AKI与肾脏替代治疗.ppt

Red Blood cell Creatinine Chlorure Potassium Urea Membrane Filtrate Inflammatory Mediators Adsorption:大分子溶质 Blood CRRT的基本模式是什么？ CRRT的基本模式 CVVH：Continuous venovenous hemofiltration 持续静-静脉血液滤过 CVVHD ：Continuous venovenous hemodialysis 持续静-静脉血液透析 CVVHDF： Continuous venovenous hemodiafiltration 持续静-静脉血液透析滤过 前稀释：置换液在滤器前与血液混合后进入滤器。 后稀释：置换液在滤器后进入患者体内 前稀释 BFR：150ml/min UFR：35ml/min BFR：150ml/min Hct：24.3% Hct：30% 前稀释35ml/min 稀释比例=QB/(QB+QR) =150/(150+35) =81% 模板来自于 / Talking about solute management in CRRT can get confusing, but it really quite simple We have solutes in the blood that we want to remove and some that we don’t want to remove. Since all solutes do not have the same characteristics, they cannot all be removed the same way. Diffusion and convection are efficient at removing small molecules Convective clearance is better for larger molecules. Ultrafiltration facilitates the convective process and some substances are adsorbed by the membrane. Resulting in more or less what we want “solute management” Let’s take a look at each principle. * * 模板来自于 * AKI与肾脏替代治疗  定义 1 预防和治疗 2 3 Contents 内 容 * AKI的CRRT治疗 AKI定义：是指不超过3个月的肾脏结构和功能的异常方面的肾损伤标志物的异常或肾小球滤过率小于60ml/（ml?1.73m2）。 AKI是危重患者常见并发症，近年报道认为AKI发生率逐年升高； 有文献显示35％以上的住院重症患者合并AKI，其病死率高达30％－60％。 AKI 的诊断标准 2012-KDIGO Clinical Practice Guideline for Acute Kidney Injury AKI is defined as any of the following: Increase in scr by≥0.3mg/dl（ ≥ 26.5umol/l）within 48 hours；or Increase in scr to ≥1.5times baseline,which is known or presumed to have occurred within the prior 7 days; or Urine volume 0.5ml/kg/h for 6 hours. Kindney International (2012)2,13-18. 2012-KDIGO AKI分期标准 AKI 分期 　　　　血清肌酐值 　　　尿量 1 7d内超过基线值的1.5－1.9倍 48小时内升高≥0.3mg/dl（26.5umol/l） 0.5ml/kg/h持续6－12小时 2 基线值的2.0－2.9倍 0.5ml/kg/h超过12小时 3 基线值的3倍及以上 绝对值≥4.0mg/dl（353.6umol/l） 开始肾脏替代治疗 18岁以下eGFR35ml/ml/min/1.73m? 0.3ml/kg/h超过24小时或无