培训课件-糖尿病肾病患者的透析治疗.ppt

血管通路 血液透析 可以控制超滤 无需自己操作 由专业人员执行透析治疗 与医护人员及其他患者之间互动频繁 短时间内快速清除水分及代谢废物 优点 需建立血管通路，并反复穿刺 增加心脏负荷 有增加血源性疾病（乙肝、丙肝）传染的可能性 需一周多次往返医院 血液透析 缺点 透析间期对饮水控制严格 有时需中心静脉置管 注意事项透析 透析要充分 控制血压：140/90mmHg 达到干体重，体重增加不超过自身体重的5% 治疗贫血：血红蛋白110-120g/L 低盐饮食 避免感染 防治心血管并发症 防治继发性甲旁亢 要达到社会复归 江苏省人民医院举行讲座及咨询活动 内容：透析的注意事项 时间：3月14日周日上午 地点：虎踞关路（省人民医院西北、清凉山东北）金盾饭店6楼多功能厅 4 4 15 幻灯3 在这个为期7年的研究中，比较了I型（胰岛素依赖型糖尿病[IDDM]）（n 16）和II型（非胰岛素依赖型糖尿病[NIDDM]（ n 16）糖尿病病人中糖尿病肾病的进展速率，对于这两种类型的糖尿病病人来说肾小球过滤（GFR）的恶化程度是相似的2。尽管肾病的进展程度相似，I型和II型糖尿病病人却代表着不同的人群：II型糖尿病病人具有年龄大，胰岛素抵抗和动脉粥样硬化性疾病的特征3-5。 Proteinuria is an important and modifiable marker for the severity of the underlying renal disease, and an important predictor for progression to end-stage renal disease.1 Once a patient with type 2 diabetes develops proteinuria, the decline in renal function appears inevitable. Glomerular filtration rate GFR declines at a rate of 4-12 mL/min/year.2,3,4 The magnitude of proteinuria is directly correlated with risk for end-stage renal disease ESRD and the rate of progression to renal failure.5,6 In addition, at any given level of proteinuria, the higher the blood pressure, the more detrimental is the effect of proteinuria on progression to renal failure. Registry data from Minnesota showed the median duration from onset of proteinuria to the development of ESRD in patients with type 2 diabetes to be 7 years.7 The cumulative incidence of chronic renal failure in type 2 diabetic patients who developed persistent proteinuria was 4.2% at 5 years, 10.7% at 10 years, and 16.8% at 15 years after the diagnosis of proteinuria. A longitudinal study among 364 Pima Indians found a cumulative incidence of end-stage renal disease of 40% at 10 years after and 61% at 15 years after the onset of proteinuria.8 The incidence of ESRD was significantly related to the duration of diabetes, duration of proteinuria, extent of hyperglycemia, type of diabetes treatment, and presence of retinopathy. Once proteinuria occurs, nephropathy appears to prog