文档介绍：在线血液透析滤过
Online hemodiafiltration (oLHDF)
费森尤斯医学部
杨洪莹
Title, Subject, Author (c) Copyright 30/12/2014
议程
•传统的血液透析治疗的局限性
•血液透析滤过在临床上的益处
-置换剂量
•血液透析滤过的定义
-滤过分数
• HDF治疗的实现
Fresenius Medical Care – THE PANY Page 2
传统的血液透析的局限性: 长期
Fresenius Medical Care – THE PANY Page 3
尿毒症毒素是一组不同成分的化合物
分子量< 500 d < 500 d > 500 – 12000 d
可溶于水的小分子物质蛋白结合的中分子
Asymmetric dimethylarginine 3-Deoxyglucosone Adrenomedullin
Benzylalcohol CMPF* Atrial natriuretic
peptide
ß -Guanidinopropionic acid Fructoselysine ß 2-Microglobulin
ß -Lipotropin Glyoxal ß -Endorphin 2微球蛋
Creatinine Hippuric acid Cholecystokinin 白
Cytidine Homocysteine Clara cell protein
Guanidine plement factor瘦素 D …
Guanidinoacetic acid Indole对-3甲酚-acetic acid Cystatin C
inic acid Indoxyl硫酸 sulfate吲哚酚… Degranulation
inhibiting protein I
Hypoxanthine 钠 Kinurenine Delta-sleep-inducing
peptide 水
Malondialdehyde Kynurenic acid Endothelin
Methylguanidine 钾… Methylglyoxal Hyaluronic acid
Myoinositol N-carboxymethyllysine Interleukin 1ß
Orotic acid P-cresol Interleukin 6
Orotidine Pentosidine Kappa-Ig light chain
Oxalate Phenol Lambda-Ig light chain
Pseudouridine P-OHhippuric acid Leptin
Symmetric dimethylarginine Quinolinic acid Methionine-
enkepahlin
Urea Spermidine Neuropeptide Y
Vanholder R. et al New insights in uremic toxins. Kidney Int, 2003, 63; 84: S6–S10
Fresenius Medical Care – THE PANY Page 4
oLHDF原理
•结合弥散和对流
–弥散=HFHD
–对流>>HFHD
•超纯透析
•通过特殊的细菌内毒素过滤系统在线生成无菌置换液
Fresenius Medical Care – THE PANY Page 5
oLHDF治疗模式
•具体模式
–前稀释Pre-dilution
–后稀释Post-dilution
Fresenius Medical Care – THE PANY Page 6
普通血液透析(超滤)模式简图
透析液泵
超滤泵
Fresenius Medical Care – THE PANY Page 7
oLHDF前稀释模式简图
透析液泵
超滤泵
置换液泵
Fresenius Medical Care – THE PANY Page 8
oLHDF后稀释模式简图
透析液泵
超滤泵
置换液泵
Fresenius Medical Care – THE PANY Page 9
oLHDF临床上的优势
与普通血液透析相比:
•中大分子毒素清除更好
•血流动力学更稳定
•改善促红细胞生成素反应
•更好地改善微炎症