CRRT及其護(hù)理ppt課件

1、.1ICU.2.3.4.5October 21, 2021 Year, Legal owner5 Remove excess fluidRegulate acid/base balanceRemove waste products and toxinsUrea CreatinineRegulate electrolyte levelsRetention of essential compoundsAlbumin, HemoglobinBasic 4 The Dialyzer; Gambro Basic Manual .6.7.8.9.10血液過(guò)濾器套件血管輸入裝置 雙腔導(dǎo)管抗凝劑溶液加溫器CR

2、RT 系統(tǒng).11.12High PressureLow PressureFluid VolumeReductionTrans Membrane Pressure (TMP)EffluentBlood in壓力梯度差形成的液體移動(dòng)清除水Blood Out.13Blood inBlood OutHigh Concentration Low ConcentrationDialysateEffluent.14High PressureLow Pressure.15.16.17.18Slow Continuous UltrafiltrationPRISMA.19Continuous Veno-Venou

3、s HemofiltrationPRISMANo .20PRISMA減低血液濃度，減少出現(xiàn)凝血，延長(zhǎng)減低血液濃度，減少出現(xiàn)凝血，延長(zhǎng)治療時(shí)間治療時(shí)間無(wú)抗凝血治療首選無(wú)抗凝血治療首選可用較高的超濾率可用較高的超濾率( (增加置換量增加置換量) )濾出液化學(xué)檢測(cè)數(shù)據(jù)濾出液化學(xué)檢測(cè)數(shù)據(jù)不能不能正確代表真正確代表真正血漿里離子成份正血漿里離子成份清除效率比后稀治療低清除效率比后稀治療低 30% 30%.21PRISMA濾器內(nèi)血液濃縮，增加出現(xiàn)凝血，濾器內(nèi)血液濃縮，增加出現(xiàn)凝血，治療時(shí)間短治療時(shí)間短只可用較低的超濾率只可用較低的超濾率( (置換量較少置換量較少) )需要抗凝血需要抗凝血( (使用抗凝血?jiǎng)?/p>

4、如肝素使用抗凝血?jiǎng)┤绺嗡? )濾出液化學(xué)檢測(cè)數(shù)據(jù)反影真正血漿濾出液化學(xué)檢測(cè)數(shù)據(jù)反影真正血漿里離子成份里離子成份清除效率比前稀治療高清除效率比前稀治療高30%.22Continuous Veno-Venous HemodialysisPRISMAS 透析液透析液.23ContinuousVeno-VenousHemodiafiltrationPRISMA .24.25.26凝膠狀凝膠狀泡沫狀泡沫狀指狀物指狀物PS, PAAN69, PMMA.27October 21, 2021 Year, Legal owner27 腎腎小球有小球有效效 濾過(guò)壓濾過(guò)壓 ?CRRT有效有效濾濾過(guò)壓過(guò)壓 ?(腎小球

5、毛細(xì)血管壓+囊內(nèi)液膠體滲透壓)-(血漿膠體滲透壓+腎小囊內(nèi)壓)中空纖維內(nèi)壓力-(血漿膠體滲透壓+中空纖維外壓力).28.29.30C long-term accessC easy to insertC good blood flow conditions股靜脈鎖骨下靜脈頸內(nèi)靜脈 頸內(nèi)靜脈C easy to insert.31Fnf arterielle AnsaugffnungenFour holes for venous return Art. InsertStraight venous return prevent stagnation and turbulences Luer-Lock

6、connectors Katheterschaft Zwischenstck Klemmen Patented Clamps Hub Flexible Length of catheterFive holes for blood suction Catheter tip .32.Bloodflow 主血管血流方向股靜脈 頸靜脈 鎖骨下靜脈 .33.34.35.36.37.38.39.40.41.42.43.44n預(yù)充液預(yù)充液n置換液置換液n透析液透析液n抗凝劑抗凝劑.45.46.47.48SCUF CVVH CVVHD CVVHDF TPE HELP.49.50.51靜脈回流方向.52.53.

7、54.55.56總?cè)肓靠側(cè)肓快o脈補(bǔ)液量靜脈補(bǔ)液量胃腸入量胃腸入量沖洗管路的沖洗管路的NS量量總出量總出量尿量尿量大便量大便量引流液（滲液）引流液（滲液）透析液透析液置換液置換液濾出液濾出液超濾液超濾液透析液透析液.57可調(diào)可調(diào)靜脈補(bǔ)液靜脈補(bǔ)液 （晶體（晶體50ml 、膠體、膠體100ml）胃腸入量（胃腸入量（100ml）沖洗管路的沖洗管路的NS（250ml）估計(jì)估計(jì)尿量（尿量（50ml）大便量（大便量（0ml）引流液（引流液（10ml）Fluid Removed(? 60).58全自動(dòng)設(shè)置負(fù)平衡全自動(dòng)設(shè)置負(fù)平衡半自動(dòng)根據(jù)出量調(diào)整入量半自動(dòng)根據(jù)出量調(diào)整入量.59速速 度度總總 量量.60.61空氣血液平面濾網(wǎng).62后稀液體.63.64.65.66.67.68.69.70.71治療中的典型壓力治療中的典型壓力Access PressureNegative-50 to -150 mmHgFilter PressurePositive+100 to +250 mmHgReturn PressurePositive+50 to +150 mmHgEffluent PressureNegative or Positive +50 to -150 mmH