肾脏替代治疗培训课件-2.ppt

1、肾脏替代治疗肾脏替代治疗定义肾脏替代治疗Renal Replacement Therapy(RRT)连续性肾脏替代治疗 Continuous Renal Replacement Therapy(CRRT)连续性血液净化 Continuous Blood Purification (CBP)定义肾脏替代治疗R e n a l R e p l a c e me n t T h e原理血液滤过血液透析血液灌流血浆置换原理血液滤过血液透析弥散（diffusion）血液透析弥散（d i f f u s i o n）血液滤过对流（convection）血液滤过对流（c o n v e c t i o n）

2、灌流（adsorption）灌流（a d s o r p t i o n）应用应用Techniques available today for renal replacement in the intensive care unit.CAVH,continuous arteriovenous hemofiltration;CHP,continuous hemoperfusion;CPFA,plasmafiltration coupled with adsorption;CPF-PE,continuous plasmafiltration plasma exchange;CVVH,continu

3、ous veno-venous hemofiltration;CVVHD,continuous veno-venous hemodialysis;CVVHDF,continuous veno-venous hemodiafiltration;CVVHFD,continuous high flux dialysis;D,dialysate;HVHF,high-volume hemofiltration;K,clearance;Pf,plasmafiltrate flow;Qb,blood flow;Qd,dialysate flow;Qf,ultrafiltration rate;R,repla

4、cement;SCUF,slow continuous ultrafiltration;SLEDD,sustained low efficiency daily dialysis;UFC,ultrafiltration control system.post-contentT e c h n i q u e s a v a i l a b l e t o d a y f o r连续血液滤过连续血液滤过连续血液透析滤过连续血液透析滤过上机后参数设置模式选择抗凝方式超滤肾脏替代治疗Renal Replacement Therapy(RRT)透析液流量5002000ml/h对流（convection

5、）血泵前输液08000ml/h(CVVH、CVVHD及CVVHDF模式下)后置换液量5001000ml/hTechniques available today for renal replacement in the intensive care unit.透析液流量5002000ml/h透析液流量5002000ml/h体外循环材料、气液平面弥散（diffusion）灌流（adsorption）后置换液量5001000ml/h滤器压和经脉压力传感器（正压）后置换液量5001000ml/h血液流量100180ml/min滤器上机后参数设置模式选择抗凝方式超滤滤器滤器结构滤器结构滤器滤器护理相关了

6、解适应症选择治疗方式、抗凝方式、血管通路执行医嘱机器操作、报警处理管路维护封管、无菌原则其他培训、交接班等护理相关了解适应症选择治疗方式、抗凝方式、血管通路监测监测模式选择模式选择时机、方时机、方式式有无禁忌有无禁忌症症压力、凝血压力、凝血药物浓度、体温、循环药物浓度、体温、循环CVVHDFTPE、HP早、连续早、连续晚、间断晚、间断肾脏肾脏非肾脏非肾脏结果：前途结果：前途光明光明，道路，道路曲折曲折适应症（7床）监测模式选择时机、方式有无禁忌症压力、凝血药物浓度、体温、循肾脏替代治疗培训课件_ 2超滤率02000ml/h(TPE模式下01000ml/h)灌流（adsorption）灌流（ad

7、sorption）滤器压和经脉压力传感器（正压）灌流（adsorption）超滤率01000ml/h滤器压和经脉压力传感器（正压）血泵前输液08000ml/h(CVVH、CVVHD及CVVHDF模式下)CAVH,continuous arteriovenous hemofiltration;CHP,continuous hemoperfusion;CPFA,plasmafiltration coupled with adsorption;CPF-PE,continuous plasmafiltration plasma exchange;CVVH,continuous veno-venous

8、hemofiltration;CVVHD,continuous veno-venous hemodialysis;CVVHDF,continuous veno-venous hemodiafiltration;CVVHFD,continuous high flux dialysis;D,dialysate;HVHF,high-volume hemofiltration;K,clearance;Pf,plasmafiltrate flow;Qb,blood flow;Qd,dialysate flow;Qf,ultrafiltration rate;R,replacement;SCUF,slow

9、 continuous ultrafiltration;SLEDD,sustained low efficiency daily dialysis;UFC,ultrafiltration control system.血液流量10450ml/min灌流（adsorption）Techniques available today for renal replacement in the intensive care unit.灌流（adsorption）超滤率01000ml/h弥散（diffusion）上机过程中调整压力变化流量调整电解质调整药物（升压药物、镇静剂、静脉营养等）Technique

10、s available today for renal replacement in the intensive care unit.Continuous Renal Replacement Therapy(CRRT)了解适应症选择治疗方式、抗凝方式、血管通路抗凝患者因素感染、ALF、MODS血管通路管径、体位体外循环材料、气液平面RRT治疗相关因素滤过分数30%超滤率0 2 0 0 0 ml/h (T P E 模式下0 1 0 0 0 ml/h)肾脏替代治疗培训课件_ 2CRRT citrate anticoagulationC R R T c i t r a t e a n t i c o

11、 a g u l a t i o n枸橼酸抗凝枸橼酸抗凝报警输入端极端负值回输端压力过高凝血（tmp、P、经脉壶)称报警输入端极端负值管道贴壁管道贴壁监测监测横膈膜复位滤器压和经脉压力传感器（正压）横膈膜复位滤器压和经脉压力传感器（正压）后置换液量5001000ml/h对流（convection）执行医嘱机器操作、报警处理透析液流量5002000ml/h超滤率02000ml/h(TPE模式下01000ml/h)透析液流量5002000ml/h血泵前输液08000ml/h(CVVH、CVVHD及CVVHDF模式下)超滤率01000ml/h对流（convection）Continuous Bloo

12、d PurificationTechniques available today for renal replacement in the intensive care unit.透析液流量5002000ml/hRRT治疗相关因素滤过分数30%灌流（adsorption）超滤率01000ml/h灌流（adsorption）后置换液量5001000ml/h执行医嘱机器操作、报警处理CAVH,continuous arteriovenous hemofiltration;CHP,continuous hemoperfusion;CPFA,plasmafiltration coupled with

13、adsorption;CPF-PE,continuous plasmafiltration plasma exchange;CVVH,continuous veno-venous hemofiltration;CVVHD,continuous veno-venous hemodialysis;CVVHDF,continuous veno-venous hemodiafiltration;CVVHFD,continuous high flux dialysis;D,dialysate;HVHF,high-volume hemofiltration;K,clearance;Pf,plasmafil

14、trate flow;Qb,blood flow;Qd,dialysate flow;Qf,ultrafiltration rate;R,replacement;SCUF,slow continuous ultrafiltration;SLEDD,sustained low efficiency daily dialysis;UFC,ultrafiltration control system.前置换液量10002000ml/h弥散（diffusion）上机前评估患者整体情况血管通路机器等硬件上机过程中调整压力变化流量调整电解质调整药物（升压药物、镇静剂、静脉营养等）上机后参数设置模式选择抗凝

15、方式超滤下机确认治疗效果上机操作后置换液量5 0 0 1 0 0 0 ml/h 上机前评估患者整体情况血参数血液流量10450ml/min置换液流量08000ml/h(CVVH和CVVHDF模式下)透析液流量08000ml/h超滤率02000ml/h(TPE模式下01000ml/h)血泵前输液08000ml/h(CVVH、CVVHD及CVVHDF模式下)参数血液流量1 0 4 5 0 ml/mi n参数举例（CVVHDF）血液流量100180ml/min前置换液量10002000ml/h 后置换液量5001000ml/h透析液流量5002000ml/h超滤率01000ml/h 抗凝无肝素/肝素

16、参数举例（C V V H D F）血液流量1 0 0 1 8 0 ml/mi n执行医嘱机器操作、报警处理对流（convection）血泵前输液08000ml/h(CVVH、CVVHD及CVVHDF模式下)对流（convection）Continuous Renal Replacement Therapy(CRRT)管路维护封管、无菌原则肾脏替代治疗Renal Replacement Therapy(RRT)前置换液量10002000ml/h凝血（tmp、P、经脉壶)了解适应症选择治疗方式、抗凝方式、血管通路透析液流量5002000ml/h结果：前途光明，道路曲折滤器压和经脉压力传感器（正压）

17、上机后参数设置模式选择抗凝方式超滤Techniques available today for renal replacement in the intensive care unit.超滤率01000ml/h执行医嘱机器操作、报警处理后置换液量5001000ml/hRRT治疗相关因素滤过分数30%超滤率01000ml/h透析液流量5002000ml/hContinuous Blood Purification超滤率01000ml/h肾脏替代治疗Renal Replacement Therapy(RRT)Techniques available today for renal replacem

18、ent in the intensive care unit.滤器压和经脉压力传感器（正压）透析液流量5002000ml/h对流（convection）滤器压和经脉压力传感器（正压）透析液流量5002000ml/h对流（convection）肾脏替代治疗Renal Replacement Therapy(RRT)RRT治疗相关因素滤过分数30%体外循环材料、气液平面超滤率01000ml/h血泵前输液08000ml/h(CVVH、CVVHD及CVVHDF模式下)执行医嘱机器操作、报警处理血泵前输液08000ml/h(CVVH、CVVHD及CVVHDF模式下)CAVH,continuous art

19、eriovenous hemofiltration;CHP,continuous hemoperfusion;CPFA,plasmafiltration coupled with adsorption;CPF-PE,continuous plasmafiltration plasma exchange;CVVH,continuous veno-venous hemofiltration;CVVHD,continuous veno-venous hemodialysis;CVVHDF,continuous veno-venous hemodiafiltration;CVVHFD,continuo

20、us high flux dialysis;D,dialysate;HVHF,high-volume hemofiltration;K,clearance;Pf,plasmafiltrate flow;Qb,blood flow;Qd,dialysate flow;Qf,ultrafiltration rate;R,replacement;SCUF,slow continuous ultrafiltration;SLEDD,sustained low efficiency daily dialysis;UFC,ultrafiltration control system.管路维护封管、无菌原则

21、透析液流量08000ml/h弥散（diffusion）管路维护封管、无菌原则对流（convection）RRT治疗相关因素滤过分数30%CAVH,continuous arteriovenous hemofiltration;CHP,continuous hemoperfusion;CPFA,plasmafiltration coupled with adsorption;CPF-PE,continuous plasmafiltration plasma exchange;CVVH,continuous veno-venous hemofiltration;CVVHD,continuous v

22、eno-venous hemodialysis;CVVHDF,continuous veno-venous hemodiafiltration;CVVHFD,continuous high flux dialysis;D,dialysate;HVHF,high-volume hemofiltration;K,clearance;Pf,plasmafiltrate flow;Qb,blood flow;Qd,dialysate flow;Qf,ultrafiltration rate;R,replacement;SCUF,slow continuous ultrafiltration;SLEDD

23、,sustained low efficiency daily dialysis;UFC,ultrafiltration control system.管路维护封管、无菌原则灌流（adsorption）后置换液量5001000ml/h灌流（adsorption）透析液流量5002000ml/hRRT治疗相关因素滤过分数30%血液流量10450ml/minCAVH,continuous arteriovenous hemofiltration;CHP,continuous hemoperfusion;CPFA,plasmafiltration coupled with adsorption;CP

24、F-PE,continuous plasmafiltration plasma exchange;CVVH,continuous veno-venous hemofiltration;CVVHD,continuous veno-venous hemodialysis;CVVHDF,continuous veno-venous hemodiafiltration;CVVHFD,continuous high flux dialysis;D,dialysate;HVHF,high-volume hemofiltration;K,clearance;Pf,plasmafiltrate flow;Qb

25、,blood flow;Qd,dialysate flow;Qf,ultrafiltration rate;R,replacement;SCUF,slow continuous ultrafiltration;SLEDD,sustained low efficiency daily dialysis;UFC,ultrafiltration control system.凝血（tmp、P、经脉壶)血泵前输液08000ml/h(CVVH、CVVHD及CVVHDF模式下)了解适应症选择治疗方式、抗凝方式、血管通路前置换液量10002000ml/h超滤率02000ml/h(TPE模式下01000ml/h)Techniques available today for renal replacement in the intensive care unit.联合治疗体温、凝血、相互影响、疗效执行医嘱机器操作、报警处理透析液流量5 0 0 2 0 0 0 ml/h 弥