腹透患者水和电解质的调控课件.ppt
- 【下载声明】
1. 本站全部试题类文档,若标题没写含答案,则无答案;标题注明含答案的文档,主观题也可能无答案。请谨慎下单,一旦售出,不予退换。
2. 本站全部PPT文档均不含视频和音频,PPT中出现的音频或视频标识(或文字)仅表示流程,实际无音频或视频文件。请谨慎下单,一旦售出,不予退换。
3. 本页资料《腹透患者水和电解质的调控课件.ppt》由用户(ziliao2023)主动上传,其收益全归该用户。163文库仅提供信息存储空间,仅对该用户上传内容的表现方式做保护处理,对上传内容本身不做任何修改或编辑。 若此文所含内容侵犯了您的版权或隐私,请立即通知163文库(点击联系客服),我们立即给予删除!
4. 请根据预览情况,自愿下载本文。本站不保证下载资源的准确性、安全性和完整性, 同时也不承担用户因使用这些下载资源对自己和他人造成任何形式的伤害或损失。
5. 本站所有资源如无特殊说明,都需要本地电脑安装OFFICE2007及以上版本和PDF阅读器,压缩文件请下载最新的WinRAR软件解压。
- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- 患者 电解质 调控 课件
- 资源描述:
-
1、腹膜透析患者的容量控制腹膜透析患者的容量控制山东省立医院肾内科王荣ESRD的流行病学状况的流行病学状况美国美国欧洲欧洲台湾台湾中国大陆中国大陆机会与挑战机会与挑战肾脏替代治疗方式选择肾脏替代治疗方式选择肾移植肾移植中心血液透析中心血液透析腹膜透析腹膜透析家庭血液透析家庭血液透析各种替代治疗的生存率各种替代治疗的生存率影响病人生存的主要因素影响病人生存的主要因素心血管事件心血管事件容量负荷的重要性容量负荷的重要性容量平衡对维持性透析患者至关重要容量平衡对维持性透析患者至关重要高血压、心衰常见,危害严重高血压、心衰常见,危害严重普及相关知识,提高依从性,可显著提高普及相关知识,提高依从性,可显著提
2、高病人生活质量及生存率病人生活质量及生存率血压正常血压正常无浮肿无浮肿体重稳定体重稳定血压低血压低体重下降体重下降无浮肿无浮肿可伴电解质紊乱可伴电解质紊乱血压高血压高可伴浮肿可伴浮肿体重增加体重增加容量不平衡容量不平衡容量负荷过多容量负荷过多容量过低容量过低Difference in BP Control by Dialysis Modality as Reported by NKF Taskforce on CV Disease高血压的发生率在血透患者中占高血压的发生率在血透患者中占 80%,腹透患,腹透患者中占者中占 50%左右左右无论是腹透还是血透患者,高血压都没有很好的无论是腹透还是血
3、透患者,高血压都没有很好的控制。相比之下,腹透患者控制好于血透患者控制。相比之下,腹透患者控制好于血透患者腹透患者血压低于血透患者归功于其缓慢超滤更腹透患者血压低于血透患者归功于其缓慢超滤更成功地达到干体重成功地达到干体重Mailloux LU,Levey AS,AJKD,1998;32(Suppl3.)S120-S141CAPD 患者存在容量患者存在容量负负荷荷过过多多 实验设计实验设计 203 203 稳定稳定 CAPDCAPD患者患者 A A组:组:充分脱水充分脱水 B B组:组:水负荷轻度增多水负荷轻度增多 CC组:中组:中-重度水负荷增多重度水负荷增多结论结论 1)30%1)30%患
4、者临床上有水负荷增多患者临床上有水负荷增多 2)2)水负荷增多表现为收缩压和平均动脉压升高水负荷增多表现为收缩压和平均动脉压升高Nakayama M et al.Perit Dial Int 2002;22:411-414Humoral effector machanisms:RAASVasopressincatecholaminesprostaglandinskinin-Kallikrein systemAtrial natriuretic peptideendothelium-derived factors Renal sympathetic nerves为什么会出现容量不平衡为什么会出现
5、容量不平衡?在处方不变和腹膜在处方不变和腹膜转运特性不变的情转运特性不变的情况下,从腹膜透析况下,从腹膜透析中获得的超滤量是中获得的超滤量是恒定的。恒定的。有必要定期评估患者的容量情况,并调整透析处方有必要定期评估患者的容量情况,并调整透析处方腹膜透析腹膜透析膜两侧的浓度膜两侧的浓度梯度清除毒素梯度清除毒素膜两侧的渗透膜两侧的渗透压差清除水分压差清除水分基础知识介绍基础知识介绍GENERAL PRINCIPLES OF TRANSPORT ACROSS THE PERITONEAL MEMBRANE surface area of the peritoneal membrane is betw
6、een 1.0 and 1.3 m2 in adultsonly about one-third of the visceral peritoneum is in contact with the dialysis solution at a given timeThere are three barriers between the dialysate in the peritoneum and capillary blood:the capillary wall;the interstitium;and the mesothelial cell layer.Pores for solute
7、 transport small pores(average radius 40 to 50)mediate the transport of lower molecular weight solutesThe large pores constitute less than 0.1 percent of the total number of pores but are much larger than the small pores(average radius 150)Ultrasmall pores(3 to 5),which constitute the third pore,Aqu
8、aporin-1 Aquaporin-1 and water transport the same water channel present in red blood cells and the proximal tubule,but different from aquaporin-2,which is the antidiuretic hormone-sensitive water channel in the collecting tubuleAquaporin-1 is present in the endothelial cells of the peritoneal microv
9、asculature as the major water channel Peritoneal tissue also contains small numbers of aquaporin-3 and aquaporin-4The aquaporin system is responsible for transcellular water transport induced by the osmotic gradient created by adding hypertonic dialysate to the peritoneum.it accounts for approximate
10、ly 40 percent of total capillary ultrafiltrationthe small pore water transport is dependent upon non-osmotic determinants MTAC vs D/PThe concept of mass transfer area coefficient represents the theoretical maximal peritoneal clearance by diffusion at time zeroThe relationship between D/P ratios and
11、MTAC is generally linear.However,D/P values may overestimate or underestimate MTAC when the MTAC is very low or very high,respectively The MTAC for sodium is 4 mL/min when 3.86%glucose is used as a dialysate,while values of 9 mL/min have been reported for chloride the MTACs for urea and creatinine a
12、re approximately 16.0 and 9.4 mL/min per 1.73m2,respectively.The average MTAC for the clearance of potassium by diffusion is between 12 and 16 mL/min in patients on CAPD.Potassium may be also be released from the peritoneal lining,resulting in MTAC values as high as 24 mL/min during the first hour.F
13、luid transport-TCUFTCUF is determined by the difference between the cumulative fluid transfer into the peritoneal cavity by ultrafiltration and the uptake of fluid out of the peritoneum predominantly through peritoneal lymphatics.Transcapillary ultrafiltration of water occurs via the small pores in
展开阅读全文