CRRT的适应症和临床应用课件.ppt

CRRT应用覆盖的部分科室肾内科心胸外科神经外科普通外科感染科急诊科神经内科心血管内科呼吸内科产科消化内科血液病科骨科肿瘤科CRRT临床应用指征（一）AKI多脏器功能衰竭（MODS）全身性炎症反应综合征（SIRS）脓毒症（Sepsis）重症病毒感染毒血症时期急性呼吸窘迫综合征（ARDS）ArtificialOrganTreatmentforMultipleOrganFailure,AcuteRenalFailure,andSepsis:RecentNewTrendsTettaC,ArtificialOrgans.2003,27(3):202-213.InterpretingtheMechanismsofContinuousRenalReplacementTherapyinSepsis:ThePeakConcentrationHypothesisRonco.ArtificialOrgans.2003,27(9):792-801.CARS(compensatoryanti-inflammatoryresponsesyndrome):即代偿性抗炎反应综合征SepsisandCRRT:ThePeakConcentrationHypothesisRonco.ArtificialOrgans.2003,27(9):792-801.CytokineRemovalduringContinuousHemofiltrationinSepticpatients15septicshockpatientsCVVH后置换法AN69每12小时更换滤器血流量:100or200ml/minVrieseetal.JASN.1999,10:846-853.ThetotalamountofInflammatorycytokinesremovedduringContinuousHemofiltrationVrieseetal.JASN.1999,10:846-853.ThetotalamountofAnti-inflammatorycytokinesremovedduringContinuousHemofiltrationVrieseetal.JASN.1999,10:846-853.CRRT临床应用指征（二）挤压综合征急性坏死性胰腺炎肿瘤溶解综合征严重烧伤复合创伤溶血性尿毒症综合征Toillustratetheprincipleofdiffusion,pictureacupofwaterasseenhereontheslide.Inthecupontheleft,aquantityofsaltispoured.Thesaltgraduallydiffusesthroughthewaterfromthehighsaltconcentrationareatothelowsaltconcentrationareauntilitisevenlydistributed.Auniformlysaltysolutioniscreatedasseeninthecupontheright.Toillustrateconvection,wegobacktotheuseofthecups.Thecupnowhasaconcentratedsolutionononesideofthesemipermeablemembrane.Asfluidmoves(byultrafiltration),solutessmallenoughtopassthroughtheporesofthemembranemovealongwiththefluid.Changeinbloodconcentrationofaspecificsoluteisdependentonthefluidvolumeremoved.Thisslideillustratestheprocessofultrafiltration.Wenowhavetwocupsoffluid.Eachcupcontainstwocompartmentsseparat