[临床医学]KDIGO-AKI急性肾损伤诊疗指南解读2012版.pptVIP

* * 利尿剂：能减少Henle袢升支细胞能量的需求，改善缺血损伤。 促进少尿型AKI向非少尿型转化，纠正水电解质紊乱，降低RRT的需求 由于延迟进入RRT可能导致肾功能恢复缓慢及死亡率增加 * * 的临床研究必须立足于 临床, 注重基层医院与大医院肾脏病中心相结合, 临床与基础研究相结合, 肾脏专业与其它临床专 业相配合, 以促进临床研究, 面向解决临床 实际问题, 高质量的发展。 * SLED 是目前ICU常用的一种模式，具有较多方面的优势。目前也被称作Hybrid RRT，似乎结合了CRRT和IHD双方面的优势。 持续缓慢低效血液透析（SLED） * * * 根据患者病情和RRT模式制定抗凝治疗方案 * * * * 加强医学生对AKI防治的教育 * * Vasodilator therapy: dopamine,fenoldopam, and natriuretic peptides We recommend not using low-dose dopamine toprevent or treat AKI. （1A） We suggest not using fenoldopam（非诺多巴）to prevent or treat AKI. ( 2C) We suggest not using atrial natriuretic peptide (ANP) to prevent (2C) or treat ( 2B) AKI * Effect of low-dose dopamine on mortality. Reprinted from Friedrich JO, Adhikari N, Herridge MSet al . Meta-analysis: low-dosedopamine increases urine output but does not prevent renal dysfunction or death.Ann Intern Med 2005; 142: 510–524 with permissionfrom American College of Physicians212； * 多巴胺---不建议 Friedrich JO, Adhikari N, Herridge MS. Meta-analysis: low-dose dopamine increases urine output but does not prevent renal dysfunction or death. Ann Intern Med 2005; 142: 510-524 降低肾灌注(Lauschke , Kidney Int 2006) 导致心律失常(Schenarts , Current Surgery 2006) 加重心肌、肠道缺血缺氧(Schenarts , Current Surgery 2006) 非诺多巴---不建议 选择性多巴胺A1受体激动剂，在降低全身血管阻力的同时增加肾血流量 RESEARCH RECOMMENDATION：We recommend further trials of ANP at doses below 0.1m g/kg/min, for the prevention or treatment of AKI.There is a possibility that ANP might be effective if it isgiven at a lower dose (0.01–0.05 mg/kg/min) in patients prophylactically or with early AKI, and during a longer period than in previous large studie； * Glycemic control and nutritional support In critically ill patients, we suggest insulin therapy targeting plasma glucose 110–149 mg/dl(6.1–8.3 mmol/l). ( 2C) We suggest achieving a total energy intake of 20–30 kcal/kg/d in patients with any stage of AKI. (2C) We suggest to avoid restriction of protein intake with the aim of preventing or delaying initiat