crrt：严重脓毒症mods邱海波.ppt

* * * * * * * * -Wash-out period between the 2 study sessions- most patients received 2 L/hr CVVH -the MAP, CI, CVP and PAOP did not change significantly over the 8 hours during CVVH or HVHF * * * * * * * * * * * * * HV-CVVH明显改善感染性休克预后 脉冲式高容量血液滤过 (Pulse HVHF) 极高容量很难维持24h以上，而且对溶质动力学无明显改进 Ranco提出了脉冲式高容量血液滤过 Seminars in Dialysis, 2006, 19(1): 69-74 6 4 2 0 Pulse L/h HVHF--- As salvage therapyin severe septic shock Objectives: To evaluate the effect PHVHF (12-h) in reversing progressive refractory hypotension in pats with sshock N=20 sshock pats with NE 0.3 μg/kg.min and and lactic acidosis Responders vs Non-R (NE and lactate levels at 6h after PHVHF) Intensive Care Med (2006) 32:713–722 Higher Uf volumes Higher membrane cut-off Permeability Convection Grootendorst AF et al , 1992 Bellomo R et al, 1998 Leese T et al. 1987 Berlot G et al. 1997 促进介质清除/遏制炎症反应的可能途径 1 2 Efficacy of membrane pore size on morbidity and mortality in an immature swine model of Staph. Aureus induced sepsis James R. Matson, Crit Care Med, 26: 730-737, 1998 Cut-off 100 KD Higher Uf volumes Higher membrane cut-off Permeability Convection Grootendorst AF et al , 1992 Bellomo R et al, 1998 Leese T et al. 1987 Berlot G et al. 1997 1 2 Use of sorbents in combination therapies Adsorption Ronco C et al. 1999 Tetta C et al. 2001 3 促进介质清除/遏制炎症反应的可能途径 Sorbent Coupled plasmafiltration-adsorption, by regenerating the plasmafiltrate, avoids unwanted losses, avoids the contact of RBC, WBC and platelets with the sorbent, and prevents treatment induced thrombocytopenia. Hemodiafilter Plasmafilter Dialysate 30 ml/min Plasmafilter 20 ml/min 100-200 ml/min CPFA: Hemodynamics and Biological Effects P 0.01 NA MAP at 10 hours of treatment versus baseline D- Norepinephrine Dose and D+ MAP 0 20 40 60 80 100 % P 0.01 TNF Prod. Phagocytosis D Monocyte TNF production and Phagocytic Capacity 0 20 40 60 80 100 P 0.01 0 500 1000 1500 % at 10 hours of t