1.Claire Gartland.CC PHNG TH C I UTR THAY TH TH N (CRRT) T ng h p t InternetBS. ng Thanh Tu n (bin d ch) dangthanhtuan65@gmail.comT ng Solution: dung d ch, s ha tan Solvent: dung mi, c kh nng ha tan Solute: ch t tan Ultrafilration: siu l c Diffusion: khu ch tn Convection: i lu Dialysate: d ch th m phn Effluent: d ch th i dangthanhtuan65@gmail.comKinetics of Haemofiltration1

2. Claire Gartland. N I DUNG nh ngha l c mu (hemofiltration) C ch c a l c mu Cc phng th c i u tr thay th th n dangthanhtuan65@gmail.com nh ngha l c mu Phng php i u tr an ton, chnh xc vhi u qu ki m sot ur mu v cn b ngd ch m khng nh h ng x u n tnh tr ngtim m ch.(Ronco and Bellomo 1998) dangthanhtuan65@gmail.comKinetics of Haemofiltration 2 3. Claire Gartland.C U T O MNG L CV t li u c u t o mng l c hemofiltration:polysulfonepolyacrylonitrilepolyamide dangthanhtuan65@gmail.comC u t o mng l c Hemofilter Mu vo C t ngang Dialysate S i r ng ra(hollow fiber) Dialysate Ngn ngoi (d ch l c)vo Ngn trong (mu) Mu ra dangthanhtuan65@gmail.comKinetics of Haemofiltration 3 4. Claire Gartland.MNG L C ng mu voV PolycarbonateH ng mu Mng ch yPolyurethaneD chD ch l c l c ra dangthanhtuan65@gmail.comNguyn t c c a CRRT L y d ch d: Siu l c (Utrafiltration) i lu (Convection) L y cc ch t tan: Khu ch tn (Diffusion) i lu (Convection) dangthanhtuan65@gmail.comKinetics of Haemofiltration4 5. Claire Gartland.Ssiu l c (ultrafiltration) L s di chuy n d ch qua mng bn th m dochnh l ch p l c dangthanhtuan65@gmail.com S siu l c L c lm di chuy n d ch qua mng bn th mc th l p l c m ho c dng.P L C M: p l c m c t o ra bn pha ngn d chl c, do l c ht c a bm d ch th i L c m ny l l c ko (pulling pressure) htd ch t pha ngn mu sang pha ngn d chl c dangthanhtuan65@gmail.comKinetics of Haemofiltration5 6. Claire Gartland.S siu l cP L C DNG p l c dng c t o ra bn pha ngnmu, t o ra do l c y c a bm mu p l c dng l l c y (pushing pressure)s y n c t ngn mu sang ngn d ch l cdangthanhtuan65@gmail.comS siu l c p l c dng c t o ra trong ngn muc a hemofilter do bm mu y mu tr vb nh nhn ho c do huy t p ng m ch. yl p l c dng. p l c m trong ngn d ch l c c th t o b ibm ht d ch ra ho c do ti ch a d ch thuth p th p xu ng d i lm tng chnhtr ng l c.dangthanhtuan65@gmail.comKinetics of Haemofiltration6 7. Claire Gartland.Skhu ch tn (Diffusion)Diffusion: l s di chuy n cc ch t tan t ni c n ng cao n ni c n ng th pxuyn qua m t mng bn th m cho n khin ng 2 ngn thng b ng nhau.dangthanhtuan65@gmail.com S khu ch tn S v n chuy n ch t tan qua mng bn th m do s chnh l ch n ng C ch v n chuy n th ng T t cho cc ch t tan TLPT nhdangthanhtuan65@gmail.comKinetics of Haemofiltration7 8. Claire Gartland. Diffusion dangthanhtuan65@gmail.comS khu ch tn V n chuy n khu ch tn l s di chuy n ch ttan m khng c di chuy n c a dung mi. T c khu ch tn ph thu c vo: a) Kch c c a ch t tan (phn t l n th khu ch tn ch m hn phn t nh ) b) Kho ng cch khu ch tn (kho ng cch ng n hn, khu ch tn nhanh hn). V d : mng dy hn th cc ch t tan khu ch tn ch m hn c) Kch th c l v di n tch b m t c a mng l c dangthanhtuan65@gmail.comKinetics of Haemofiltration8 9. Claire Gartland.HemodialysisTh i ra ngoiDialysate raMu i vo (t b nh nhn)Dialysate voMu i ra (tr v b nh nhn)N ng th p N ng cao dangthanhtuan65@gmail.com dangthanhtuan65@gmail.comKinetics of Haemofiltration 9 10. Claire Gartland.S i lu (Convection) Convection: s di chuy n c a ch t tan km theodi chuy n n c solvent drag, qua mng bnth m do tc ng c a p l c.dangthanhtuan65@gmail.comS i lu S di chuy n d ch qua mng bn th m i theo s d ch chuy n c a ch t tan SOLUTE DRAG L c ch v n chuy n ch ng T t cho cc ch t tan c TLPT nh v trung bnhdangthanhtuan65@gmail.comKinetics of Haemofiltration10 11. Claire Gartland.Convection dangthanhtuan65@gmail.comS i lu S di chuy n c a ch t tan t l thu n v i sdi chuy n c a dung mi S di chuy n c a dung mi ph thu c vo chnh l ch p l c. Lu l ng cng tng thanh th i cng t t. S i lu cng nh h ng b i tnh th m(kch th c l = pore size) c a mng. dangthanhtuan65@gmail.comKinetics of Haemofiltration11 12. Claire Gartland. S i lu Cc ch t tan c kch th c trung bnh, khi skhu ch tn b ch m, th s i lu l c chchnh duy nh t. S thanh th i ch t tan ph thu c: a) M c p l c siu l c b) N ng ch t tan trong plasma c) Tnh ch t mng l c dangthanhtuan65@gmail.com HemofiltrationTh i ra ngoi Mu i vo (tb nh nhn) D ch thayth Mu i ra(tr v b nh nhn) p l c th pp l c cao dangthanhtuan65@gmail.comKinetics of Haemofiltration12 13. Claire Gartland.Tr ng l ng phn t(ch t tan)Daltons Inflammatory Mediators (1,200-40,000)largemiddlesmalldangthanhtuan65@gmail.comdangthanhtuan65@gmail.comKinetics of Haemofiltration13 14. Claire Gartland.Cc phng th c CRRTdangthanhtuan65@gmail.com1. S.C.U.FSlow continuous ultrafiltration (Siu l c ch m lin t c) Mu i vo chu trnh tu n hon ngoi c thqua mng l c theo ki u M-TM ho c TM-TM. D ch siu l c sinh ra do tr ng l c ho c bmht trong khi v n chuy n qua mng m khng c thay th . Th tch d ch siu l c = chnh xc s s t cnc a b nh nhn.dangthanhtuan65@gmail.comKinetics of Haemofiltration 14 15. Claire Gartland.S.C.U.FSlowcontinuousultrafiltrationdangthanhtuan65@gmail.com S.C.U.F N c v cc ch t tan t huy t tng ctch kh i mu b nh nhn qua m t mng bnth m lu l ng th p (lo-flux semi-permeablemembrane). Hi u qu l y ch t tan th t v ch b ng phngphp i lu. V l ch s : ban u ng i ta s d ng huy t pb nh nhn nh l bm y mu vo chu trnh(A-V). Tr ng l c c tc d ng nh l c i lu. Ngy nay: ng i ta s d ng bm mu v bmd ch l c cho chnh xc.dangthanhtuan65@gmail.comKinetics of Haemofiltration 15 16. Claire Gartland.dangthanhtuan65@gmail.com S.C.U.F T c siu l c = 50-100ml/hr p d ng: dng ki m sot l ng d ch d(qu t i) c a b nh nhn. C th vi gi 24gi /ngy. Th ng ch s d ng cc mng l c nh v chc n t c siu l c th p. Khng th ng xuyn s d ng trong l c mu(blood purification).dangthanhtuan65@gmail.comKinetics of Haemofiltration16 17. Claire Gartland.2. C.A.V.H Continuous Arterio-Venous Haemofiltration Mu i vo chu trnh ngoi c th qua m t mng c tnh th m cao theo phng th c M TM (khng dng bm mu). S siu l c sinh ra do tr ng l c (khng dng bm d ch th i). T c siu l c cao hn s s t cn c a b nh nhn v c n truy n vo d ch thay th qua bm. Thay th d ch m t ph n ho c hon ton ty m c tiu l c mu v ki m sot th tch mu.dangthanhtuan65@gmail.com C.A.V.H Continuous arterio-arterio- venous haemofiltrationdangthanhtuan65@gmail.comKinetics of Haemofiltration 17 18. Claire Gartland.C.A.V.H 1977, Peter Kramer l n u m t k thu tCAVH. Huy t p ng m ch y mu qua chutrnh ngoi c th qua mng c tnh th m cao vkhng c n bm mu. p l c th y tnh (do tr ng l c) s siu l cv s i lu ch t tan x y ra. p l c xuyn mng c tng ln b ng cch t ti ch a d ch th p xu ng, v v y lm tng pl c m bn pha ngn d ch.dangthanhtuan65@gmail.comC.A.V.H S siu l c th ng nhi u hn m c th tch c nki m sot, v v y c n thi t b i hon d ch thayth .D CH THAY TH : M t s ch t tan c n thi t c trong d ch thay th(cc ion Na, Cl, Ca, Mg, HCO3) cn b ng ionv p l c th m th u mu. Cc ch t tan khng mong mu n (K+, H+, ur ...)khng c thay th do n ng trong mucc ch t ny cng lc cng gi mdangthanhtuan65@gmail.comKinetics of Haemofiltration18 19. Claire Gartland. C.A.V.H T c siu l c 10-15 ml/pht S lm s ch mu ch nh vo s i lu.Cc i m gi i h n: Ph thu c vo huy t p b nh nhn Tnh an ton Khng c h th ng bo ng Tnh hi u qu khng c h th ng ki m sotchnh xc d ch l y ra dangthanhtuan65@gmail.comC.V.V.H Continuous Veno-Venous Haemofiltration(non-automated) Gi ng nh CAVH nhng th c hi n qua phngth c TM TM v v y c n c bm y mu vochu trnh. S siu l c sinh ra do tr ng l c (khng dngbm d ch th i). T c siu l c cao hn s s t cn c a b nhnhn v c n truy n vo d ch thay th qua bm. Thay th d ch m t ph n ho c hon ton ty m ctiu l c mu v ki m sot th tch mu. dangthanhtuan65@gmail.comKinetics of Haemofiltration19 20. Claire Gartland. C.V.V.H Continuous Veno-Venous Veno- Haemofiltration (non- (non-automated)dangthanhtuan65@gmail.com C.V.V.H (non-automated) CVVH c s d ng l y c 2 phn t kchc nh v trung bnh v ki m sot cn b ngd ch. D ch truy n cng s d ng t m c tiu lms ch mu. p l c xuyn mng tng khi lm th p ti ch ad ch th i. T c bm mu 80-300 ml/pht, y u t chnh t hi u qu i u tr T c siu l c 10-30 ml/phtdangthanhtuan65@gmail.comKinetics of Haemofiltration 20 21. Claire Gartland. C.V.V.H(automated) K thu t gi ng nh CVVH non-automated,i m duy nh t khc l t c siu l c cki m sot b ng m t bm tnh ton c t c d ch l y ra.dangthanhtuan65@gmail.com C.V.V.H Continuous Veno-Venous Veno- Haemofiltration (automated)dangthanhtuan65@gmail.comKinetics of Haemofiltration 21 22. Claire Gartland.dangthanhtuan65@gmail.com C.V.V.H.D Continuous Veno-Venous Haemodialysis K thu t ny cng dng phng th c TM-TMthng qua m t bm mu. D ch th m phn (dialysate) i ng c chi u v imu cng b ng ki m sot b ng m t bm. D ch l c ra ki m sot b ng 1 bm quy t nhm c s t cn b nh nhn. Thanh th i ch t tan b ng phng php khu chtn. Khng c n d ch thay th .dangthanhtuan65@gmail.comKinetics of Haemofiltration 22 23. Claire Gartland. EFFLUENT/ ULTRAFILTRATEC.V.V.H.D CONTINUOUS VENO-VENO-VENOUSHAEMODIALYSISdangthanhtuan65@gmail.comdangthanhtuan65@gmail.comKinetics of Haemofiltration 23 24. Claire Gartland. C.V.V.H.D Continuous Veno-Venous Haemodialysis L ng d ch th i v siu l c tng ng v i sm t cn b nh nhn. S thanh th i ch t tan nh vo s khu ch tn:ch t tan khng mong mu n trong mu (n ng cao) s khu ch tn vo d ch th m phn (n ng th p). i u tr ny r t c hi u qu trong m c tiu l ycc ch t tan TLPT nh . T c bm mu: 80-200 ml/pht. Lu l ng d ch th m phn 17-33 ml/pht (1-2Lt/gi ).dangthanhtuan65@gmail.com C.V.V.H.D.FContinuous Veno-Venous Haemo-Diafiltration Mu qua mng l c tnh th m cao nh vo m tbm mu theo phng th c TM-TM. D ch th m phn i ngn d ch l c ng c chi uv i mu, cng nh m t bm. D ch th i/siu l c c l y ra v i s ki m sotc a m t bm D ch thay th c thm vo cng nh m tbm t c s lm s ch mu nh mongmu n Thanh th i ch t tan nh vo c hai: s khu chtn v s i lu.dangthanhtuan65@gmail.comKinetics of Haemofiltration24 25. Claire Gartland.C.V.V.H.D CONTINUOUSVENO-VENO-VENOUS HAEMODIAfILOTRATION dangthanhtuan65@gmail.com dangthanhtuan65@gmail.comKinetics of Haemofiltration25 26. Claire Gartland.C.V.V.H.D.FContinuous Veno-Venous Haemo-Diafiltration Trong CVVHDF c 4-5 bm: Bm mu theo mode TM-TM. Bm d ch th m phn: a d ch i ng c chi u v i mu, trong ngn d ch. Bm d ch thay th (1-2 bm): tr c mng (pre-filter) ho c sau mng (post-filter) ty m c lm s ch mu c n thi t. Bm d ch th i ra/d ch siu l c: ty m c s t cn mong mu n. dangthanhtuan65@gmail.comC.V.V.H.D.FContinuous Veno-Venous Haemo-Diafiltration Hi u qu l y cc ch t TLPT nh v trung bnh Lu l ng mu: 80-200 ml/pht T c d ch th m phn: 1-2 l/gi T c siu l c: 2-4 l/gi y l phng php ph i h p gi ahemodialysis v haemofiltration. dangthanhtuan65@gmail.comKinetics of Haemofiltration 26 27. Claire Gartland. T.P.ETherapeutic Plasma Exchange Mu qua mng bn th m (g i l plasma filter)theo phng th c TM-TM b ng l c y c abm mu. D ch th i ra l huy t tng, c ki m sot b im t bm d ch th i. Huy t tng ti ng l nh (F.F.P) ho c dungd ch albumine (H.A.S) ng vai tr l d ch thayth v c bm vo b ng m t bm. S thay th ny l thay th hon ton.dangthanhtuan65@gmail.comFFP/ALBUMIN PLASMA FILTER T.P.E Therpaeutic Plasma Exchangedangthanhtuan65@gmail.comKinetics of Haemofiltration 27 28. Claire Gartland.T.P.E Therapeutic Plasma Exchange Huy t tng th i ra ch a cc ch t tan b nh l( c ch t, protein b t th ng) Phng php ny i u tr gin o n, ch vi gitrong 1 ngy. Lu l ng mu: 100-200 ml/pht T c siu l c: 0.5-2 lt/gidangthanhtuan65@gmail.com Haemoperfusion Mu c y b ng bm mu vo m t mngl c ch a ch t h p ph l than ho t tnh(charcoal filter). Khng c siu l c Khng thay th d ch Ch nh trong ng c thu c v h i ch ngnhi m khu n huy t giai o n s m. Lu l ng mu 100-200 ml/phtdangthanhtuan65@gmail.comKinetics of Haemofiltration 28 29. Claire Gartland.Adsorption dangthanhtuan65@gmail.comHAEMOPERFUSION dangthanhtuan65@gmail.comKinetics of Haemofiltration29