crrt發(fā)展及應(yīng)用

1、連續(xù)腎臟替代治療應(yīng)用的技術(shù)及實(shí)踐前景,連續(xù)腎臟替代治療,CRRT,ICU的適應(yīng)癥,CRRT,作為合并諸如休克，心性和非心性肺水腫，血液動力學(xué)不穩(wěn)定，出血，高代謝等并發(fā)癥的多臟器衰竭一部分的急性腎功能衰竭抗利尿的液體超負(fù)荷無或少尿癥的腸外營養(yǎng)高鉀血癥高鈉血癥清除毒素和介質(zhì)（內(nèi)毒素，前列腺素，白細(xì)胞介素等）,1977 Kramer 等 第一次報道連續(xù)動-靜脈血液濾過 (CAVH)1981 Bischoff 開發(fā)在連續(xù)靜-靜

2、脈血液濾過中應(yīng)用泵驅(qū)動血液的方法 (CVVH)1985 Geronemus進(jìn)一步發(fā)明 了連續(xù)動-靜脈血液透析 (CAVHD)1987 Uldall引入連續(xù)靜-靜脈血液透析 (CVVHD),Historical Overview,間斷腹膜透析 (IPD)血液灌流 (HP)血液濃縮血漿分離血液透析 (HD)血液濾過(HF)血液透析濾過 (HDF),CRRT,連續(xù)腹膜透析 (CAPD)連續(xù)循環(huán)腹膜透析 (CCPD)緩慢

3、持續(xù)超濾 (SCUF)連續(xù)動-靜脈血液濾過 (CAVH)連續(xù)動-靜脈血液透析 (CAVHD)連續(xù)動-靜脈血液透析濾過 (CAVHDF)連續(xù)靜-靜脈血液濾過 (CVVH)連續(xù)靜-靜脈血液透析 (CVVHD)連續(xù)靜-靜脈高流量透析 (CVVHFD)連續(xù)動-靜脈血液透析濾過 (CVVHDF),Blood Purification Procedures in ICU,連續(xù)治療,間斷治療,,Complications,Complic

4、ations,連續(xù)治療,間斷治療,Dialysis Treatment,HF,,,,,,,血液,HD,,,,,,,,,,,血液,,,透析液,,,,,,,,血液,,D,HDF,,,,,,mmHg,血液,,血液,,D,,,低流量濾器,高流量濾器,高流量濾器,diffusion,convection,diffusion/convection,HF,HD,HDF,腎臟,,CAVH,A,,V,,,,,,高流量,CAVH,,,,A,,V,,,,,,

5、高流量,CAVHD,A,,V,,,,,,,,,透析液超濾液,,,透析 液,低流量,CAVHDF,,,,,,,A,,V,,,,,透析液超濾液,,高流量,SCUF,,,V,,V,PV,,,,高流量,CVVHD,,,V,,V,,PV,PA,,,,,低流量,,,肝素,CVVH,,,V,,V,PV,PA,,,,高流量,CVVHFD,,,V,,V,,PV,PA,,,,,高流量,,,CVVHDF,,,V,,V,PV,PA,,,,,高流量,CVV

6、HD,,,V,,V,,PV,PA,,,,,,,低流量,CVVH,,,,V,,V,,PV,PA,,,,,,高流量,CVVHFD,,,V,,V,,PV,PA,,,,,,,高流量,CVVHDF,,,,V,,V,,PV,PA,,,,,,,高流量,Replacement Solution,Bicarbonate Solution,,E‘lytes,Na+-Bicarbonate,,,,置換液,加熱器,,肝素,,,V,,V,,PV,PA,,,,超

7、濾 液,,,,BLD,,SAD,,,Postdilution,Predilution,Filter? Substitution?,Heparinisation in CRRT,Anticoagulation in CRRT,Monitoring,體外循環(huán)治療開始每4小時檢測一次PTT/ACT直至“狀態(tài)穩(wěn)定”!!,Drug Monitoring,分子量蛋白結(jié)合分布容積內(nèi)生清除率,Which System?,Filtrabilit