CVVH超濾率及濾過分?jǐn)?shù)計(jì)算

1、Bouman CS et al. Effects of early high-volume CVVH on survival and recovery of renal function in IC patients with ARF. Crit Care Med 2002; 30: 2205 (n=106)Critical Care 2009, 13:R57Lancet 2000; 356: 26 -30high-volume、 血液入口血液入口血液出口血液出口透析液入口透析液和濾出液出口橫截面橫截面空心纖維膜空心纖維膜腎小球囊腎小管腎小球溶溶質(zhì)隨液體質(zhì)隨液體移移動(dòng)動(dòng)“溶溶劑劑拖移拖移”CV

2、VHCVVH治療定量評價(jià)指標(biāo)？治療定量評價(jià)指標(biāo)？Blood flow150 mls/minBlood flow115 mls/minQ Qufuf/ /Q Qp p基于血漿的濾過分?jǐn)?shù)基于血漿的濾過分?jǐn)?shù) 30%前稀前稀后稀后稀要達(dá)到要達(dá)到35mL/h/kg35mL/h/kg劑量，需劑量，需設(shè)置多少設(shè)置多少置換液置換液量量？QB (ml/min)208150208300稀釋因子稀釋因子QB/(QB+QRF)Post (1.00)0.770.830.87UFR (ml/kg/h)352729(35*0.83)30.5假設(shè)假設(shè): 75 kg; Hct = 0.30; dose = 35 ml/hr/k

3、g (post) , 后稀釋：后稀釋： 置換液：置換液：35*75=2625ml 前稀稀釋比例：前稀稀釋比例： 208/(208+2625/60)=0.83, 208血流速為上述條件下維持FF30%的最低血流速。前稀釋時(shí)，同樣置換液下，血液在進(jìn)入濾器前已被稀釋，血液中溶質(zhì)的 濃度減少，單位時(shí)間內(nèi)濾器接觸的溶質(zhì)少。與后稀釋CVVH相比，這意味 著在流出液速率確定的情況下，被清除到流出液中的溶質(zhì)要少一些。溶 質(zhì)清除效率較后稀釋降低血流速越高，效率的損失降低，前稀釋的相對效果減少置換液置換液2625(后后)2625(前前)300要達(dá)到要達(dá)到UFR40ml/kg/h 前稀和后稀置換液量如何分配？前稀和

4、后稀置換液量如何分配？Intensity of Continuous Renal-Replacement Therapy in Critically Ill Patients, higher-dose(ml/kg/h)lower-dose(ml/kg/h)Outcome(90-d mortality)timeRonco et alLancet, 2000Saudan et alKidneyInt, 2006Bouman et alCrit Care Med, 2002Tolwani et alJ Am Soc Nephrol, 2008The RENAL Replacement Therapy Study InvestigatorsN Engl J Med, 2009higher-dose(ml/kg/h)lower-dose(ml/kg/h)Outcome(90-d mortality)timeTolwani et alJ Am Soc Nephrol, 2008The RENAL Replacement Therapy Study InvestigatorsN Engl J Med, 2009True dose in Continuou