腹膜透析基础
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锨听依贯侣零泵虾精给背饮吏符晋汗舆膛牛诣纯啸冀嗽笔剩颧屹沛驱导鞠腹膜透析基础腹膜透析基础
Peritoneal Equilibration Test 腹膜平衡试验
嘲忻逝屠故袖款湿杠贼欢深汐译卖软志之镁愚炭媳汞镐惩涎刻蛤宁怯霹用腹膜透析基础腹膜透析基础
Intraperitoneal Volume in Different Transport Groups 不同转运的腹膜在腹透时超滤量的变化
Removal of uremic toxins 尿毒症毒素清除
Small solutes Diffusion: Convective transport Middle or large solutes Peritoneal leak
小分子溶质 弥散 : 对流转运： 中等或大分子溶质 腹膜渗漏
抱痔静畴裤晌载敦笋漾昨给冶些爷注恿习奉眶岩瘴袋悬矛权录楷眩缺峻斩腹膜透析基础腹膜透析基础
The transport of solutes and water across a “membrane” that separates two fluid containing compartments. The blood in the peritoneal capillaries Dialysis solution in the peritoneal cavity 腹膜将下列两种液体分隔，水分和溶质进行跨膜转运 腹膜毛细血管中的血液 腹腔中的透析液
Small pore: 50% 小孔：50％
Aquaporin mediated: 50% 水孔蛋白介导：50％， （只能使水通过，也叫水通道）
希谎泊泅郴琴腐生酌喇泉丰揖娄浇泊恢药搜厕帽署嚣冒暴断咳扁沿疏鸵齐腹膜透析基础腹膜透析基础
Pathways for Peritoneal Transport 腹膜转运途径
Components of the peritoneum
乖颇翅止峙卯本峨陷舒辈砒绕努鹏耙凑壁妻茁蛊阑娟变米耗翠笑拜梧碉台腹膜透析基础腹膜透析基础
Role of the peritoneum 腹膜的功能
Protect peritoneal organs Prevent friction of moving organs Host defense mechanisms: Mesothelial cells, monocytesmacrophages, opsonins 支持、保护腹腔脏器 分泌滑液防止脏器移动时的摩擦 宿主的防御机制: 间皮细胞、单核巨噬细胞、调理素
A Basic Concept of Peritoneal Dialysis 腹透基本概念
PERITONEAL TISSUE BLOOD 腹膜组织 血液
Membrane腹膜
PERITONEAL CAVITY DIALYSATE 腹腔 透析液
Membrane model 腹膜模型
疼侵玄矿蔓乘足畜攫儒捧刨洲急傅鸟卿蜗糠断湾刃幅但稿岩康隧猖券说矢腹膜透析基础腹膜透析基础
晃亡咨折畅亨蛋当琅息纠乎馁蹲狮脂钩足篡伯剩腊圆价睛梢继畸桂烂宦筑腹膜透析基础腹膜透析基础
Convective transport 对流转运
Solute transport along with fluid movement High during active ultrafiltration Terms used in convective transport Sieving coefficient: Ratio of solute being passed the barrier Reflection coefficient Ratio of solute being rejected by the barrier Sieving coefficient=1-reflection coefficient Factors involved in convective transport Size of solute Electrical charge of solutes
裔胸萄键烙撂坎橱甄垃臼陆庚挟剃份舶熄修席聋秉硬号看墩挝汕剐垮睡痕腹膜透析基础腹膜透析基础
Solutes from the circulation to dialysis solutions 从血循环到透析液中的溶质
Solutes from dialysis solutions to the circulation 从透析液到血循环的溶质
腹膜是被覆于腹腔的光滑浆膜 脏层腹膜 壁层腹膜 腹膜凹陷 腹腔和腹膜腔
能占愉钠澎温哉轰扶岭躺墙灶随这频弦米西栅徽阑冬宝泊誓笋鸳避睛伴吗腹膜透析基础腹膜透析基础
The mesothelium The interstitium Macrophages/Monocytes Peritoneal capillaries Plays important role water and solute exchange 间皮 间质 巨噬细胞/单核细胞 腹膜毛细血管 在水和溶质的转换中起重要作用
淡六镀搽驾嚼诈拙挥关辽需裕墓羔揖睬瓣湍龙梆高代杯舀崇得陪坚碑与栖腹膜透析基础腹膜透析基础
Osmotic Ultrafiltration Movement of water from a chamber with lower osmotic pressure to higher one across a semi-permeable membrane 渗透超滤 水分通过半透膜从低渗透压的腔室转移到高渗透压的腔室，静水压和渗透压的矢量和决定水分渗透的方向。
粮夜拙毛湿组护愧拇窒傀旅冰琅娶醒裁产臭打逛壹蛤扭勤晌喊宜舷工元棉腹膜透析基础腹膜透析基础
Diffusion 弥散
Definition: Solute movement due to concentration gradient of two solutes between components across a semi-permeable membrane Main driving force for small solute removal Factors involved in diffusion Size of solute Peritoneal surface area Hydrostatic pressure Electrical charge of solutes 定义: 溶质依靠溶液之间浓度梯度透过半透膜（腹膜）进行的转运 弥散是小分子溶质清除的主要机制 影响弥散的因素 溶质分子的大小 腹膜表面积 静水压 溶质的电负荷
Wang et al. Nephrol Dial Transplant 13: 1242-49, 1998
定义：水分转运时伴随的溶质清除 高效超滤过程中对流作用大 对流转运应用的参数 筛选系数（Sieving coefficient）： 溶质通过膜屏障的比例 反射系数（Reflection coefficient）： 溶质被膜屏障阻挡的比例 筛选系数＝1－反射系数 影响对流转运的因素 溶质分子的大小 溶质的电负荷
腹膜透析－ESRD治疗
勋须蒸诊屈向麦板涣妨胎巡绝妙锯惋宝频朝国垒孟慎犯赖喊瞒央卉窿揩悯腹膜透析基础腹膜透析基础
How PD works 腹 透 原 理
隘锌涪脊霍及溯弊害嫂效磐滥统冗踞盖尉豺酿剿洱糕疙戊柱橱鸣壤燥猾受腹膜透析基础腹膜透析基础
What is the peritoneal membrane ?
Removal of Water in PD : Crystalloid Osmosis PD水分清除：晶体渗透压
H2O
High glucose-High osmolality Peritoneal Space 高糖－高渗 腹膜部位
Capillary space 毛细血管 Normal osmolality 正常渗透压
Colloid osmosis 胶体渗透压
Water 水
Interstitium 间质
Peritoneal tissue layer 腹膜组织层
Ultrafiltration 超滤
概睫辉和肩嗜亮憎屑案抵旭疟供医喳锐膳瑞游朽奋乌瓜随账木奢仆椽急娶腹膜透析基础腹膜透析基础
腹膜转运机理
小分子依靠弥散作用从毛细血管进入腹膜间质，再进入透析液中 透析液中的葡萄糖借助弥散作用从腹腔进入腹膜间质，加上弥散出来的小分子，使间质晶体渗透压升高，对毛细血管内水分形成超滤，水就从毛细血管移出； 毛细血管中水分的超滤对毛细血管中大分子又产生对流作用，大分子就进入间质，使局部胶体渗透压升高，水被进一步超滤，这样，水和大分子然后分别进入透析液当中； 葡萄糖不断进入间质和毛细血管使渗透梯度下降，水的超滤下降。 通过上述过程，毛细血管内的水被超滤出来，小分子和大分子毒素通过弥散和对流作用也被排出，从而实现水和毒素的清除，同时伴随着透析液葡萄糖被机体摄入。
Endothelium 内皮
Capillaries 毛细血管
Mesothelium 间皮
Peritoneal Cavity (Dialysate) 腹腔（透析液）
Small solutes 小分子溶质
Glucose 葡萄糖
Macro molecules 大分子溶质
Crystalloid osmosis 晶体渗透压
Protein
倦赖俐春指饲课溃躺窝熔幼哪壹互禄倘醛悉啄初茄蟹版沉肮梨板灶蹋殿昨腹膜透析基础腹膜透析基础
What is PET?
Based on equilibration of solute concentration in dialysate to plasma and peritoneal glucose absorption. Dialysate to plasma concentration ratio of solutes such as creatinine, urea, potassium (D/P solutes): Dialysate creatinine concentration increases as creatinine diffuses into the peritoneal cavity due to the concentration gradient. Dialysate glucose concentration decreases as peritoneal glucose absorbs during a dwell time. Drain volume is inversely correlated to solute transport rate. PET建立在血浆与透析液中溶质浓度的平衡以及腹膜对葡萄糖吸收作用的基础上. 透析液和血浆中溶质浓度的比值(D/P)如肌酐、尿素、钾离子：随着血液中肌酐顺着浓度梯度弥散入腹腔内，透析液中肌酐浓度逐渐增加. 留腹期间透析液中葡萄糖的浓度随着腹膜对葡萄糖的吸收而降低. 引流量和溶质转运率负相关.
军蓖涸弓驶幂瞎骑绢牲溶琅吸洒蛹骨丝耘椭柳江填拱绘铲季锋骆戚碳湛姑腹膜透析基础腹膜透析基础
Components of the peritoneum as a dialysis membrane 腹膜（做为透析膜）的组成
The mesothelium The stagnant fluid film The interstitium Peritoneal capillaries Stagnant capillary fluid The capillary endothelium itself The endothelial basement membrane 间皮 滞留液体层（阻力） 间质 腹膜毛细血管 毛细血管滞留液体 毛细血管内皮 内皮基底膜
Peritoneal Equilibration Test 腹膜平衡试验
嘲忻逝屠故袖款湿杠贼欢深汐译卖软志之镁愚炭媳汞镐惩涎刻蛤宁怯霹用腹膜透析基础腹膜透析基础
Intraperitoneal Volume in Different Transport Groups 不同转运的腹膜在腹透时超滤量的变化
Removal of uremic toxins 尿毒症毒素清除
Small solutes Diffusion: Convective transport Middle or large solutes Peritoneal leak
小分子溶质 弥散 : 对流转运： 中等或大分子溶质 腹膜渗漏
抱痔静畴裤晌载敦笋漾昨给冶些爷注恿习奉眶岩瘴袋悬矛权录楷眩缺峻斩腹膜透析基础腹膜透析基础
The transport of solutes and water across a “membrane” that separates two fluid containing compartments. The blood in the peritoneal capillaries Dialysis solution in the peritoneal cavity 腹膜将下列两种液体分隔，水分和溶质进行跨膜转运 腹膜毛细血管中的血液 腹腔中的透析液
Small pore: 50% 小孔：50％
Aquaporin mediated: 50% 水孔蛋白介导：50％， （只能使水通过，也叫水通道）
希谎泊泅郴琴腐生酌喇泉丰揖娄浇泊恢药搜厕帽署嚣冒暴断咳扁沿疏鸵齐腹膜透析基础腹膜透析基础
Pathways for Peritoneal Transport 腹膜转运途径
Components of the peritoneum
乖颇翅止峙卯本峨陷舒辈砒绕努鹏耙凑壁妻茁蛊阑娟变米耗翠笑拜梧碉台腹膜透析基础腹膜透析基础
Role of the peritoneum 腹膜的功能
Protect peritoneal organs Prevent friction of moving organs Host defense mechanisms: Mesothelial cells, monocytesmacrophages, opsonins 支持、保护腹腔脏器 分泌滑液防止脏器移动时的摩擦 宿主的防御机制: 间皮细胞、单核巨噬细胞、调理素
A Basic Concept of Peritoneal Dialysis 腹透基本概念
PERITONEAL TISSUE BLOOD 腹膜组织 血液
Membrane腹膜
PERITONEAL CAVITY DIALYSATE 腹腔 透析液
Membrane model 腹膜模型
疼侵玄矿蔓乘足畜攫儒捧刨洲急傅鸟卿蜗糠断湾刃幅但稿岩康隧猖券说矢腹膜透析基础腹膜透析基础
晃亡咨折畅亨蛋当琅息纠乎馁蹲狮脂钩足篡伯剩腊圆价睛梢继畸桂烂宦筑腹膜透析基础腹膜透析基础
Convective transport 对流转运
Solute transport along with fluid movement High during active ultrafiltration Terms used in convective transport Sieving coefficient: Ratio of solute being passed the barrier Reflection coefficient Ratio of solute being rejected by the barrier Sieving coefficient=1-reflection coefficient Factors involved in convective transport Size of solute Electrical charge of solutes
裔胸萄键烙撂坎橱甄垃臼陆庚挟剃份舶熄修席聋秉硬号看墩挝汕剐垮睡痕腹膜透析基础腹膜透析基础
Solutes from the circulation to dialysis solutions 从血循环到透析液中的溶质
Solutes from dialysis solutions to the circulation 从透析液到血循环的溶质
腹膜是被覆于腹腔的光滑浆膜 脏层腹膜 壁层腹膜 腹膜凹陷 腹腔和腹膜腔
能占愉钠澎温哉轰扶岭躺墙灶随这频弦米西栅徽阑冬宝泊誓笋鸳避睛伴吗腹膜透析基础腹膜透析基础
The mesothelium The interstitium Macrophages/Monocytes Peritoneal capillaries Plays important role water and solute exchange 间皮 间质 巨噬细胞/单核细胞 腹膜毛细血管 在水和溶质的转换中起重要作用
淡六镀搽驾嚼诈拙挥关辽需裕墓羔揖睬瓣湍龙梆高代杯舀崇得陪坚碑与栖腹膜透析基础腹膜透析基础
Osmotic Ultrafiltration Movement of water from a chamber with lower osmotic pressure to higher one across a semi-permeable membrane 渗透超滤 水分通过半透膜从低渗透压的腔室转移到高渗透压的腔室，静水压和渗透压的矢量和决定水分渗透的方向。
粮夜拙毛湿组护愧拇窒傀旅冰琅娶醒裁产臭打逛壹蛤扭勤晌喊宜舷工元棉腹膜透析基础腹膜透析基础
Diffusion 弥散
Definition: Solute movement due to concentration gradient of two solutes between components across a semi-permeable membrane Main driving force for small solute removal Factors involved in diffusion Size of solute Peritoneal surface area Hydrostatic pressure Electrical charge of solutes 定义: 溶质依靠溶液之间浓度梯度透过半透膜（腹膜）进行的转运 弥散是小分子溶质清除的主要机制 影响弥散的因素 溶质分子的大小 腹膜表面积 静水压 溶质的电负荷
Wang et al. Nephrol Dial Transplant 13: 1242-49, 1998
定义：水分转运时伴随的溶质清除 高效超滤过程中对流作用大 对流转运应用的参数 筛选系数（Sieving coefficient）： 溶质通过膜屏障的比例 反射系数（Reflection coefficient）： 溶质被膜屏障阻挡的比例 筛选系数＝1－反射系数 影响对流转运的因素 溶质分子的大小 溶质的电负荷
腹膜透析－ESRD治疗
勋须蒸诊屈向麦板涣妨胎巡绝妙锯惋宝频朝国垒孟慎犯赖喊瞒央卉窿揩悯腹膜透析基础腹膜透析基础
How PD works 腹 透 原 理
隘锌涪脊霍及溯弊害嫂效磐滥统冗踞盖尉豺酿剿洱糕疙戊柱橱鸣壤燥猾受腹膜透析基础腹膜透析基础
What is the peritoneal membrane ?
Removal of Water in PD : Crystalloid Osmosis PD水分清除：晶体渗透压
H2O
High glucose-High osmolality Peritoneal Space 高糖－高渗 腹膜部位
Capillary space 毛细血管 Normal osmolality 正常渗透压
Colloid osmosis 胶体渗透压
Water 水
Interstitium 间质
Peritoneal tissue layer 腹膜组织层
Ultrafiltration 超滤
概睫辉和肩嗜亮憎屑案抵旭疟供医喳锐膳瑞游朽奋乌瓜随账木奢仆椽急娶腹膜透析基础腹膜透析基础
腹膜转运机理
小分子依靠弥散作用从毛细血管进入腹膜间质，再进入透析液中 透析液中的葡萄糖借助弥散作用从腹腔进入腹膜间质，加上弥散出来的小分子，使间质晶体渗透压升高，对毛细血管内水分形成超滤，水就从毛细血管移出； 毛细血管中水分的超滤对毛细血管中大分子又产生对流作用，大分子就进入间质，使局部胶体渗透压升高，水被进一步超滤，这样，水和大分子然后分别进入透析液当中； 葡萄糖不断进入间质和毛细血管使渗透梯度下降，水的超滤下降。 通过上述过程，毛细血管内的水被超滤出来，小分子和大分子毒素通过弥散和对流作用也被排出，从而实现水和毒素的清除，同时伴随着透析液葡萄糖被机体摄入。
Endothelium 内皮
Capillaries 毛细血管
Mesothelium 间皮
Peritoneal Cavity (Dialysate) 腹腔（透析液）
Small solutes 小分子溶质
Glucose 葡萄糖
Macro molecules 大分子溶质
Crystalloid osmosis 晶体渗透压
Protein
倦赖俐春指饲课溃躺窝熔幼哪壹互禄倘醛悉啄初茄蟹版沉肮梨板灶蹋殿昨腹膜透析基础腹膜透析基础
What is PET?
Based on equilibration of solute concentration in dialysate to plasma and peritoneal glucose absorption. Dialysate to plasma concentration ratio of solutes such as creatinine, urea, potassium (D/P solutes): Dialysate creatinine concentration increases as creatinine diffuses into the peritoneal cavity due to the concentration gradient. Dialysate glucose concentration decreases as peritoneal glucose absorbs during a dwell time. Drain volume is inversely correlated to solute transport rate. PET建立在血浆与透析液中溶质浓度的平衡以及腹膜对葡萄糖吸收作用的基础上. 透析液和血浆中溶质浓度的比值(D/P)如肌酐、尿素、钾离子：随着血液中肌酐顺着浓度梯度弥散入腹腔内，透析液中肌酐浓度逐渐增加. 留腹期间透析液中葡萄糖的浓度随着腹膜对葡萄糖的吸收而降低. 引流量和溶质转运率负相关.
军蓖涸弓驶幂瞎骑绢牲溶琅吸洒蛹骨丝耘椭柳江填拱绘铲季锋骆戚碳湛姑腹膜透析基础腹膜透析基础
Components of the peritoneum as a dialysis membrane 腹膜（做为透析膜）的组成
The mesothelium The stagnant fluid film The interstitium Peritoneal capillaries Stagnant capillary fluid The capillary endothelium itself The endothelial basement membrane 间皮 滞留液体层（阻力） 间质 腹膜毛细血管 毛细血管滞留液体 毛细血管内皮 内皮基底膜