新生儿急性肾损伤(AKI)及其治疗进展.pptVIP

新生儿急性肾损伤（AKI）及其治疗进展暨南大学从属第一医院儿科杨方新生儿急性肾损伤（AKI）及其治疗进展1/38

历史背景20世纪:急性肾衰名称、定义、标准众多、混乱二十一世纪开始有新进展RIFLEAKIN，以AKI概念替换ARFKDICO指南新生儿急性肾损伤（AKI）及其治疗进展2/38

AKI定义成人:48小时内Scr上升≧26.5umol/L(0.3mg/dl)7天内Scr上升≧1.5倍GFR下降≧25%,尿量0.5ml/kg.h,6小时小儿:eCCL(eGFR）下降≧25%,尿量0.5ml/kg.h,8小时新生儿急性肾损伤（AKI）及其治疗进展3/38

Pediatric-modifiedRIFLE(pRIFLE)criteriaEstimatedCCIUrineoutputRiskeCCIdecreaseby25%0.5ml/kg/hfor8hInjuryeCCIdecreaseby50%0.5ml/kg/hfor16hFailureeCCIdecreaseby75%or0.3ml/kg/hfor24horeCCI35ml/min/1.73㎡anuricfor12hLossPersistentfailure4weeksEndEnd-stagerenaldiseaseStage(persistentfailure3months)eCCI,estimatedcreatinineclearance;pRIFLE,pediatricrisk,injury,failure,lossandend-stagerenaldisease.Akcan-Arikan,etal.KidneyInt.,71:1028-1035新生儿急性肾损伤（AKI）及其治疗进展4/38

成人AKIRIFLE标准ClassGFRcriteriaUrineoutputcriteriaRiskIncreasedcreatininex1.5UrineoutputorGFRdecrease25%0.5ml/kg/hx6hInjuryIncreasedcreatininex2UrineoutputorGFRdecrease50%0.5ml/kg/hx12hFailureIncreasedcreatininex3UrineoutputorGFRdecrease75%0.3ml/kg/hx24horcreatinine≧4mg/dloranuriax12h(acuteriseof≧0.5mg/dl)LossPersistentAKI=completelossofrenalfunction4weeksESKDEnd-stagekidneydisease3months新生儿急性肾损伤（AKI）及其治疗进展5/38

婴幼儿肾脏发育特点新生儿肾脏发育及功效不成熟肾脏体积仅为成人17%GFR为成人1/4,到1~2岁时到达成人水平新生儿及婴幼儿肾小管重吸收功效差,易出现水及电解质紊乱。新生儿急性肾损伤（AKI）及其治疗进展6/38

早产儿及足月新生儿GFRAgeClearance(ml/minper1.73㎡)Pre-terminfants1-3days