肾脏替代治疗基础及原理.ppt

***辅助治疗：原发病治疗，控制血压/血脂，营养，EPO,补铁，控制血磷等****讨论透析质量时，可以加入劣质膜如非合成膜的影响。举例市场上的非合成膜如Nipro,Toray产品，以便受训人员面对客户时可以阐述***辅助治疗：原发病治疗，控制血压/血脂，营养，EPO,补铁，控制血磷等*1.透析膜是个半透膜。半透膜的孔径在透析（扩散）的过程中决定滤过物质的大小。小分子物质可以顺利滤过，中分子和大分子物质小部分滤过。2.同样的力（浓度梯度）可以让小分子移动但是不能让中分子移动。*******HD:countercurrentflowofdialysate,maintaintheconcentrationdifference;***肾脏、标准HD、HF、HDF治疗***肾脏、标准HD、高效HD、高通HD、HDF治疗**Pre-dilutionusesmorereplacementfluidtoachievesameeffectwithpost-dilution,soincreasesthecostfortreatment在透析器内血液侧的液体超滤到膜外，伴随着液体的移动，清除了中分子物质。**:Post-dilutionwasassociatedwithreducedfilterlifewithoutanybeneficialeffectondailychangesinureaandcreatininelevels.Pre-dilutionappearsapreferabletechnicalapproachtoCVVH.UchinoS,FealyN,BaldwinI,MorimatsuH,BellomoR.DepartmentofIntensiveCare,AustinRepatriationMedicalCentre,Melbourne,Vic.,Australia.2003***辅助治疗：原发病治疗，控制血压/血脂，营养，EPO,补铁，控制血磷等**Targetingatdifferentgroupofsolutesatdifferentdisciplinarydisease:renal/cardiac/hepatic/hemo/clinicallimitationpracticallimitation:Differentmachines,facilities,notversatile;CRRTcombinedseveralkindofthattogether,moreflexibleandusefulCCPD=APD,becauseitusesacycler,so…**解释术语。Hypovolaemialeadtorenalbloodsupplyinsufficientcomorbidwithheartfailureorcoronaryproblem;Fluidinflow:antibiotics+transfusion/plasmaexpander+parenteralnutrition;Electrolyteimbalance,acidbaseimbalance;Sepsis;hyperthermia;cardiacfailure;ARDS;transplantation;moreandmorenewfield;chemotherapyderivedrenalfailure.Continuousveno-venoushemofiltrationmayimprovesurvivalfromacuterespiratorydistresssyndromeafterbonemarrowtransplantationorchemotherapy.DiCarloJV,AlexanderSR,AgarwalR,SchiffmanJD.DivisionofPediatricCriticalCareMedicine,StanfordUniversityMedicalSchoolandLucilePackardChildrensHospital,PaloAlto,California94304,USA