净化中心梁馨苓,急性肾功能衰竭（ARF）ARF是一个临床综合征，不同病因引起肾小球滤过功能短时间内迅速下降，Ccr低于正常的50%，血BUN，肌酐迅速升高，出现急性尿毒症症状，水电解质酸碱平衡失调，或在慢性肾功能衰竭的基础上出现Ccr较基础值急剧下降15%。,50年代以前,ARF死亡率高达80-95%60年代-80年代,血液净化技术广泛应用,死亡率渐趋下降90年代,死亡率略有上升,三个脏器功能衰竭者,死亡率高达85%以上发展肾脏替代治疗的目的是降低重症ARF及危重病例的病死率,ARF死亡率高的原因,ARF原发病谱变迁单纯性ARF比例下降MODS、老年患者比例上升传统HD技术未能缩短ARF的病程及降低死亡率,肾脏替代治疗,间歇性血液透析治疗：1960-1990年持续性肾脏替代治疗：1990-2019年肾脏联合替代治疗：2019-今后肾小球替代+肾小管替代,A.R.F.,R.R.T.,M.O.S.T.,M.O.D.,M.O.R.,M.O.F.,血液透析的概念,工作原理：利用半透膜两侧离子浓度差，通过弥散作用进行溶质的交换，直到离子浓度平衡。特点：治疗时间3-4小时，间歇性治疗，血液透析机器，普通的透析膜，清除小分子物质较好（MW8mg/dL(5-10yrs)9mg/dL(10-15yrs)UremicsymptomSevermalnutrition,Introductions:Whendowestartdialysis?,Introductions:Whendowestartdialysis?,ARF:oliguria2danuria1dSerumCr50%+basisacutepulmonaryedema,infantadultWeight2.9kg70kgPeritonealSA1,512cm220,781cm2PSA/wt522cm2/kg285cm2/kg*PSA(PeritonealSurfaceArea)isproportiontoBodysurfacearea,isnotproportiontoweight,Introductions:Peritonealmembranesurfacearea,ApparatusforPD,PDCatheter,Cath,Pediatric,Adult,Tenckhoff/2cuff,30cm,32cm,37cm,41cm,42cm,47cm,Curl/2cuff,57cm,62cm,Swanneck,37.5cm,43c,56.5cm,Swanneck/curl/2cuff,38.9cm,43cm,59cm,62.5cm,*QuintonPeritonealCatheter/Kendall,IPD:1stday:Exchangevol:10-15ml/kg(300-500ml/m2)Cycletime:60mininflow:5-10minindwell:30-40minoutflow:15-20minLater,volumeandcycletimecanbeincreasedgraduallyeg.)Vol:upto600-1,400ml/m2Cycletime:2-6hr,Modalities:AcutePDprescription,Modalities:ChronicPDPrescription,CAPD(1)EarlystageVolume:800(600-1,000)ml/m24(3-5)exchanges/dayday:1.5%,x3(5hrs)night:1.5-4.25%,x1(8hrs)(2)AdaptedVolume:gradualincreaseupto900-1,200ml/m2(35-45ml/kg),2.APDModality(CCPD,NIPD,COPD.)Adequateresidualrenalfunction-NIPD-Sessionduration:8-12hr-6-8exchanges/session(0.75-2hr/cycle)-Fillvol:8001,200ml/m2-1.5%dextrose(prn:2.5%),Modalities:ChronicPDPrescription,Conclusion,Dialysisprescriptionhasbecomemoreindividuallyadaptedtoeachpatient.Theavailabilityofnewdialysissolutionsandtheincreasedu