CRRT的局部枸橼酸抗凝.ppt

持续肾脏替代治疗的局部枸橼酸抗凝 ICU中的急性肾脏功能衰竭*: BEST Kidney 患病率 1738/29269 (5.7%, 95%CI 5.5 – 6.0%) 危险因素 感染性休克(47.5%, 95%CI 45.2 – 49.5%) 住院病死率 60.3% (95%CI 58.0 – 62.6%) *少尿( 200 ml/12 hr)和(或)明显的氮质血症(BUN 84 mg/dL) Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 2005; 294: 813-818 急性肾功能衰竭的定义: RIFLE标准 GFR标准 UO标准 Risk 肌酐增加x 1.5或GFR降低 25% UO 0.5 ml/kg/hr x 6 hr Injury 肌酐增加x 2或GFR降低 50% UO 0.5 ml/kg/hr x 12 hr Failure 肌酐增加x 3或GFR降低 75% UO 0.3 ml/kg/hr x 24 hr 或无尿x 12 hr Loss 持续ARF = 肾脏功能完全丧失 4周 ESRD 终末期肾病 3月 Bellomo R, Ronco C, Kellum JA, et al. Acute renal failure: definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004; 8: R204-R212 ICU的急性肾脏损伤(AKI) Ostermann M, Chang RWS. Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med 2007; 35: 1837-1843 35.8% 急性肾功能衰竭的治疗(n = 646) Perez-Valdivieso JR, Bes-Rastrollo M, Monedero P, et al. Prognosis and serum creatinine levels in acute renal failure at the time of nephrology consultation: an observational cohort study. BMC Nephrology 2007; 8: 14-22 持续肾脏替代治疗管路寿命 满足治疗要求 降低治疗费用 减少重新安装管路的护理时间 18 – 30 hr Holt AW, Bierer P, Glover P, Plummer JL, Bersten AD. Conventional coagulation and thromboelastograph parameters and longevity of continuous renal replacement circuits. Intensive Care Med 2002; 28: 1649-55. Stefanidis I, Hagel J, Frank D, Maurin N. Hemostatic alterations during continuous venovenous hemofiltration in acute renal failure. Clin Nephrol 1996; 46(3): 199-205. Kox WJ, Rohr U, Waurer H. Practical aspects of renal replacement therapy. Int J Artif Organs 1996; 19: 100-5. Tan HK, Baldwin I, Bellomo R. Continuous veno-venous haemofiltration without anticoagulation in high-risk patients. Intensive Care Med 2000; 26: 1652-7. 持续肾脏替代治疗的影响因素 血管通路位置 中心静脉导管: 口径, 管腔设计 血流可靠性 血滤管路设计 透析膜的生物相容性 护