【持续性肾脏替代治疗crrt英文精品课件】cvvh-continuous veno-venous hemofiltration (65p)

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1、MazenKherallah,MD,FCCPKingFaisalSpecialistHospital&ResearchCenterInternalMedicine,InfectiousDiseaseandCriticalCareMedicineCVVHcontinuousveno-venoushemofiltrationheadtraumaHistory:Kramer1979(Germany)Inadvertentcannulationofthefemoralarteryledtoaspontan

2、eousexperimentwithC-arterio-VH:patient'scardiacfunctionalonecapableofdrivingthesystemlargevolumesofultrafiltratewereproducedthroughthehighlypermeablehemofilter'continuousarterio-venoushemofiltration'systemcouldprovidecompleterenalreplacementtherapyina

3、nanuricadultheadtraumaHistory:pediatricsLieberman1985(USA):slowcontinuousultrafiltration('SCUF')tosuccessfullysupportananuricneonatewithfluidoverloadRonco1986(Italy):CAVHinneonatesLeone1986(USA):CAVHinolderkids1993:generalacceptanceofpump-drivenCVVHas

4、lessproblematicthanCAVHheadtraumaTheIdealModeofRenalReplacementTherapyforCriticallyIllPatients:RemoveexcessfluidandtreatfluidoverloadCorrectandcontrolazotemiaCorrectandcontrolelectrolyteimbalancesAssistinmaintainingacid-basebalanceThisgoalsmustbeaccom

5、plishedwithoutPrecipitatingadditionalhemodynamicinstabilityheadtraumaCVVH1.near-completecontroloftherateoffluidremoval(i.e.theultrafiltrationrate)2.precisionandstability3.electrolytesoranyformedelementofthecirculation,includingplateletsorredorwhiteblo

6、odcells,beremovedoraddedindependentlyofchangesinthevolumeoftotalbodywater.headtraumaCRRT:IndicationsSCUFAcutepulmonaryedemaSevereedemainCongestiveheartfailurewithdiuretic-unresponsiveoliguriadespiteinotropicsupportHepaticfailureOliguricoranuricpatient

7、swithacuterenalfailureNephroticsyndromeCVVHFDrugintoxicationSepticshockRhabdomyolysisTumor-lysissyndromeHyperthermiaSeverelacticacidosisheadtraumaHighVolumeHemofiltrationandTherapeuticPlasmaExchangeThromboticthrombocytopenicpurpuraHUSHyperviscositysyn

8、drome:macroglobulinemia,cryoglobulinemia,andmultiplemyelomaHyperbilirubinemiaFocalglomerulosclerosisRapidprogressiveglomerulonephritisMystheniagravisLambert-EatonsyndromeGuillanBarreSyndromeSystemicvasculitis:SLEheadtraumaCVVH:AdvantagesPrecis