CRRT治疗容量如何控制

1、1会计学CRRT治疗容量如何控制治疗容量如何控制CVVHDFR?b=100-200ml/min; ?d=20-40ml/min; ?f=8-15ml/min透析液透析液透析液透析液+UF+UFCRRT治疗中水和溶质清除机制治疗中水和溶质清除机制水：超滤；水：超滤； 溶质：弥散、对流与吸附；溶质：弥散、对流与吸附；弥弥 散散弥散是溶质通过半透膜的一种方式弥散是溶质通过半透膜的一种方式，主要驱动主要驱动力是离子浓度梯度差；在一个限定的分布空间力是离子浓度梯度差；在一个限定的分布空间，半透膜两侧的物质有达到相同浓度的趋势。，半透膜两侧的物质有达到相同浓度的趋势。Chest 2007; 132:137

2、91388对对 流流对流是溶质通过半透膜的另一种方式，在跨对流是溶质通过半透膜的另一种方式，在跨膜压差作用下，溶质及溶剂一起通过半透膜膜压差作用下，溶质及溶剂一起通过半透膜。Chest 2007; 132:13791388CRRT水的清除机制及其相关概念水的清除机制及其相关概念Int J Artif organs.2008;31(2):145-55CVVHDFR透析液透析液透析液透析液+UF+UFCVVHRUFCRRT治疗中水和溶质清除机制治疗中水和溶质清除机制Int J Artif organs.2008;31(2):145-55CVVHD透析液透析液透析液透析液+UFCRRT治疗中水和溶质

3、清除机制治疗中水和溶质清除机制Int J Artif organs.2008;31(2):145-55CRRT水的清除机制及其相关概念水的清除机制及其相关概念Int J Artif organs.2008;31(2):145-55透析液透析液CVVHDFR透析液透析液+UF+UFCRRT水的清除机制及其相关概念水的清除机制及其相关概念Int J Artif organs.2008;31(2):145-55透析液透析液CVVHDFR透析液透析液+UF+UFInt J Artif organs.2008;31(2):145-55Fluid imbalanceExcessive positive b

4、alance(Patient fluid overload)Excessive negative balance(Hypovolemia)Insufficient fluid removalFluid gain (special case)Cumulative excessive fluid removal (Total UF)Excessive fluid removal rate (Total UF)Harm:Hazardous situation:重症患者容量失衡及其危害重症患者容量失衡及其危害Int J Artif organs.2008;31(2):145-55Kidney Inte

5、rnational.2009;76: 422427Fluid accumulation,survival and recovery of kidney function in critically ill patients with AKIKidney International.2009;76: 422427Fluid accumulation,survival and recovery of kidney function in critically ill patients with AKIKidney International.2009;76: 422427The importanc

6、e of fluid management in Acute lung injury secondary to septic shockChest.2009;136:102-109Chest.2009;136:102-109Blood Purif 2010;29:331338The importance of fluid management in Acute lung injury secondary to septic shockConclusions: Both early and late fluid management of septic shock complicated by

7、ALI can influence patient outcomes.The importance of fluid management in Acute lung injury secondary to septic shockChest.2009;136:102-109 Clinical Skin Turgor Capillary refill Venous distention Orthostasis Blood Pressure Organomegaly Pulmonary edema Urine volume Urine Osmolality Monitoring Invasive

8、 Central Venous Pressure Pulmonary Artery Pressure Cardiac Output (PAC, PICCO) Pre-Load parameters Volume responsiveness (SPV, PPV) Non-Invasive Echocardiography Bioimpedance SpectroscopyAssessment of Volume StatusCrit Care Med.2004; 32:691699Crit Care Med.2004; 32:691699Crit Care Med.2004; 32:69169

9、9Crit Care Med.2004; 32:691699Crit Care Med.2004; 32:691699Assessment of Volume StatusFluid Removal on DialysisInterstitial Space Vascular Space Refill RateDialyzerUFRCapillary Membrane interface for NDFInt J Artif organs.2008;31(2):145-55Fluid imbalanceExcessive positive balance(Patient fluid overload)Excessive negative balance(Hypovolemia)Insufficient fluid removalFluid gain (special case)Cumulative excessive fluid removal (Total UF)Excessive fluid removal rate (Total UF