CRRT石家庄-培训课件.ppt

Siminars In Dialysis.2006;19(4):311-316 局部枸橼酸抗凝 抗凝过程中潜在的并发症：高钠血症、代谢性碱中毒、低钙血症和高钙血症； 枸橼酸三钠输注速度17.5-25.8mmol/h，如果要加大抗凝效果，不选择增加输注速度，可通过降低血流量，增加体外循环血液中枸橼酸根浓度来实现； 肝功能不全患者使用枸橼酸抗凝仍有争议； Intensive Care Med (2007) 33:1563–1570 选择合适的血滤器和适当的抗凝措施 选择适当的血滤器和抗凝措施的根本目的：延长回路及血滤器寿命、提高疗效！ PAN膜是目前危重患者最常用血滤器； 目前应用最广泛的为普通肝素抗凝，局部枸橼酸抗凝是一非常有发展潜力的抗凝措施； CRRT治疗剂量选择与疗效 Effects of different in continuous veno-venous haemofilltration on outcomes of acute renal failure 492 patients considered 67 excluded 425 patients randomised 146 assigned ultrafiltration at 20 mL h-1 Kg -1 139 assigned ultrafiltration at 35 mL h-1 Kg -1 140 assigned ultrafiltration at 45 mL h-1 Kg -1 146 patients completed study with ultrafiltration of ＞85% of prescribed 139 patients completed study with ultrafiltration of ＞85% of prescribed 140 patients completed study with ultrafiltration of ＞85% of prescribed Lancet. 2000; 355: 26–30 Effects of different in continuous veno-venous haemofilltration on outcomes of acute renal failure Lancet 2000; 355: 26–30 41% 57% 58% Survival(%) Adding a dialysis dose to continuous hemofiltration increases survival in patients with ARF Patients treated by CRRT (n=371) Patients assessed for eligibility (n=310) Excluded (n=104) Not meeting inclusion criteria (n=30) Informed consent not obtained (n=74) Randomly allocated (n=206) Allocated to CVVH (n=102) Did not recive CVVH (n=4) Allocated to CVVHDF (n=104) Did not recive CVVHDF (n=3) Analyzed (n=102) Died within the first 24h (n=9) Analyzed (n=104) Died within the first 24h (n=10) CVVH 1–2.5 l/h replacement fluid; CVVHDF 1–2.5 l/h replacement fluid; 1–1.5 l/h dialysate fluid; Kidney International (2006) 70, 1312–1317 Adding a dialysis dose to continuous hemofiltration increases survival in patients with ARF Kidney International (2006) 70, 1312–1317 39% 59% Survival(%) Effects and dose of continuous renal replacement therapy in acute kidney injury Summary of studies evaluating the dose of continuous renal replacement therapy Effluent flow r