20xx年醫(yī)學(xué)專題—icu中的血液凈化指南之我見(參考版)
2024-10-31 17:17本頁面
【正文】 Thank You,第四十二頁，共四十二頁。AKI的急性期推薦應(yīng)用CRRT，尤其是對(duì)于嚴(yán)重血流動(dòng)力學(xué)不穩(wěn)定、需大量清除液體以便于進(jìn)行更有效藥物治療的患者。有些研究(y225。ir243。,Thank You !,第四十一頁，共四十二頁。,Key Points,RRT may be postponed when the underlying disease is improving, other organ failure recovering and the slope in the serum creatinine rise declines, in order to see if renal function is also recovering. It is recommended to continue RRT as long as the criteria defining severe oliguric ARF (RIFLEfailureoliguria) are present. If the clinical condition improves, it may be considered to wait before connecting a new circuit to see whether renal function recovers. RRT should be restarted in case of clinical or metabolic deterioration.,第三十九頁，共四十二頁。,標(biāo)準(zhǔn)(biāozhǔn)與個(gè)體化,You are unique!,Standard!,第三十七頁，共四十二頁。,RRT in ICU: Preference,4. The clinician`s experience It is wise to use a form of RRT that is familiar to all the staff involved 5. Other specific clinical considerations Convective modes of RRT may be beneficial if the patient has septic shock CRRT can aid feeding regimes by improving fluid management CRRT may be associated with better cerebral perfusion in patients with an acute brain injury or fulminant hepatic failure,第三十五頁，共四十二頁。,RRT in ICU: Preference,Decision about which technique to use depends on: 1. What we want to remove from the plasma,第三十三頁，共四十二頁。)結(jié)果： Although patients included were more severely ill, overall mortality in the IVOIRE study remains very low (39% at 28 days and 52% at 90 days) compared with the RENAL study. This may be due to the earlier start of treatment at the renal injury level. Awaiting results from this important trial, 35 ml/kg/h should remain the standard dose in septic AKI, particularly in the presence of shock.,JoannesBoyau O, Honore PM: Hemofiltration Study: IVOIRE Study: clinicaltrials. gov ID NCT00241228., last Accessed in June 2011.,第三十一頁，共四十二頁。,JoannesBoyau O, Honore PM: Hemofiltration Study: IVOIRE Study: clinicaltrials. gov ID NCT00241228., last Accessed in June 2011.,Crit Care 2009, 13:R57. J Nephrol 2011, 24:165176.,第三十頁，共四十二頁。 多中心的 “IVOIRE study” (hIgh Volume in Intensive care)，在sepsis引起的AKI，休克(xiūk232。,Dose or intensity of CRRT,然而， 需要強(qiáng)調(diào)的是： 專家的意見是患者治療劑量要足夠，至少25 ml/kg/h。,Dose or intensity of CRRT,而關(guān)于(guāny,Dose or intensity of CRRT,第二十七頁，共四十二頁。,Contents,Introduction,1,Type of therapy,2,Timing of CRRT,3,Dose of CRRT,4,Conclusions,5,6,第二十五頁，共四十二頁。j236。,Timing of CRRT,When initiation of RRT is considered, it is important to realize that: the consequences of ureamic toxicity, metabolic acidosis and/or fluid overload are likely to be more
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