CVVH模式下体外循环部分的血流动力学关系理论模型推导及分析  

Derivation and analysis of the theoretical model of hemodynamics in the extracorporeal circulation of CVVH mode

作　　者：武云珍 Wu Yunzhen(Dongying People's Hospital,Dongying 257091,China)

机构地区：[1]山东省东营市人民医院重症医学科,山东东营257091

出　　处：《中华重症医学电子杂志》2020年第4期431-438,共8页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

摘　　要：目的使用相关定律或数学关系,推导出CVVH不同稀释模式与不同位置处的压力、流量、阻力三者之间的数学关系,以此来更好地理解CRRT的运行与压力信息的分析。方法根据欧姆定律、泊肃叶定律、肾小球滤过率,推导出前置换、后置换、前后置换联合三种情况下,滤器、滤膜、静脉壶、深静脉导管四个位置的相关指标间关系。结果1.在滤器部位:(1)滤器前后的压力差取决于流经滤器的流量及滤器阻力。(2)滤器阻力主要取决于流经滤器的混合溶液的黏滞度,及毛细小管的直径、数量。2.在滤膜部位:跨膜压(静水压)与跨膜流量(滤液)、滤膜的面积、滤膜的通透性、及滤器内的胶体渗透压有关。3.在静脉壶和静脉导管部位:滤器后压力(回路端压力)主要反应静脉壶与静脉导管的阻力。结论将CRRT之CVVH模式运行相关的所有数据以公式形式列出,可以更直观的分析各个因素之间的相关性,简单易懂,全面不易遗漏,有良好普及性,可以帮助临床更好地操作分析CRRT。Objective To better understand the operation and pressure information of CRRT by deducing the hemodynamic relationship in extracorporeal circulation of CVVH mode.Methods It was divided into three dilution modes and four parts in CVVH mode.The mathematical formulas were developed based on Ohm law,Poiseuille law and the physiology of GFR.Results 1.In Filter part,the pressure difference between the pre-Filter and post-Filter is determined by the resistance and flow of Filter.2.In Filtermembrane part:TMP is determined by the value of filtration,the area and the permeability of the membrane,and the colloid osmotic pressure in Filter.3.In Venous-chamber and Venous-catheter part:the Post-Filter pressure is a reflection of total resistance of chamber and catheter.Conclusion The hemodynamic relationship in extracorporeal circulation of CVVH mode could be analyzed more clearly with the mathematical models.

关 键 词：持续肾脏替代治疗 持续静脉-静脉血液滤过 欧姆定律 泊肃叶定律 血滤机报警分析 

分 类 号：R459.7[医药卫生—急诊医学] R459.5[医药卫生—治疗学]