HowPDWorksCH腹透原理课件.ppt

How PD works 2 腹透原理 2 Min Sun PARK, ., Ph. D., Medical Director Baxter Asia Renal Confidential – Not for distribution Contents of talk 内容? What is peritoneal membrane ? ? Physiology of peritoneal dialysis ? Uremic toxin removal ? Fluid removal ? Sodium removal ? PD prescription ? Adequacy ? Membrane transport: PET ? Indications and contraindications of PD ? Preparing and performing PD ? APD ? Complications related to PD ? Clinical e of PD ? How to set-up PD center ?什么是腹膜? ?腹膜透析( peritoneal dialysis , PD) 的生理学?尿毒症***的清除?液体的清除?钠的清除?腹膜透析处方?充分性?膜转运:腹膜平衡试验(PET) ?腹膜透析的适应症和禁忌症?腹膜透析的准备和实施?自动腹膜透析( automatic peritoneal dialysis, APD) ? PD 相关并发症? PD 的临床预后?怎样建立 PD 中心? Confidential – Not for distribution Goal of Dialysis 透析目标? Maintains symptom-free by replacing some of the functions performed by the healthy kidneys. ? To removes uremic toxins accumulated in the blood ? Water ? Electrolytes ? Urea, creatinine, phosphate, PTH, etc. ?H +? Minimizes mortality and morbidity ? Prevents short- and long-plications ?通过替代正常肾脏的部分功能减轻肾衰时机体相关症状?清除积聚在血液中的尿毒症***?水分?电解质?尿素、肌酐、磷、甲状旁腺激素等等?氢离子?发病率和死亡率最低化?预防短期、长期并发症 Confidential – Not for distribution What is “ adequate ” treatment? 何谓“充分的”治疗?? Avoidance of fluid overload + Blood pressure control + Preservation of residual renal function + Well nourished + Phosphorus control + Acid-base balance + Correction of anaemia + Sufficient removal of uremic toxins - absence of uremic symptoms + MDt/P - physician time per patient Ram Gokal 2002 ?避免水负荷?血压良好控制?保护残存肾功能?营养良好?控制血磷?酸碱平衡?纠正贫血?清除足够的尿毒症***-没有尿毒症相关症状?医生治疗每个病人的时间医生对每个病人的治疗所付出的时间直接关系到病人的治疗质量,这是目前国际上公认的概念医生对每个病人的治疗所付出的时间直接关系到病人的治疗质量,这是目前国际上公认的概念 Confidential – Not for distribution How to achieve it ? 如何达到治疗目标? ? Sufficient fluid and toxin removal: dose of dialysis ? It depends on ? Residual renal function ? Body size ? Co-morbid condition ?充分清除水分和***:透析剂量?有赖于: ?残存肾功能?体形大小?合并症情况 Confidential – Not for distribution How to measure toxin removal ? 如何评估***清除情况? ? Surrogate markers of uremia ? Crea