内科学教学课件：Chronic Renal Failure (2).pptVIP

Specific measure of prevention and cure b. Hyperkalemia: [k+]6.5mmol/l ●5%natriibicarbonat 100ml st iv in 5 minutes ● 10%calcium gluconate 20ml st iv ●　loop diuretic ● 50% glucose 50-100ml and insulin 6-12U st iv ● take orally　kayexalate 　 ● dialysis Specific measure of prevention and cure c.Metabolic acidosis: 5%natriibicarbonat is applied to raise [HCO3] to 17.1 mmol/l, must prevent hypocalcaemia convulsion by using 10% calcium gluconate. d. disorders of calcium and phosphate: GFR30mi/min, calcium carbonate 0.5~ 2.0 tid tid po . Obviously low calcium, replenish calcitriol 0.25μg/d, 2~4 weeks. Specific measure of prevention and cure 2) Cardiovascular and pulmonary disorder a. Hypertension: most of them is volume-depended, thus limiting water and sodium is advisable, dehydrating drug or filtration is commonly recommended. ACEI is favorite .Blood pressure should be controlled at least the level of 130/80mmHg. Proteinuria 1g/d, blood pressure should be further reduced to 125/75mmHg. But hyperkalemia must noticed. b. Pericarditis should be dialyzed actively qd 1 weeks c. Heat failure treatment specially focus on eliminating of water and Na. Loop diuretics are higher doses required. Dialyze. d. Uremia pneumonia is sensitive to dialysis. Specific measure of prevention and cure 3) Blood system complication Anemia could be ameliorated by EPO, in same time, folic acid (10mg, tid, po) vitamin B12(50μg, tid, po ) and iron EPO: starting dosage: 80-120U/kg.per week 2-3 times /week ih Target hemoglobin: 110-120g/l, HCT0.33-0.66, The side effect: hypertension （1）初始剂量皮下给药剂量：100~120IU/Kg/W，每周2~3 次。静脉给药剂量：120~150IU/Kg/W，每周3 次。 初始剂量选择要考虑患者的贫血程度和导致贫血的原因，对于Hb7g/dl 的患者，应适当增加初始剂量。 对于非透析患者或残存肾功能较好的透析患者，可适当减少初始剂量。 对于血压偏高、伴有严重心血管事件、糖尿病的患者，应尽可能的从小剂量开始使用rHuEPO 。 （2）剂量调整rHuEPO 治疗期间应定期检测Hb 水平：诱导治疗阶段应每2～4 周检测一次Hb 水平；维持治疗阶段应每1～2 月检测一次Hb 水平。应根据患者Hb 增长速率调整rHuEPO 剂量：初始治疗Hb 增长速度应控制在每月1～ 2g/dl 范围内稳定提高，4 个月达到Hb 靶目标值。如每月Hb 增长速度1g/dl ，除外其它贫血原因（见附录：EPO 抵抗原因），应增加rHuEPO 使