文档介绍：CRRT的局部枸橼酸抗凝
血透室方咏梅
ICU中的急性肾脏功能衰竭*: BEST Kidney
患病率
1738/29269 (%, 95%CI – %)
危险因素
感染性休克(%, 95%CI – %)
住院病死率
% (95%CI – %)
*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 > 25%
UO < ml/kg/hr x 6 hr
Injury
肌酐增加x 2或GFR降低> 50%
UO < ml/kg/hr x 12 hr
Failure
肌酐增加x 3或GFR降低> 75%
UO < 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, e 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
%
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 ans 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,