剂量计算器在CRRT中的应用-课件PPT

1、Prisma 与与 Prismaflex 系统系统2021/8/26 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB22021/8/26 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB32021/8/26 2007, Gambro Lu

2、ndia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB41234562021/8/26 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB5废液与UFR 剂量1重要计算重要计算2滤过分数：基于血流基于血浆2021/8/26 2007, Gambro Lundia AB 2007

3、, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB6血流重要剂量参数重要剂量参数稀释比例342021/8/26 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB7置换液流速重要剂量参数重要剂量参数透析液流速562021/8/26 2007, Gambro Lundia AB 2007, Gamb

4、ro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB82021/8/26 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB9显示与目标剂量的偏离12021/8/26 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 200

5、7, Gambro Lundia AB 2007, Gambro Lundia AB10血流量增加的空间22021/8/26 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB11后稀释32021/8/26 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lu

6、ndia AB12显示对改变治疗过程中流速的影响42021/8/26 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB13增加的治疗操作 增加血液流量 减小透析液 增加PBP 100% 后稀释52021/8/26 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambr

7、o Lundia AB142021/8/26 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB15低于目标的当前剂量在该方法中，血流和100%后稀释是限制因子122021/8/26 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB16废液和

8、UFR 剂量12滤过分数：基于血流:基于血浆2021/8/26 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB1712增加A2021/8/26 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB18废液和UFR 剂量12滤过分数：基于血流基

9、于血浆2021/8/26 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB19Clark et al., Artif Organs 2003*: 对于后稀释中的相同剂量：对于后稀释中的相同剂量： QR 需求量需求量 = 3.2 L/hr 020406080100120140160180200100150200250300350400Blood Flow (ml/min)Replacement Fluid Flow (

10、ml/min)100 kg85 kg70 kg55 kg40 kgPatient SizeQB = 130 mL/min; QR 需求量需求量 = 8.5 L/hrQB = 180 mL/min; QR 需求量需求量 = 6.5 L/hr A2021/8/26 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB20QE (mL/h)清除率或流速清除率或流速 (mL/min)小分子溶小分子溶质质清除清除率率 流出速率比流

11、出速率比整个流出速率整个流出速率谱谱 2M清除率很低清除率很低，因，因为为其弥散速其弥散速率低率低Brunet et al., AJKD 19992021/8/26 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB21Parakininkas and Greenbaum, Ped Crit Care Med 2004在流速在流速 (QR 与与 QD) 相同相同时时, CVVHD的的尿素清除率尿素清除率总总是高是高于前

12、稀于前稀释释CVVH2021/8/26 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB2212A2021/8/26 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB23UFR 剂量12滤过分数：未改变2021/8/26 2007, Gam

13、bro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB242021/8/26 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB25122021/8/26 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gam

14、bro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB26UFR剂量12滤过分数：未改变2021/8/26 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB27在相同的流出速率在相同的流出速率下，下，CVVHDF中的中的尿素清除率尿素清除率总总是高是高于前稀于前稀释释CVVH在相同的流出速率在相同的流出速率下，在流出速率范下，在流出速率范围围的大部分，的

15、大部分， 2M 的的清除速率基本相同清除速率基本相同Troyanov et al, Nephrol Dial Transplant 20032021/8/26 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB282021/8/26 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 20

16、07, Gambro Lundia AB29122021/8/26 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB30剂量 OK12滤过分数：OK2021/8/26 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB31Ronco et a

17、l., Lancet 20002021/8/26 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB32122021/8/26 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB33剂量 OK12滤过分数：OK2021/8/26 2007, G

18、ambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB34Quf = 超滤速率超滤速率 (后稀释后稀释 + Pt. 流体清除流体清除)Qp = 血液流量血液流量 血液流量血液流量 = 滤过分数滤过分数 滤过分数滤过分数 = 血浓缩血浓缩 (增加凝血) 滤过分数滤过分数 =QUFQP滤过分数必须滤过分数必须 25%2021/8/26 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB 2007, Gambro Lundia AB35体重 (kg)6080100120QB (Hct=0.30)167222278333QB (Hct=0.35)180240299359*剂量剂量: 35 mL/hr/kg; 滤过分数滤过分数 = 30% 滤过