导致急性肾衰竭。.pptVIP

急性肾功能衰竭Acute Renal Failure (ARF) 刘松桥 东南大学医学院急诊与危重病医学教研室 东南大学附属中大医院危重病医学科 东南大学急诊与危重病医学研究所 概论 Outline ARF的病因 Etiological Factors ARF的病理生理 Pathology And Physiology ARF的临床表现 Clinical Manifestation ARF的诊断 Diagnosis ARF的非替代治疗 Un- replacement Therapy ARF的替代治疗 Replacement Therapy 21世纪急性肾衰竭的治疗策略 Strategy in 21 Century 概论 Outline 各种原因引起的急性肾功能损害 Acute renal functional lesion caused by various kinds of factors 在短时间(数小时至数日)内出现氮质代谢产物积聚， 水电解质和酸碱平衡失调及全身并发症 Accumulation of nitrogenous waste during short time (nh - nd)，various complications emerge (eg: Water-Electrolyte, acid-base disturbance and others) 是一种严重的临床综合病症 A kind of critically ill syndrome 概论 Outline 急性肾损伤 Acute Kidney Injury, AKI 概论 Outline 发病率在普通人群(Incidence rate in common people)为0.5%～1％，住院患者(Incidence rate of hospitalized patients)为2%～7％，而在ICU及术后患者(Incidence rate of ICU pts and postoperative pts)则为4%～25％ 单纯急性衰竭的病死率(Mortality of acute renal failure)为7%～23%，而ICU中急性肾衰竭的病死率（Mortality of acute renal failure in ICU）高达50%～80% 概论 Outline 概论 Outline ARF的病因 Etiological Factors ARF的病理生理 Pathology And Physiology ARF的临床表现 Clinical Manifestation ARF的诊断 Diagnosis ARF的非替代治疗 Un- replacement Therapy ARF的替代治疗 Replacement Therapy 21世纪急性肾衰竭的治疗策略 Healing Strategy in 21 Century ARF的病因 Etiological Factors 肾功能的正常维持 In order to maintain normal renal function 足够的血液循环和肾脏灌注 Adequate circulation volume and kidney perfusion 完整的细胞功能 Intact cell function 肾小管和输尿管的通畅 Nephric tubule and unobstructed duct 急性肾衰竭的病因复杂 Causes of ARF : various Etiologies 肾前性因素 Prerenal 肾性因素 Intrinsic 肾后性因素 Postrenal 肾前性 Prerenal Causes 肾性因素 Intrinsic 肾后性 Postrenal 急性肾衰竭的患病危险因素 Risk factors of ARF 全身性感染 全身性感染是急性肾衰竭患病最重要的独 立危险因素。 Independence risk factor: Sepsis 肾毒性药物的应用 Nephrotox