AKI的定义、诊断及治疗.pptx

AKI的定义、诊断及治疗2021/9/12目 的更新观念,提高认识;了解新指标,早期做诊断;应用新技术,早期做干预。2021/9/12流行病学2021/9/12It occurs in 5%of all hospitalized patients and 35% of those in intensive care units Mortality is high:up to 75–90% in patients with sepsis35–45% in those withoutMedian hospital length of stay (LOS) stratified by single acute organ system dysfunction (AOSD), including acute renal failure (ARF). 2021/9/12AcuteRenal FailureAcuteKidney Injury2021/9/12ARF定义的提出the first description of ARF termed ischuria renalis, was by William Heberden in 1802;named acute Bright’s disease, was well described in William Osler’s early works (1909);During World War I the syndrome was named ‘War Nephritis’ ;World War II, Bywaters and Beall,crush syndrome;Homer W.Smith who is credited with the introduction of the term ‘ARF’ in 1951.BY 2002, at least 35 definitions in the literature 。急性肾衰竭是指肾小球滤过功能在数小时至数周内迅速降低而引起的以水、电解质和酸碱平衡失调以及含氮废物蓄积为主要特征的一组临床综合症。2021/9/12RIFLE分级2002 年急性透析质量倡议组(ADQI)制定了ARF的 RIFLE 分级诊断标准。2021/9/12Bellomo R, et al. Crit Care 2004;8:R204-R212AKI定义提出的必要性Chertow 等研究表明,血肌酐上升26.5μmol/L 可使病死率上升4.1 倍。大量临床研究显示, 肾功能轻度损伤即可导致AKI 发病率及病死率的增加。2021/9/12AKI的定义2005 年, 急性肾损伤网络( acute kidney injury network, AKIN ) 于荷兰阿姆斯特丹召开了急性肾衰竭研讨会,建议将ARF改名为AKI。AKIN将AKI定义为:病程在3个月以内, 包括血、尿、组织学及影像学检查所见的肾脏结构与功能的异常。AKI的诊断标准为: 肾功能在48 h内突然减退, 表现为至少两次血肌 酐升高的绝对值≥26.5μmol/L; 或血肌酐较基础值升高≥50%; 或尿量0.5 ml/( kg·h) ,时间超过6 h（排除梗阻性肾病或脱水状态）。2021/9/12Int J Artif Organs,2007,30(5):373- 376.AKI的分期诊断标准分期血清肌酐标准尿量标准1期绝对升高≥26.5μmol/L或相对升高≥50%＜0.5ml/(Kg·h)(时间＞6h)2期相对升高＞200%-300%＜0.5ml/(Kg·h)(时间＞12h)3期相对升高＞300%或在≥353.6 μmol/L基础上再急性升高≥44.2 μmol/L少尿[＜0.5ml/(Kg·h)] × 24h或无尿[＜0.3 ml/(Kg·h)] ×12h2021/9/12Int J Artif Organs,2007,30(5):373- 376.AKI的分期与预后2021/9/12Crit Care Med,2006,34（7）:1913－ 1917． %%%9.1%%%5.2%3.7%%InjuryRiskFailureAKI的分期与预后2021/9/12Crit Care Med,2006,34（7）:1913－1917．IncidenceClinical outcomesAKI危险分级的敏感性有所提高,但在发病率及预后方面无显著差异!2021/9/12小结一急性肾损伤的定义更加明确,干预治疗的窗口期大大提前,对于早期诊断、早期治疗和降低病死率具有更积极的意义。重新命名能更贴切的反映疾病的基本性质,可将这一综合征的临床诊断提前。但就其病因,肾损机制,并没有根本的不同,目前两