1、This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller
2、and DS18B20 temperature sensor.正确处理心力衰竭与肾功能不全、贫血的关系北京协和医院心内科 严晓伟This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer
3、. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.CRS的分类建议 CRS type I 心功能突然恶化导致急性肾损伤 CRS type II 慢性心功能不全导致渐进性、永久性的肾脏疾病 CRS type III 急性肾功能不全导致急性心功能障碍 CRS type IV CKD导致心功能降低、心脏肥厚和 CV事件风险增加 CRS type V 全身病变同时导致心脏和肾脏功能异常J. Am. Coll. Cardiol. 52:1527-1539 (2008
4、)3This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontrolle
5、r and DS18B20 temperature sensor. 心衰环境下，心脏和肾脏的相互作用将加剧体内的容量超负荷心肾综合征肾脏方面的问题包括： 神经激素系统和细胞因子的大量活化 有效肾灌注和 GFR的降低，急性肾衰竭 利尿抵抗 RAAS系统介导的肾纤维化4This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single
6、 bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.患病率和病死率增加 利尿剂治疗肾功能受损 肾灌注减少利尿和排钠抵抗的发生血流量减少神经激素系统的活化心衰时的心肾综合征5This paper mainly introduces the design of an intelligent temperature contro
7、l system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.0.7 0.6 0.5 0.4 0.3 0.2 0.1 0.0 -心衰时的肾功能与患病率和
8、病死率的相关性 患者 总数 1906例 NYHA 分级 III (n=1138) III/IV (n=607) IV (n=161) 肾功能 损伤 程度是死亡率的强预测因子1906例 CHF患者的 GFRc与死亡率的关系Hillege et al. Circulation. 2000;102:203-210.0 200 400 600 800 1000 1200DaysProportion mortality76 mL/min6This paper mainly introduces the design of an intelligent temperature control system
9、 which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.利尿剂 1减少体液容量血管扩张剂 1降低前负荷和 /或后负荷 不减少容量正性肌力药物 1增加收缩力不减少容
10、量88%*3 21%*3 15%*3Use inADHERE131. Fonarow GC. Rev Cardiovasc Med. 2001;2(suppl 2):S7.2. Fonarow GC, for the ADHERE Scientific Advisory Committee. Rev Cardiovasc Med. 2003;4(suppl 7):S21.3. Fonarow GC. Slide presentation. http:/ * Data for IV preparations used in all enrolled discharges (n = 105,388
11、) for periodOctober 1, 2001 to December 31, 2003.心力衰竭的常规治疗 *7This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. T
12、he core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.常用静脉药物0102030405060708090100患者比例(%) 静脉用利尿剂 多巴酚丁胺 多巴胺 米力农 奈西立肽 硝酸甘油 硝普钠静脉应用的血管活性药物88%6% 6% 10%3% 1%10%ADHERE Registry. Benchmark Report. 2004. 总入组的出院患者 (n=105,388) 2001.102004.18This paper mainly introduces th
13、e design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.
14、Bayliss et al. Br Heart J. 1987;57:17用药前(n=12)血浆肾素活性(ng/mL/h)50102.50.5血浆醛固酮 (pmol/L)Mean, 95%ConfidenceInterval1000600200100 P =.0007P =.0002用药后(n=11) 心衰时应用利尿剂激活神经激素系统用药前(n=12)用药后(n=11)9This paper mainly introduces the design of an intelligent temperature control system which realizes the function
15、of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.Krmer et al. Am J Med. 1999;106:90.神经激素系统活性增高导致利尿抵抗近曲小管血管紧张素 II增加钠重吸收肾小球去甲肾上腺素 (和内
16、皮素 ) 降低肾血流量和 GFR集合管醛固酮增加钠重吸收10This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the syste
17、m are AT89C51 microcontroller and DS18B20 temperature sensor.单用呋噻米治疗使肾功能 (GFR)降低-25-20-15-10-50510150 500 1000 1500 2000 2500Urine Output (mL) 08 hGFR (% Change)安慰剂静脉应用呋噻米Gottlieb et al. Circulation. 2002;105:1348.CHF患者静脉应用呋噻米 80mg后 GFR的变化值 11This paper mainly introduces the design of an intelligent
18、 temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.心衰时利尿抵抗的原因 肾功能及钠离子远端传递能力的下
19、降 利尿剂吸收率的变异 (生物利用度 ) 神经激素系统的活化 (RAAS/SNS系统 ) 药物 /饮食因素 钠摄入增多 服药依从性差 非常用剂量1. Neuberg et al. Am Heart J. 2002;144:31-38.2. Brater. N Engl J Med. 1998;339:387-395.3. Wilcox. J Am Soc Nephrol. 2002;13:798-805.12This paper mainly introduces the design of an intelligent temperature control system which rea
20、lizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.心衰时利尿抵抗的应对 限制每日液体入量 (1.01.5 L) 适当减少每日盐摄入量 (2 g) 避免使用 NSAID类药物 应
21、用并逐渐增加 ACEI/ARB类药物的剂量 用袢利尿剂治疗，分次分量口服并逐渐增量，或持续静脉应用 合并应用袢利尿剂和噻嗪类利尿剂连续作用于肾单位 加用小剂量的螺内酯 (12.525 mg)This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B2
22、0 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.2009Circulation发表的 Val-HeFT研究二次分析：缬沙坦显著降低 心衰合并 CKD患者的联合死亡率和发病率Anand IS, et al. Circulation 2009;120(16):1577-84.注：首发事件（联合死亡率和发病率）定义为死亡、猝死复苏，因心衰住院，院外应用静脉正性肌力药和血管扩张剂 4小时以上； CKD
23、定义： eGFR60ml/min/1.73m2； Cox模型的变量包括：蛋白尿， CKD，男性， 65岁，种族，缺血性心脏病，血红蛋白，房颤，糖尿病，收缩压，脉搏， LVEF，生化参数等Val-HeFT研究事后分析： 5010例心衰患者在标准抗心衰治疗基础上随机接受缬沙坦或安慰剂治疗，平均随访 23个月。对 2916例基线合并 CKD的患者采用多元 Cox比例风险回归模型进行分析1009080706050HR=0.86， 95%CI 0.74-0.99， p=0.01缬沙坦（ 33.8%）安慰 (38.1%)月累计生存率（%）14%P=0.010 6 12 18 24 30 36合并 CKD
24、非 CKDNNT（治疗1年预防1例发病事件）10080604020035100缬沙坦对于合并 CKD的心衰患者甚至比非 CKD患者获益更多治疗 1年预防 1例发病事件，缬沙坦需治疗 100例心衰但非 CKD患者，但仅需治疗 35例心衰合并 CKD患者This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus dig
25、ital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.ACEI/ARB显 著降低心衰合并 CKD患者 30天及 1年死亡率对明尼苏达州心脏调查进行回顾分析，纳入 2169例心衰住院患者，基线进行体重及肌酐检测，并计算 GFR12.3%18.5%11.1%41.0%Berger AK, et al. Am Heart J 2007;153:1
26、064-73.经校正多重危险因素后，使用 ACEI或 ARB显著降低 30天死亡率 (OR=0.45， 95%CI 0.28-0.59)和 1年死亡率 (OR=0.72， 95%CI 0.58-0.91)34%73%50403020100死亡率（%）30天死亡率P=0.051年死亡率ACEI/ARB非 ACEI/ARBP=0.0515This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature meas
27、urement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.超滤与袢利尿剂的比较Schrier. J Am Coll Cardiol. 2006;47:1-8. 超滤液相对血浆是等渗的，而袢利尿剂所排的尿液相对血浆几乎都是低渗的； 超滤治疗比利尿剂排钠能力更强；
28、 超滤治疗不引起电解质紊乱； 超滤治疗相比利尿剂排出的细胞外液的量更多16This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of th
29、e system are AT89C51 microcontroller and DS18B20 temperature sensor. 超滤从血液中滤除液体的速度，与血管从 组织中自然吸收 体液的速度相同，从而保持稳定的循环血容量 超 滤在短时间内从血液中滤除液体，触发一种代偿机制即： 血浆或血管再补充，以缓冲循环血容量的降低。超滤排液的特点1. Lauer et al. Arch Intern Med. 1983;99:455-460.2. Marenzi et al. J Am Coll Cardiol. 2001;38:4.VascularSpaceUF血管管腔间质腔 (水肿 )NaN
30、aNaNaKPH2OKPPR17This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51
31、microcontroller and DS18B20 temperature sensor.静脉利尿剂与超滤治疗后的尿液和超滤液中电解质水平的比较钠 钾 镁020406080100120140静脉用利尿剂超滤治疗P =.000025P =.000017P =.017mg/dLAli et al. J Card Fail. 2006;12(6 suppl):114.18This paper mainly introduces the design of an intelligent temperature control system which realizes the function o
32、f temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.心衰患者超滤治疗可能的禁忌症 难以建立静脉通道时； 低血压； 高凝状态； 慢性肾病第 V期须血透时； 患者对利尿剂有反应时；19This paper mainly i
33、ntroduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 tempera
34、ture sensor.RAPID 试验 : 48 小时总排液量P =.028mL-11000-9000-7000-5000-3000-10001000超滤治疗 常规治疗Bart et al. J Am Coll Cardiol. 2005;46:2043-2046. 20This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using si
35、ngle bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.急性失代偿充血性心衰住院患者超滤治疗与静脉应用利尿剂的比较研究：一种前瞻性随机对照临床试验（ Ultrafiltration versus IV Diuretics for Patients Hospitalized for Acute Decompensated
36、 Congestive HF: A Prospective Randomized Clinical Trial）UNLOAD TrialCostanzo MR et al. J Am Coll Cardiol. 2007;49:675-683. 21This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus dig
37、ital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.研究设计 前瞻性随机多中心试验，比较早期静脉单用超滤与静脉单用利尿剂治疗对容量超负荷心衰患者的体重、症状和住院情况等指标。Costanzo MR et al. J Am Coll Cardiol. 2007;49:675-683. 22This paper mainly introduc
38、es the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature se
39、nsor.I I I一级终点： 48小时体重下降体重减少量(kg)超滤组 标准治疗组P =.001M = 5.0, CI + 0.68 kg(N=83)M = 3.1, CI + 0.75 kg(N=84)6 -5 -4 -3 -2 -1 -0 -Costanzo MR et al. J Am Coll Cardiol. 2007;49:675-683. 23This paper mainly introduces the design of an intelligent temperature control system which realizes the function of tem
40、perature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.二级终点： 48小时体液净减少量P =.001M = 3.3, CI + 0.29 L (N=82)M = 4.6, CI + 0.29 L(N=81)体液净减少量(liter
41、s)超滤治疗组 标准治疗组5.554.543.532.52Costanzo MR et al. J Am Coll Cardiol. 2007;49:675-683. 24This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and sin
42、gle chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.安全终点 在每个评估间期，两组患者的血清 BUN, Na, Cl-, 和 HC3水平的差异均无显著临床意义。 治疗期间发生血清钾水平 3.5 mEq/L的情况 ，超滤组 1名(1%)患者，标准治疗组 9名 (12%)患者。 (P=.018) 在随机分组后的第一个 48小时，两组低血压的发生的次数相当：超滤组为 4次 (4.4%) ，标准治疗组为 3次 (3%)。C
43、ostanzo MR et al. J Am Coll Cardiol. 2007;49:675-683. 25This paper mainly introduces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The co
44、re components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.血管活性药物应用的情况P =.015超滤治疗组（ UF） 标准治疗组（ SC）需要血管活性药物患者比例(%)20181614121086420UF: N=98 SC: N=99P =.086UF: N=100 SC: N=10048 小时 全部住院期间312817Costanzo MR et al. J Am Coll Cardiol. 2007;49:675-683. 26This paper mainly introd
45、uces the design of an intelligent temperature control system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature
46、sensor.BNP水平的变化超滤治疗组 （ UF） 标准治疗组（ SC）BNP (pg/mL)0-100-200-300-400-500-600-700-800UF: N=92 SC: N=88UF: N=80 SC: N=76UF: N=71 SC: N=66P=.576 P=.463 P=.68448小时 30 天 90 天Costanzo MR et al. J Am Coll Cardiol. 2007;49:675-683. 27This paper mainly introduces the design of an intelligent temperature control
47、 system which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.024超滤组 (N=65) 一次性静推利尿剂组 (N=45) 持续静注利尿剂组 (N=21)
48、Rehosp. Equivalents/Pt超滤 vs 一次性静推利尿剂： P=.050超滤 vs 持续静注利尿剂 ：P =.016一次性静推 vs持续静注利尿剂 ： P =.36290天的平均再住院次数m = 0.31, CI + 0.33 m = 2.29, CI + 1.35m = 1.31, CI + 0.55Costanzo MR et al. J Am Coll Cardiol. 2007;49:675-683. 28This paper mainly introduces the design of an intelligent temperature control syste
49、m which realizes the function of temperature measurement and control by using single bus digital temperature sensor DS18B20 and single chip microcomputer. The core components of the system are AT89C51 microcontroller and DS18B20 temperature sensor.免于再住院的比率超滤组 (UF) vs 一次性静推利尿剂组 (IV Bolus Diuretic) vs 持续静注利尿剂组 (IV Continuous Diuretic) .00.20.40.60.801.000 10 20 30
