急性肾损伤诊治进展.pptxVIP

急性肾损伤诊治进展;About AKI guideline;指南内容;内 容 提 要;概 述; 患病率： 1%（社区）~ 7.1%（医院） 人群发病率：486~630 pmp/y AKI需要RRT发病率：22~203pmp/y 死亡率： 医院获得AKI死亡率：10~80% 合并多脏器功能衰竭死亡率：50% 需要RRT治疗者死亡率：高达80% ;World Incidence of AKI; AKI流行病学现状 ;AKI相关的全因死亡率;AKI各期的发病率;AKI流行病学（KDIGO-2012）;内 容 提 要;Definition about AKI;AKI的定义;AKI的分期;AKI分期标准;AKI的诊断和分级（RIFLE与AKIN标准）;;Major causes of AKI;AKI病情评估;AKI的早期诊断;AKI生物标志物与肾单位的解剖部位;内 容 提 要;AKI的高危人群;休克患者的补液建议;AKI患者利尿剂的使用问题;袢利尿剂可防止或减轻AKI？;Effect of furosemide on all-cause mortality;血管扩张药;内 容 提 要;Stage-based management of AKI;Goals of RRT in AKI;;顽固性高钾血症6.5mmol/L;;;The optimal timing of dialysis for AKI is not defined. In current practice, the decision to start RRT is based most often on clinical features of volume overload and biochemical features of solute imbalance (azotemia, hyperkalemia, severe acidosis).;近期的研究表明，适当早期进行RRT， 可以降低AKI患者的死亡风险;RRT开始指征;AKI患者RRT的治疗时机---何时开始？;AKI患者RRT的治疗时机---何时停？;血液净化模式;;; PD is still the most common modality used in patients younger than 6 years of age. The relatively low cost, technical simplicity, no need for anticoagulation or placement of central venous catheters, and excellent tolerance in hemodynamically unstable patients are among the most significant advantages of PD. The outcomes of critically ill patients with AKI treated with PD are comparable to other dialysis modalities. Therefore, the decision about dialysis modality should be based on local expertise, resources available, and patient‘s clinical status. Bonilla-Félix M. Blood Purif. 2013;35(1-3):77-80. ;RRT的血管通路问题;AKI患者RRT治疗模式的选择;CVVHDF方案;AKI患者RRT治疗剂量的设定;Ronco et al. Lancet 355:26-30,2000;不同CVVH剂量组患者生存率比较;Ronco研究结论;重症急性肾损伤患者肾脏替代???疗的剂量研究（ATN研究）;Acute renal failure trial network （ATN）Study;Kaplan–Meier Plot of Cumulative Probabilities of Death;重症急性肾损伤患者RRT的剂量研究（RENAL研究）;RENAL研究设计;Kaplan–Meier Estimates