腹膜透析充分性优秀PPT.ppt
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1、Anatomy of The PeritoneumAnatomy of The PeritoneumThe lining of the abdominal cavity Two layers:parietal(壁层)-lines the anterior wall and undersurface of the diaphragm-20%of total SA;blood supply fromabdominal wallvisceral(脏层)-covers the abdominal organs-80%of total SA;blood supply from mesenteric aa
2、 and portal vvGokal R,Textbook of PD,pp.61-70Anatomy of The PeritoneumAnatomy of The PeritoneumSize 1.5 2 m2;approximates BSA Highly Vascular Semi-permeable/bi-directional“Lymphatic”drainage through diaphragmatic stomata(腹膜孔)Continuous with Fallopian Tubes(输卵管)in femalesIt is important to be aware o
3、f the continuity of the peritoneal cavity with theFallopian tubes as retrograde menstruation(逆行性月经)-which may occur in any woman but goes undetected-will cause bloody dialysate and create concern in the PD patient.Transport Processes in PeritonealTransport Processes in PeritonealDialysisDialysisOsmo
4、sis(渗透)-Movement of water from an area of higher concentration(lower solute concentration)to an area of lower concentration(higher solute concentration)Diffusion(扩散)-Movement of solute from an area of higher concentrationto an area of lower concentrationModels of Peritoneal TransportModels of Perito
5、neal Transport The three pore modelThe three pore model The pore-matrix model The pore-matrix model The distributed model The distributed modelThese models are not mutually exclusive;rather they should be viewed as complementary to one another.T Transport Across the Peritoneal ransport Across the Pe
6、ritoneal Endothelium:The Three Pore ModelEndothelium:The Three Pore Model Large pores(100-200)few in number(3%of SA)transport macromoleculesclefts between endothelial cells Small pores(40-60)most numerous(95%of SA)allow transport of small solutes and waterpostulated to be clefts in the endothelium;h
7、ave not been demonstrated anatomically BasedTransport Across the Peritoneal Transport Across the Peritoneal Endothelium:The Three Pore Model(Endothelium:The Three Pore Model(续)Ultrasmall(transcellular)pores(4-6)many in number(but only 2%of SA)transport water only(Na sieving)Demonstrated to be AQP 1(
8、水通道蛋白)Water Transport in Aquaporin-1Water Transport in Aquaporin-1Knockout MiceKnockout MiceYang et al.AJP 276:C76,1999问题:假如反复在90分钟放出腹透液,对病人电解质会产生什么影响?Ultrafiltration in PD:Ultrafiltration in PD:The Pore-Matrix ModelThe Pore-Matrix Model多糖包被,细胞衣Effective Peritoneal Surface AreaEffective Peritoneal S
9、urface AreaIncreased“effective”peritoneal surface area may occur:During peritonitis After prolonged exposure to high glucose-containing fluids这就是为什么腹膜炎时和长期透析后这就是为什么腹膜炎时和长期透析后“PET高转运的缘由!高转运的缘由!Kt/V(HD)=ln(R.008xt)+(43.5xR)x0.55UF/WAdequacy is a concept,not a number,and includes more than the issues l
10、isted above.Fun fact:Urea was discovered by Hilaire Rouelle in 1773.It was the first organic compound to be artificially synthesized from inorganic starting materials,in 1828 by Friedrich Woehler.残肾GFR 计算残肾GFR=(肾尿素清除率+肾肌酐清除率)/2;肾尿素清除率(ml/min)=(尿尿素血清尿素)24 h 尿量 1 440肾肌酐清除率(ml/min)=(尿肌酐血清肌酐)24 h 尿量 1 4
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