kdigoaki急性腎損傷診療指南解讀20xx版(參考版)
2025-05-28 22:52本頁面
【正文】 KDIGO,2022 ?當(dāng) AKI作為多臟器功能衰竭的一部分，需要提前進入腎臟替代治療 (1C) ? AKI患者臨床癥狀改善并出現(xiàn)腎功能恢復(fù)的早期征象應(yīng)適當(dāng)推遲 RRT(1D) ?過早行 RRT帶來的問題 ?靜脈血栓的形成 ?導(dǎo)管相關(guān)性感染 ?抗凝治療導(dǎo)致的出血 ?其他并發(fā)癥 KDIGO,2022 CRRT與利尿劑 ? We suggest not using diuretics to enhance kidney function recovery, or to reduce the duration or frequency of RRT. ( 2B) KDIGO,2022 Typical setting of different RRT modalities for AKI (for 70kg patient) We suggest using CRRT, rather than standard intermittent RRT, for hemodynamically unstable patients. (2B) KDIGO,2022 Guideline 12：對醫(yī)學(xué)生的培養(yǎng) AKI ｛ 預(yù)防 診斷 治療 KDIGO,2022 。 ⑤ 改善營養(yǎng)支持，保障營養(yǎng)補充及藥物治療 ,維持內(nèi)環(huán)境穩(wěn)定。 ? ③ 持續(xù)穩(wěn)定地控制氮質(zhì)血癥及電解質(zhì)和水鹽代謝 。 142: 510524 ?降低腎灌注 (Lauschke , Kidney Int 2022) ?導(dǎo)致心律失常 (Schenarts , Current Surgery 2022) ?加重心肌、腸道缺血缺氧 (Schenarts , Current Surgery 2022) 非諾多巴 不建議 選擇性多巴胺 A1受體激動劑，在降低全身血管阻力的同時增加腎血流量 RESEARCH RECOMMENDATION： We remend further trials of ANP at doses below g/kg/min, for the prevention or treatment of is a possibility that ANP might be effective if it isgiven at a lower dose (– mg/kg/min) in patients prophylactically or with early AKI, and during a longer period than in previous large studie； KDIGO,2022 Glycemic control and nutritional support ? In critically ill patients, we suggest insulin therapy targeting plasma glucose 110–149 mg/dl(– mmol/l). ( 2C) ? We suggest achieving a total energy intake of 20–30 kcal/kg/d in patients with any stage of AKI. (2C) ? We suggest to avoid restriction of protein intake with the aim of preventing or delaying initiation of RRT. ( 2D) ? We suggest administering – g/kg/d of protein in non catabolic AKI patients without need fordialysis ( 2D), – g/kg/d in patients with AKI on RRT (2D), and up to a maximum of g/kg/d in patients on continuous renal replacement therapy (CRRT) and in hypercatabolic patients. ( 2D) ? We suggest providing nutrition preferentially via the enteral route in patients with AKI. (2C） KDIGO,2022 Growth factor intervention ? We remend not using rebinant human (rh)IGF1 to prevent or treat AKI. （ 1B） human IGF1：重組人胰島素樣生長因子 1 KDIGO,2022 Prevention of aminoglycoside and amphotericinrelated AKI ? We suggest not using aminoglycosides for the treatment of infections unless no suitable, less nephrotoxic, therapeutic alternatives are available. (2A) ? We suggest that, in patients with normal kidney function in steady state, aminoglycosides are administered as a single dose daily rather thanmultipledose daily treatment regimens. (2B) ? We remend monitoring aminoglycoside drug levels when treatment with multiple daily dosing is used for more than 24 hours. (1A) ? We suggest monitoring aminogly
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