血液透析機(jī)報(bào)警操作課件

1、一：相關(guān)醫(yī)學(xué)和技術(shù)基礎(chǔ)二：血透機(jī)組成及作用三 ：相關(guān)報(bào)警及處理Diffusion彌散Start開始時(shí):DifferentConcentrations膜兩側(cè)濃度有差別End結(jié)束時(shí):EqualConcentrations膜兩側(cè)濃度相同timeDiffusion is a consequence of the random movementof all molecules (Brownian Movement).彌散是微分子物質(zhì)隨機(jī)的運(yùn)動(dòng)可導(dǎo)致均勻分布的結(jié)果 Ultrafiltration超濾TimePressureStart:End:Exertion of pressure on one side

2、 of the membrane produces filtration of water with solutes, as long as they can pass the membrane.運(yùn)用壓力的作用將水份從膜一側(cè)推到另一側(cè)，膜孔夠大時(shí)溶質(zhì)也可以被擠出Reverse Osmosis反滲透作用Time & Pressure時(shí)間和壓力Similar to ultrafiltration pressure is applied to one side of the membrane. Reverse osmosis is especially important for the purif

3、ication of water for the production of dialysate.類似于超濾靠壓力作用于膜的一側(cè)，反滲是生產(chǎn)透析用的純凈水的重要方法。H2Owater soluble moleculesHFFmmHgmmHgBBHDBDBDHDFmmHgBmmHgDBDlow-flux低通透析器high-flux高通透析器high-flux高通透析器diffusionconvectionadsorptiondiffusion/convectionadsorptionTherapy types治療模式Hemodialysis血液透析Hemofiltration血液濾過(guò)Hemodi

4、afiltration血液透析濾過(guò)彌散原理對(duì)流吸附彌散對(duì)流吸附Hemodialysis血液透析Diffusive metabolic transport through semi-permeable membranes with balance of a concentration difference between blood and dialysis fluid. 利用血液和透析液中溶質(zhì)的濃度差別使溶質(zhì)在彌散作用下通過(guò)半透膜隨透析液排出Small molecular substances will essentially more effective.小分子物質(zhì)可有效的被清除Hemofi

5、ltration血液透析濾過(guò)Soluble substances are swept along in a fluid stream through high permeable membranes (convection). The convection depends on the transmembrane pressure and on membrane features like size, density, and quality of the pores (cut-off- value“).可溶物質(zhì)隨著通過(guò)高通透性半透膜的液體流動(dòng)而被清除（對(duì)流）。對(duì)流依靠跨膜壓和膜的物理性質(zhì)（面

6、積、密度、質(zhì)量、孔徑）來(lái)實(shí)現(xiàn)。High moleculare substances, as long as they are below the cut-off-value“, will be eliminated in a better way. 清除高分子量物質(zhì)（只要是低于膜孔的篩選值的物質(zhì)）的有效方法diffusive convective adsorptive clearanceBmmHgDBDhigh-fluxHemodialysis血液透析and Hemofiltration血液透析濾過(guò)HDF Hemodiafiltration血液透析濾過(guò)Combination of two di

7、alysis technics, hemodialysis and hemofiltration:high clearance of conventionel small molecules by diffusion linked withhigh clearance of middle molecules by convection.結(jié)合兩種治療模式：血液透析和血液濾過(guò)結(jié)合由彌散產(chǎn)生的小分子物質(zhì)的高清除率和由對(duì)流產(chǎn)生的中大分子物質(zhì)的高清除率兩種方式的優(yōu)點(diǎn)。mmHgBmmHgDBDDiffusion + Convection + Adsorptionhigh-flux高通濾器透析機(jī)的組成透析液

8、供給系統(tǒng)監(jiān)護(hù)報(bào)警系統(tǒng)：血路監(jiān)護(hù)報(bào)警（動(dòng)脈壓、靜脈壓、空氣報(bào)警）；透析液路監(jiān)護(hù)報(bào)警（溫度、電導(dǎo)度、漏血、跨膜壓）操作控制系統(tǒng)：超濾、鈉曲線、B液、溫度、 透析液流量顯示系統(tǒng)：輔助裝置：血泵、肝素泵、動(dòng)靜脈管路、透析器血透機(jī)部分報(bào)警及操作FRESENIUS基本報(bào)警操作：報(bào)警極限管理： 動(dòng)脈/靜脈報(bào)警極限居中：如無(wú)居中，按開始/重現(xiàn)設(shè)置鍵，顯示Center limit,再按開始/重新設(shè)定鍵，動(dòng)脈和靜脈報(bào)警極限按實(shí)際值居中?？缒簣?bào)警極限居中：如無(wú)居中，按超濾鍵開關(guān)鍵兩次，跨膜壓報(bào)警極限全部打開，接著跨膜壓報(bào)警極限按實(shí)際值居中。改變動(dòng)脈壓報(bào)警窗的大小。按slect鍵，按上下鍵，選3，報(bào)警界限。按確認(rèn)鍵

9、，再按上下鍵，選3.1動(dòng)脈警界線，按確認(rèn)鍵。通過(guò)按上下鍵改變動(dòng)脈壓報(bào)警窗的大小，再按確認(rèn)鍵。改變靜脈壓報(bào)警窗的大小。按slect鍵，按上下鍵，選3，報(bào)警界限。按確認(rèn)鍵，再按上下鍵，選3.2靜脈警界線，按確認(rèn)鍵。通過(guò)按上下鍵改變靜脈壓報(bào)警窗的大小。再按確認(rèn)鍵。改變跨膜壓警界限。窗位置：按slect鍵，按上下鍵，選3，報(bào)警界限。按確認(rèn)鍵，再按上下鍵，選3.3跨膜壓警界線，按確認(rèn)鍵。按上下鍵，選TMP窗位置，按確認(rèn)鍵，通過(guò)按上下鍵改變TMP窗的位置。再按確認(rèn)鍵。Flow alarm (流量報(bào)警)故障一般發(fā)生在使用之中，此種故障通知工程師。Upper flow alarm（上流量報(bào)警）一般發(fā)生在機(jī)器清洗過(guò)程中，一般與浮子開關(guān)，210過(guò)濾器等有關(guān)。Water alarm（水報(bào)警）一般水機(jī)故障，或水機(jī)連接處開關(guān)。Low temperature（低溫報(bào)警）一般發(fā)生在使用當(dāng)中，通知工程師。Conductivity（電導(dǎo)度報(bào)警）發(fā)生在T1自檢中AB液吸桿是否放錯(cuò)或檢查AB液泵工作狀態(tài)Blood leak（漏血報(bào)警）需要檢查漏血傳感器的參考電壓等。Rinse failure F02一般為無(wú)消毒液Positive