CRRT儿科应用与管理-20120606-陆国平.pptVIP

份子量 (大小) 清除率、分子大小、液体流速 该技术在儿童PICU属于新兴技术 部分单位仍然认为需要肾脏科完成 设备采购困难 设备和耗材在国内的供应严重受限 在新生儿开展的担忧和经验不足 CRRT在ARDS中的作用 CRRT缓慢、等张排除液体，较好的血液动力学耐受性，清除一些不利的神经体液因子，清除心肌抑制因子 Canand等对52例充血性心力衰竭，心功能Ⅳ级，肾功能正常患者，行静-静脉缓慢连续超滤（VVSCUF）取得了良好疗效。 对常规治疗无效的CHF患者，CRRT不失为一个良好的治疗方法。 CRRT in Infants and Children Vascular access Internal Jugular Vein (right side) Femoral Vein Subclavian Vein Catheters 6 months 4-5 F Single lumen 6-12 months 6.5-7.5 F Double lumen 1-3 years 8.5-9 F Double lumen 3 years 9-11 F Double lumen CRRT in infants and children Blood flow Neonates Infants Children 20kg Children 20kg ml/min 10 - 20 20 - 40 50 - 75 75 - 100 CRRT in Infants and Children Dialysate flow In acute renal failure Neonates 15-20 ml/min/m2BSA(*) Infants 15-20 ml/min/m2BSA Children 15-20 ml/min/m2BSA In Multiple organ system failure Neonates 15-20 ml/min/m2BSA Infants 15-20 ml/min/m2BSA Children 15-20 ml/min/m2BSA (*)BSA : Body Surface Area CRRT in Infants and Children CVVHDF Qb Qf Qd (ml/min) (ml/min/m2) (ml/min/m2) Neonates 10-25 5 15-25 Infants 25-50 5 15-25 Children 50-100 5 15-25 Qb = Blood flow Qd = Dialysate flow Qf = Ultrafiltration flow Dialysate Hemosol B0 + KCL 3.5 - 4.5 mmol/L + Glucose 6g/L UF Replacement Hemosol B0 + KCL 3.5 - 4.5 mmol/L CRRT in Infants and Children Ultrafiltration rates In acute renal failure Neonates 8-10 ml/min/m2BSA(*) Infants 8-10 ml/min/m2BSA Children 10-15 ml/min/m2BSA In Multiple organ system failure Neonates 8-10 ml/min/m2BSA Infants 8-10 ml/min/m2BSA Children 10-15 ml/min/m2BSA (*)BSA : Body Surface Area CRRT in Infants and Children Fluid removal（CRRT致肾功能下降10%） 1-2 ml/kg/h Anticoagulation Unfractioned-Heparin Bolus 50-100 IU/kg Continuous infusion 5-20 IU/kg/h ACT pre-Filter 180-200 sec CRRT in Infants and Children Safe extracorporeal-volume 10% of the Blood volume Neonates 30ml Infants 50ml Children 100ml 血流动力学不稳定、新生儿等采用全血/胶体预充 CRRT in