14连续性血液净化在儿童危重症的应用，陆国平.ppt

临床应用 ACT CRRT 谢 谢 ！ * The continuous therapies provide a slow, gentle treatment of ARF and fluid overload very much like the native kidney. CRRT is generally well tolerated by critically ill, hemodynamically unstable patients. Moreover, control of azotemia, acid-base balance and fluid volume can easily be achieved with CRRT. * The continuous therapies provide a slow, gentle treatment of ARF and fluid overload very much like the native kidney. CRRT is generally well tolerated by critically ill, hemodynamically unstable patients. Moreover, control of azotemia, acid-base balance and fluid volume can easily be achieved with CRRT. * * The continuous therapies provide a slow, gentle treatment of ARF and fluid overload very much like the native kidney. CRRT is generally well tolerated by critically ill, hemodynamically unstable patients. Moreover, control of azotemia, acid-base balance and fluid volume can easily be achieved with CRRT. * 治疗剂量 小容量（普通容量）：内环境紊乱 高容量：危重患者清除炎症介质 我院常用抗生素剂量调整 药物 常用剂量 肾衰竭剂量 小剂量CRRT 1500 mL/m2/h 大剂量CRRT 环丙沙星 5-10mg/kg q12h 2.5-5mg/kg q12h 2.5-5mg/kg q12h 3.75-5mg/kg q12h 左氧氟沙星 500mg q24h 250mg q24h 500mg 首剂，250mg q24h 莫西沙星 400mg q24h(不需要调整剂量) 头孢曲松 50-100mg/kg q24h 50mg/kg q24h 50mg/kg q24h 50-100mg/kg q24h 头孢噻肟（他定、匹肟、唑啉、氨曲南) 50mg/kg q8-12h 25-50mg/kg q12-18h 25-50mg/kg q12-18h 25-50mg/kg q12 美平 20mg/kg q8h 10-20mg/kg q12h 10-20mg/kg q12h 20-40mg/kg q12h 泰能 33mg/kg q8h 20mg/kg q12h 15-20mg/kg q12h 20-25mg/kg q8-12h 我院常用抗生素剂量调整 药物 常用剂量 肾衰竭剂量 小剂量CRRT 1500 mL/m2/h 大剂量CRRT 万古霉素 15-20mg/kg q12h N/A 15-20mg/kg 首剂，15-20mg/kg q24-48h 利奈唑胺 10mg/kg q8h 10mg/kg q8h(不调整剂量） 特治星 100mg/kg q8h 70mg/kg q8h 70mg/kg q8h 70-100mg/kg q8h 阿米卡星 10mg/kg q24h N/A 10mg/kg 首剂，7.5mg/kg q24-48h 氟康唑 7-10mg/kg q24h 3.5-5mg/kg q24h 7-10mg/kg q24h 7-10mg/kg q24h 伏立康唑 7mg/kg q12h 4mg/kg q12hpo,Scr50ml/min 7mg/kg q12h po 7mg/kg q12h po 两性霉素脂质体 3-5mg/kg q24h 3-5mg/kg q24h(不用调整剂量） 阿昔洛韦 5mg/kg q8h 5mg/kg q12-24h 5-7.5mg/kg q24h 5-7.5mg/kg q24h CRRT剂量选择 存在争议 极低容量血液滤过