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長期透析病患低血壓之處置原則
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Transcript of 長期透析病患低血壓之處置原則
- (hypotension) 20-30%(cramps) 5-20%(nausea, vomiting) 5-15 %(headache) 5 %(chest pain) 2-5 %(back pain) 2-5 %(itching) 5 %(fever, chills)
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(intra-dialysis) (pre-dialysis), chronic hypotension
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( (refilling)
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30mmHg100mmHg
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()()
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(blood pressure, BP)= (cardiac output, CO) (total peripheral vascular resistance, TPR)
* C.O. = heart rate (HR) Stroke volume * stroke volume:(70 mL, 70kg)
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Starling forces : oncotic pressure () v.s. hydrostatic pressure ()
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(UF)
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(UF) (refilling)
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5~6%()
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-(constrictive pericarditis):
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(tissue ischemia)SLE
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: acetate (preload)
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: (biocompatibility) (cytokines) (mediators),
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: (1)(2)(volume expansion) : (7.5% saline, 3% saline, 6% dextran, 50% )
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(3)
(4):
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(5) :(albumin) UFL-carnitine (),DOPA, (NSAID), Sertraline (Zoloft) (6) : norepinephrine, phenylepinephrine, caffeine, midodrine, Amezinium
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() (Hct > 25-30%)
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() () (37 35)(HDF) (HF)(PD)
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L-Carnitine: EphedrineFludrocortisoneCaffeineVasopressinSertaline (Zoloft) Midodine (Gutron) Risumic
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Thank you for your attention