Показания к диализу креатинин

Показания к диализу креатинин

. :

—  .

—  30 , 60 , 120 , 180 , 240 .

—  — 90 .

—  — 6 .

—  24 Kt/V.

— 

, Kt/V, , .

Kt/V :

: UrU (/), UrD (/), UrS (/), U24 (), D24 (), W (), , 0,6 0,55

(/) :

: Kr , rU (/), rD (/), rS (/), U24 (), D24 ()

90- , . , .

PD-Adequest (Baxter), PDC (Gambro) Pack PD (Fresenius) 5.

5

,

PD-Adequest (Baxter)

,

Pack PD (Fresenius)

CAPD, CCPD, TPD NIPD

,

PDC — Peritoneal Dialysis Capacity (Gambro)

CAPD, CCPD TPD

PNA/PCR Kt/V

PDC (Rippe, Haraldsson, 1994):

(Ê) (m) (s):

,Jvs — ,sm — m, CP, CD —

:

: JvC=UFcoeff. C (Pcapill-Dpprot-Pip-DpglucDpureaDpNaDpanions)

: JvS=UFcoeff. S (Pcapill-ssDpprot-Pip-ssDpglucssDpureassDpNassDpanions)

: JvL=UFcoeff. L (Pcapill-Pip)

Jv — , UFcoeff. — , Pcapill — , Pip — , Dp — () ,s — .

, , ( 6).

6.

, PDC

(B. Haraldsson, 1994)

, 2

1,73 10%

,

23590 10%

, /

1,49 10%

, /

0,41 10%

, // Hg

0, 069 10%

:

— .

—  ( ).

—  .

—  .

—  .

—  ().

—  .

, , , . . , Brunner F. P. et al. 1975 . C , , , . :

.

T

l

d

U

W

l

q

p

P

S

1

2

3

4

5

6

7

8

9

10

0-6

7-12

13-18

(T) . : , , , . . (l) , . (d) , . (U) , . (W) , , . . . (l) , . :

l= l — [( U+W)/2]

(q) :

q = d / l

c . (p) :

p = l — q.

(P) :

(%) = 100 ´ 1 ´ p2 ´ p3 ´ … ´ px.

( S) 1. :

_________________________________________

S = P ´ Ö q1 ( l1 — d1) + q2 ( l2 — d2) + … + qx ( lx — dx)

, .

t- : ___________

t = (P1 — P2) Ö (S12 + S22 )

— :

P = 100 (l d (l — (U + W) 2))

, , . .

, , , .

( — ) , .

.

, , , . 80% , : 15% , 40% .

(Becks Depression Score (BDI) — Èíäåêñ äåïðåññèè Áåêà; Physical Symptoms Check List — c; Patient Quality of Life Assessment — Îöåíêà êà÷åñòâà æèçíè ïàöèåíòà), c , .

, , . , 32 /. , 1 , , , , . .

().

, , , . 100 / , , , . . , (100 /) Ht (30%) 27% .

.

, , ( 1,0 1,2 //) . (PCRn . :

Uur — .

PCRn , PCRn . PCRn . , PCRn < 0.8 // , > 1.1 // .

PNA (Protein equivalent of Nitrogen Apperance) — , SGA (Subjective Global Assessment) — .

PNA :

PNA (/) = 10.76 (0.69 UNA (/) + 1.46),

UNA — .

PNA .

SGA , 1 7, 7 — .

1.   6 . >10% ( 1-2), 5-10% ( 3-5), <5% ( 6-7). , , .

2.   . , , .

3.   ( ). , . .

4.   . , ( ), , , , .

SGA. , . , , , .

SGA . , SGA . , .

, , . .

:

—  — ;

—  ;

—  ;

—  ;

—  ;

—  , ;

—  .

:

—  ;

—  / , ( , );

—  ;

—  .

:

—  ;

—  , ;

— — .

, .

. ( ) 2-3 6 . 2-4 . , , , , . 1 , (10-20 ). 2-5 . , , , .

, . Kt/V, . Kt/V , .

6 . 6 , Kt/V 4 .

. . , . , .

, 1,73 2 .

Kt/V , (. ).

. .

Watson Hume Mellits-Cheek .

Watson:

: V () = 2,447 + 0,3362 W () + 0,1074 H () — 0,09516 ()

: V () = -2,097 + 0,2466 W () + 0,1069 H ()

Hume:

: V () = -14,012934 + 0,296785 x W () + 0,192786 H ()

: V () = -35,270121 + 0,183809 W () + 0,344547 ()

DuBois and DuBois, Gehan and George Haycock.

DuBois and DuBois: BSA (2) = 71,84 x W ()0,425 ()0,725

Gehan and George: BSA (2) = 0,0235 x W ()0,51456 ()0,42246

Haycock: BSA (2) = 0,024265 x W ()0,5378 ()0,3964

W — (), (), ().

. CAPD Kt/V 2.0 60 /./1.73 2. , , Kt/V, KTtV . , .

NIPD Kt/V 2.2 66 /./1.73 2.

CCPD Kt/V 2.1 63 /./1.73 2 (òàá 7).

7.

Kt/V

, //1,73 2

CAPD

2,0

60

NIPD

2,2

66

CCPD

2,1

63

( Dialysis Outcome Quality Initiative, National Kidney Foundation).



Источник: pandia.ru


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