急性肾损诊断及治疗药物的应用PPT课件.pptx

急性肾损诊断及治疗药物的应用浙江大学附属邵逸夫医院危重医学科黄曼AKI的定义和分期2012 AKI的定义和分期 AKI 定义为符合以下任一项者：48小时内 SCr ? ≥ 0.3 mg/dl (≥ 26.5 μmol/L）；SCr 比基线值?达 ≥ 1.5倍， 已知或推测7天内发生尿量0.5 ml/kg/h，持续达6小时指南推荐血清肌酐和尿量仍然作为AKI最好的标志物流行病学AKI≈ 7% 住院病人ICU中急性肾损伤（AKI）的发生率为10.8-67% ICU中急性肾损伤并需要肾脏替代治疗的发生率为4.9%.AKI的发生率为总ICU床位数*住院天数的10% Nash K, Hafeez A, Hou S: Hospital-acquired renal insufficiency. American Journal of Kidney Diseases 2002; 39:930-936. Hoste E, Clermont G, Kersten A, et al.: RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: A cohort analysis. Critical Care 2006; 10:R73. Osterman M, Chang R: Acute Kidney Injury in the Intensive Care Unit according to RIFLE. Critical Care Medicine 2007; 35:1837-1843. Intensive-Care National Audit Research Centre 2005 流行病学流行病学不同定义下AKI的死亡率Kellum et al. Current Opin in Crit Care 2002InjuryFailureRiskMeta分析显示，RIFLE分级越差，死亡率越增加RIFLE分级下的死亡率AKI严重程度升高与死亡率呈线性关系AKI 需要RRT治疗是住院患者死亡率的独立风险因素AKI患者需要RRT治疗的死亡率达50-70%血肌酐轻微的变化，即便未达到Risk分级，也与死亡率增高密切关联 Hoste E, Clermont G, Kersten A, et al.: RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: A cohort analysis. Critical Care 2006; 10:R73. Chertow G, Levy E, Hammermeister K, et al.: Independent association between acute renal failure and mortality following cardiac surgery. American Journal of Medicine 1998; 104:343-348. Uchino S, Kellum J, Bellomo R, et al.: Acute renal failure in critically ill patients: A multinational, multicenter study. JAMA 2005; 294:813-818. Coca S, Peixoto A, Garg A, et al.: The prognostic importance of a small acute decrement in kidney function in hospitalized patients: a systematic review and meta-analysis. American Journal of Kidney Diseases 2007; 50:712-720.AKI的危险因素年龄75岁既往疾病史：慢性肾功能不全，高血压，糖尿病，动脉粥样硬化性周围血管病变脓毒血症，缺血性疾病，心功能衰竭，肝脏疾病，一些外科手术（心脏和血管的手术），横纹肌溶解，尿路梗阻，各种肾毒性药物的使用（包括各种造影剂） Uchino S, Kellum JA, Bellomo R et al. Acute renal failure in critically ill patients:a multinational, multicenter study. JAMA 2005; 294