建立CRRT 的临床步骤.ppt

1、1,建立CRRT 的临床步骤,血管通路 滤器选择 抗凝技术 置换液配方与液体管理 药物应用,2,血管通路 Vascular Access,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-lumen catheters 1.Double -D 2.Double-O 双导管 Double-Catheters 1.Dual-Catheter 2.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 polysulfone polyacrylonitrile polyamide,T

2、he hemofiltration membrane consists of relatively straight channels of ever-increasing diameter that offer little resistance to fluid flow.,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, uric acid, sodium, potassium, ionized calcium and almost all drugs not bound to plasma proteins). 所有 C

3、VVH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 filtration fraction,滤过分数表示血液脱水的程度， filtration fraction (FF), which is the fraction of plasma water removed by ultrafiltration: FF(%) = (UFR x 100) / QP QP 为滤器血浆流量 ml/min. QP = BFR* x (1-Hct) *BFR:血流速,8,超滤率ultrafiltrate rate,FF(%) = (UFR x 100) / QP QP = BFR*

4、x (1-Hct) 例如 BFR = 100 ml/min Hct = 0.30 (i.e. 30%), QP = 70 ml/min. 滤过分数 30%滤器易凝血. 因此 the maximum allowable FF is set at 30%, a BFR of 100 ml/min yields a UFR = 21 ml/min. QP: the filter plasma flow rate in ml/min.,SIEVING COEFFICIENT,1.0,0,5600 inulin,11800 b2-m,21000 RBP,44000 orosomucoide,54000

5、a1 AT,66500 albumin,MOLECULAR WEIGHT=SOLUTE SIZE,DEFINITION:The cut-off point of a solute for any membrane is a sieving coefficient of 0.1 . This means that 10% of the molecules will pass and 90% will not pass .,0.5,60 urea,Cut-off point,O.1,筛选系数与截留分子量,10,超滤系数与膜流量,Ultrafiltration coefficient K Uf Low flux membrane : 6 ml/h.mmHg.m2 = K Uf Mid fl