1、CRRT的基础知识的基础知识BIRMBIRMBIRMBIRM肾单位肾单位BIRMBIRM9509501801801.51.5血浆流量血浆流量肾小球滤过量肾小球滤过量终尿终尿BIRMBIRM50.0%86.1%99.4%99.9%100.0%UreaK+Na+HCO3-Glucose重吸收量占滤过量%重吸收量占滤过量%BIRMBIRM入路入路回路回路入球小动脉入球小动脉出球小动脉出球小动脉肾小球肾小球肾小管肾小管BIRMBIRMBIRMBIRM基膜基膜（-）毛细血管毛细血管内皮细胞内皮细胞肾小囊脏肾小囊脏层 细 胞层 细 胞肾小球滤过膜肾小球滤过膜BIRMBIRMBIRMBIRMBIRMBIRM
2、BIRMBIRMBIRMBIRMS 入路入路回路回路透析液透析液 HFS 入路入路回路回路滤过液滤过液置换液置换液HFBIRMBIRM可由肾小球滤过可由肾小球滤过分子量分子量500005000H H2 2O O（1818）NaNa(23)(23)UreaUrea(60)(60)GlucoseGlucose(180)(180)CreatinineCreatinine(13)(13)Myoglobin Myoglobin(17000)(17000)HeparinHeparin(11200)(11200)B2-microglobulinB2-microglobulin(11800)(11800)IL
3、-1IL-1(31000)(31000)TNF TNF(17400)(17400)PepsinPepsin(35000)(35000)AlbuminAlbumin(69000)(69000)HemoglobinHemoglobin(68000)(68000)Prothrombin Prothrombin(68000)(68000)IgGIgG(160000)(160000)Fibrinogen Fibrinogen(341000)(341000)BIRMBIRM入路入路回路回路入球小动脉入球小动脉出球小动脉出球小动脉肾小球肾小球肾小管肾小管BIRMBIRMBIRMBIRM入路入路回路回路置换液
4、置换液前稀释前稀释后稀释后稀释Qf=KmTMPQf=KmTMP 置置换换液液流流量量血血流流量量血血流流量量BIRMBIRMBIRMBIRMBIRMBIRMBIRMBIRM入路入路回路回路滤出液滤出液置换液置换液BIRMBIRM入路入路回路回路滤出液滤出液BIRMBIRMS 入路入路回路回路滤过液滤过液+透析液透析液透析液透析液 HFBIRMBIRMS 入路入路回路回路滤过液滤过液透析液透析液 置换液置换液HFBIRMBIRMBIRMBIRM950950180180BIRMBIRMBIRMBIRMBIRMBIRM药 物蛋白结S肾外途径 CVVH时剂量合率（小数）药物清除%率（小数）2L/h(GFR30)1L/h(GFR15)常用计量 万古霉素10150.90.031g q12h1g q2448h1g q4896h 乙胺碘呋酮960.0311015mg/kg/24h同前同前BIRMBIRMBIRMBIRMBIRMBIRMBIRMBIRMBIRMBIRMBIRMBIRMBIRMBIRMBIRMBIRMBIRMBIRMBM25BM11BM14BIRMBIRMBIRMBIRM
