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#46
24.12.2006, 14:05
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Öèòàòà:
 
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#47
27.12.2006, 08:07
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Íó ÷òî æ, äèñêóññèÿ íå ñîñòîÿëàñü, òåìà íå àêòóàëüíà, ñîçäàíèå ïðåäëîæåííîãî FAQ êðîìå àâòîðà òîïèêà íèêîãî íå çàèíòåðåñîâàëî.
Òåì íå ìåíåå, áîëüøîå ñïàñèáî âñåì ïèñàâøèì è ÷èòàâøèì, áûëî î÷åíü ïðèÿòíî ïîîáùàòüñÿ. Óñïåõîâ â íîâîì ãîäó! Äìèòðèé Òðîùàíñêèé
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#48
27.12.2006, 13:14
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Öèòàòà:
Ôîðóì ó Ëàøóòèíà çàðàáîòàë, âîññòàíàâëèâàåòñÿ ÷àñòü äèñêóññèè èç ñòàðîãî ôîðóìà. ß äàë òàì ññûëêó- ìîæåò, êòî èç íåôðîëîãîâ çàãëÿíåò- ïîäåëèòñÿ ñâîåé ïåðñïåêòèâîé... Ñïàñèáî åøå ðàç. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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#49
27.12.2006, 16:18
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Öèòàòà:
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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#50
28.12.2006, 00:18
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Öèòàòà:
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#51
28.12.2006, 00:35
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FAQ ¹1 - ×òî òàêîå RIFLE?
Îòâåò: Until recently, a systematic definition of acute renal failure (ARF) was lacking, which led to significant confusion both clinically and in the medical literature. In 2004, the Acute Dialysis Quality Initiative (ADQI) group published the RIFLE classification of ARF, based on changes from the patient's baseline either in serum creatinine level or glomerular filtration rate (GFR), urine output (UO), or both. The RIFLE classification of ARF is as follows: Risk (R) - Increase in serum creatinine level X 1.5 or decrease in GFR by 25%, or UO <0.5 mL/kg/h for 6 hours Injury (I) - Increase in serum creatinine level X 2.0 or decrease in GFR by 50%, or UO <0.5 mL/kg/h for 12 hours Failure (F) - Increase in serum creatinine level X 3.0, decrease in GFR by 75%, or serum creatinine level > 4 mg/dL; UO <0.3 mL/kg/h for 24 hours, or anuria for 12 hours Loss (L) - Persistent ARF, complete loss of kidney function >4 wk End-stage kidney disease (E) - Loss of kidney function >3 months Since baseline serum creatinine level and GFRs are not readily available, the consensus committee recommends the use of the Modification of Diet in Renal Disease (MDRD) equation (see Lab Studies) to estimate the patients GFR/1.73 mm based upon: serum creatinine level, age, gender, and race. The proportional decrease in GFR should be calculated from 70 mL/min per 1.73 mm2, the agreed upon lower limit of normal. Îòñþäà - [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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#52
28.12.2006, 11:39
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Öèòàòà:
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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#53
06.03.2007, 17:22
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...êàê òàì, â "Àëèñå..."- (øåïîòîì)...îíè îïÿòü âçÿëèñü çà ñâî¸..."
Äìèòðèé, îöåíèòå äèñêóññèþ âíèçó... (òîëüêî ó Ëàøóòèíà êîììåíòàðèè íå ñðàçó ïîÿâëÿþòñÿ)
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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#55
09.03.2013, 10:29
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Íó è êàê âàøå òåïåðåøíåå ìíåíèå î CPFA ïðè ñåïñèñå?
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#56
25.03.2013, 10:34
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Äàííûõ íåò, Àëåêñåé.
ß òóò áûë íåäàâíî íà îòå÷åñòâåííîé êîíôåðåíöèè- è òàêîå îùóùåíèå- ÷òî ïîñëåäíèõ äåñÿòè ëåò íå áûëî, âñå ãîâîðÿò îäíî è òî æå, è îðãàíèçàöèÿ ìûñëåé ïðåæíÿÿ. Ìíå ëè÷íî ïîêà ÿ â Ðîññèè íå èíòåðåñíî äîáàâëÿåò ëè ÑPFA ê òåðàïèè ñåïñèñà ïîêà åñòü ÿâíûé áàðäàê â íàçíà÷åíèè äåéñòâèòåëüíî ñïàñèòåëüíûõ äåéñòâèé -ðàöèîíàëüíîé àíòèáèîòèêîòåðàïèè, ïèòàíèÿ, ïðîôèëàêòèêè òðîìáîýìáîëèè è ò.ï.- òî, ÷òî äåøåâî è ñåðäèòî íóæíî äåëàòü, îãíåì, ìå÷îì è äîáðûì ñëîâîì. À â íàøèõ äåëàõ- ïåðâî-íàïåðâî áèòüñÿ çà àäåêâàòíóþ çàìåñòèòåëüíóþ òåðàïèþ- àäåêâàòíîå åå íà÷àëî è çàâåðøåíèå áåç ìèñòèêè è âòîðè÷íûõ âûãîä, ýêçîòèêà ïîòîì
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#57
25.03.2013, 11:13
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Êñòàòè- ê ñëîâó äëÿ íàøåäøèõ ïî ïîèñêîâèêó ëåêöèÿ ñåé÷àñ çäåñü
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] ... åñòü íåáîëüøèå èçìåíåèíÿ, êàñàþùèåñÿ äîçû (25 ìë/êã/÷àñ) è ìàøèí- (äàæå çäåñü óæå Ïðèçìàôëåêñ âñòðåòèøü ÷àùå Ïðèçìû) íî â öåëîì äëÿ îçíàêîìëåíèÿ ïî-ïðåæíåìó îïðåäåëåííóþ öåííîñòü ïðåäñòàâëÿåò
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#58
21.03.2014, 23:14
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Çäðàâñòâóéòå.Êîëëåãè ïðîøó âàøåé ïîìîùè â áîëåå ëó÷øåì ïîíèìàíèè äåëà.
Ó íàñ â ÎÐÈÒ îòíîñèòåëüíî íåäàâíî ïîÿâèëèñü ðàñõîäíèêè ê ôðåçåíèóñ ìóëüòèôèëüòðàò,ïðîâåëè êðàòêóþ ó÷åáó,ñòàëè ðàáîòàòü,ïðèìåðíî çà 1,5 ãîäà ïîÿâèëèñü êîå-êàêèå ïîëîæèòåëüíûå ðåçóëüòàòû,îïûò. Íåäàâíî ïðèåçæàë ïðåäñòàâèòåëü ôðåçåíèóñ,ïðîâîäèë ìàñòåð-êëàññ,âûÿâèëèñü îøèáêè. ñòàëè ðàáîòàòü ïî åãî ðåêîìåíäàöèÿì,ïîÿâèëèñü íîâûå âîïðîñû.Ïðîøó âàøåé ïîìîùè,÷òîáû ðàçîáðàòüñÿ. Ðàáîòàåì ñ íàáîðàìè CVVH è CVVHDF. Îáúåìîçàìåùåíèå 35ìë/êã/÷àñ, ïîòîê êðîâè 150-200 ìë/ìèí, à âîò ñ ïàðàìåòðàìè óëüòðàôèëüòðàöèè ïðîáëåìû... Ðàíüøå ìû êàê ðàñ÷èòûâàëè,ê ïðèìåðó íóæíî ó áîëüíîãî çà ïðîöåäóðó çàáðàòü 2000 ë æèäêîñòè, ìû ñòàâèëè 80ìë/÷àñ è ïîëó÷àëè ðåçóëüòàò,îòåêè óõîäèëè,áîëüíûì ñòàíîâèëîñü ëó÷øå. À ïîñëå ìàñòåð êëàññà âûÿñíèëîñü ÷òî ïàðàìåòð óëüòðàôèëüòðàöèè íóæíî ñòàâèòü îò 200-400 èëè áîëüøå( 20% îò ïîòîêà êðîâè).Ìàñòåð îáúÿñíèë ýòî êàê îáúåì îáðàçóþùåéñÿ â îðãàíèçìå âîäû,èëè ïåðâè÷íàÿ ìî÷à. Íî ó ìåíÿ â ãîëîâå íå óêëàäûâàåòñÿ, åñëè åìó ñòàâèòü íà ñóòêè 200 ìë/÷àñ óëüòðàôèëüòðàöèþ ó íåãî çàáåðåòñÿ 4,800 ëèòðîâ æèäêîñòè,à åñëè ìî÷èòñÿ,ïëþñ òåìïåðàòóðèò,ïîòåðè äðóãèå åùå åñòü,òî ñêîëüêî æå åìó âëèòü ïðèäåòñÿ æèäêîñòè â âåíó è âûïèòü... Ïîæàëóéñòà ïðîøó âàøåé ïîìîùè â ðàçáîðå äàííîãî âîïðîñà! Çàðàíåå ñïàñèáî!
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#59
29.06.2014, 16:04
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Ìû ëåãêî óëüòðàôèëüòðèðóåì 100-400 ìë.÷àñ.
Ìíå êàê ÷åëîâåêó ñëåäÿùåìó çà áîëüíûì è êðóòÿùåìó ìàøèíó, ñòàâèòñÿ çàäà÷à ñäåëàòü áîëüíîãî ñêàæåì 150 ìë\÷àñ íåòòî íåãàòèâíûì. Òî åñòü ÿ ñ÷èòàþ ñêîëüêî ó áîëüíîãî ñðåäíåå ïîòðåáëåíèå æèäêîñòè ñ ÷àñ, ïðèáàâëÿþ ê ýòîìó íàñêîëüêî ñóõèì ÿ õî÷ó åãî ñäåëàòü (150 ìë â äàííîì ñëó÷àå) è âûñòàâëÿþ óæå â ìàøèíå ýòó öèôðó íà áëèæàéøèé ÷àñ. Êàæäûé ÷àñ ïåðåñìàòðèâàþ.  ïðèíöèïå, ïðè çàäà÷å ïîñóøèòü áîëüíîãî ìîæíî è ïîñòåïåííî óâåëè÷èâàòü óëüòðàôèëüòðàöèþ äî ïîëóëèòðà â ÷àñ ïðè óñëîâèè ÷òî äàâëåíèå è ïðî÷èå ïàðàìåòðû íå ñòðàäàþò. Ñêîðîñòè öèðêóëÿöèè êðîâè â 150-200 ìë\ìèí âïîëíå äîñòàòî÷íî. Ñîáòâåííî óëüðàôèëüòðàöèÿ ñîâìåùàåòñÿ âìåñòå â ïîëíîé ïðîãðàììîé CVVHDF. Èëè íà Ïðèçìàôëåêñå èëè íà Àêâàðèóñå (áàðàõëî, à íå ìàøèíà). Àíòèêîàãóëèðóåì öèòðàòîì èëè ðåæå ãåïàðèíîì. Èíîãäà âîîáùå íè÷åì, íî òîãäà êîíå÷íî ñèñòåìû íà äîëãî íå õâàòàåò.
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Ëèíåéíûé âèä
