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連續性血液透析替代療法(CRRT)之原理、種類及模式、治療時機
及適應症之簡介
三軍總醫院 腎臟內科
宋志建醫師
Structure of artificial kidney
306100135
DiffusionConcentration gradient
306100135
306100135
Ultrafiltration / Convection Pressure gradient
Hemodialysis‐Diffusion血液透析
血液 進入之處
血液 排出之處
廢物排出 (from patient)
(to patient)
補充液
HIGH 壓力LOW 壓力
Hemofiltration‐Convection血液過濾
透析液(擴散)
補充液(對流;後補充)
動脈端靜脈端
靜脈端 動脈端
HD
HF
HemoDiaFiltration
補充液透析液
Blood In
Blood Out
廢物排出
(from 病人)
(to 病人)
Fluid removal Fluid regulation Normal kidneyIHDPDCRRT
+++
+++
++
+++
++++
-
-
+++
Hemofiltration(CAVH, CVVH)
Hemodialysis(CAVHD, CVVHD)
Hemodiafiltration(CAVHDF, CVVHDF)
Fluid Convection Convection Convection
Solute Convection Diffusion Convection+Diffusion
Back transport
None Possible Possible
CRRT‐Terminology• CAVH(F): Continuous arteriovenous hemofiltration• CAVHD: Continuous arteriovenous hemodialysis• CAVHDF: Continuous arteriovenous hemodiafiltration• CVVH(F): Continuous venovenous hemofiltration• CVVHD: Continuous venovenous hemodialysis• CVVHDF: Continuous venovenous hemodiafiltration• AVSCUF: Arteriovenous slow continuous ultralfiltration• VVSCUF: Venovenous slow continuous ultralfiltration
C‐ Continuous HD‐ hemodialysis V‐ Venous HF‐ hemofiltrationA‐ Arterial HDF‐ hemodiafiltration
有D就會有dialysate (透析液) 有F就有replacement fluid (置換液)
有置換液,無透析液
• 前稀釋法即是在血液過濾器之前給予補充液• 當過濾器易凝固或血比容大於35%以上時,建議使用前稀釋法補充。
有透析液,無置換液
有置換液,有透析液
無置換液,無透析液
名詞定義
縮寫 全 名 原 理 補充液 透析液
H Hemofiltration Convection + -
HD Hemodialysis Diffusion - +
HDF Hemodiafiltration Diffusion +Convection
+ +
SCUF Slow Continuous Ultrafiltration
Ultrafiltration - -
基本原理
• 血液透析過濾(HDF) = 血液透析(HD) + 血液過濾(HF)
• 血液透析(HD)清除中、小分子尿毒效果好• 血液過濾(HF)清除大分子效果好• 置換補充液給予體積越多,大分子清除率越高
敗血症 ?
Infection Sepsis Severe Sepsis MODS Death
1965 2004
死亡率 ~ 50%
定義:由感染(細菌,病毒,黴菌,或劑生物)而導致的全身性炎性反應症候群 (SIRS) 。
疾病特徵 :• 休克(Perl,1995),(Brun‐Buisson,1995) • 血氧過低(Perl,1995) • 多器官系統衰竭(Brun‐ Buisson,1995),(Angus,2001) • 出現瀰漫性血管內凝血反應(Perl,1995 )
Adsorption
ADSORPTION Hemoadsorption, HAHemoperfusion, HP
MOSTMultiple Organ Support Therapy
CRRT
SCUF
CPFA / PP
CO2 Removel
Plasmapheresis
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