kdigoaki急性腎損傷診療指南解讀20xx版-文庫(kù)吧資料
2025-05-31 22:52本頁(yè)面
【正文】 coside drug levels when treatment with singledaily dosing is used for more than 48 hours. (2C) ? We suggest using topical or local applications of aminoglycosides (., respiratory aerosols, instilled antibiotic beads), rather than . application, when feasible and suitable. ( 2B) KDIGO,2022 Prevention of aminoglycoside and amphotericinrelated AKI ? We suggest using lipid formulations of amphotericin B rather than conventional formulations of amphotericin B. (2A) ? In the treatment of systemic mycoses or parasitic infections, we remend using azole antifungal agents and/or the echinocandins rather than conventional amphotericin B, if equal therapeutic efficacy can be assumed.(1A) KDIGO,2022 Other methods of prevention of AKI in the critically ill ? We suggest that offpump coronary artery bypass graft surgery not be selected solely for the purpose of reducing perioperative AKI or need for RRT. (2C) ? We suggest not using NAC to prevent AKI in critically ill patients with hypotension. (2D) ? We remend not using oral or . NAC for prevention of postsurgical AKI. (1A) CIAKI:預(yù)防對(duì)比劑急性腎損害 KDIGO,2022 Guideline 5：醫(yī)療資源合理分配 ? 多學(xué)科參與 AKI指南制定 ? 腎科醫(yī)生會(huì)診提供?？埔庖?jiàn) ? 合理的轉(zhuǎn)診方案 ? 密切監(jiān)護(hù)治療 ? 腎臟科與 ICU醫(yī)生協(xié)作 When to request a renal referral？ KDIGO,2022 Guideline 6： RRT模式的選擇 建議個(gè)體化治療！ (1B) Kanagasundaram,2022 KDIGO,2022 Guideline 7： 透析器和透析液的選擇 透析器： ?合成膜透析器 (1B) ?改良纖維素膜透析器 (1B) 透析液： ?首選碳酸氫鈉透析液 /置換液 (1C) ?透析液微生物的控制 KDIGO,2022 Guideline 8：血管通路 ? 臨時(shí)建立靜脈 靜脈通路 (1A) ? 選擇足夠長(zhǎng)度的透析導(dǎo)管以降低再循環(huán)率 (1B) ? 置管部位和導(dǎo)管類型需根據(jù)患者的病情選擇 (2C) ? 由經(jīng)驗(yàn)豐富的醫(yī)生負(fù)責(zé)置管 (1A) ? 實(shí)時(shí)超聲導(dǎo)引有助于置管 (1D) ? 對(duì)有進(jìn)展至 CKD45期風(fēng)險(xiǎn)的患者，盡量避免行鎖骨下靜脈置管，保護(hù)患者的血管資源 (1D) KDIGO,2022 Guideline 8：血管通路 ? 保護(hù)非優(yōu)勢(shì)側(cè)的上肢血管 (2C) ? 定期更換臨時(shí)導(dǎo)管以降低感染的風(fēng)險(xiǎn) (1C) – 頸內(nèi)靜脈： 3周 – 股靜脈： 1周 – 3周：建議用皮下隧道導(dǎo)管 ? 導(dǎo)管僅限于 RRT治療時(shí)使用 (1D)以預(yù)防感染 KDIGO,2022 Guideline 9：體外抗凝 ? 根據(jù)患者病情和 RRT模式制定抗凝治療方案 (1C) ? 推薦枸櫞酸局部抗凝降低出血風(fēng)險(xiǎn) (2C) ? 具有出血風(fēng)險(xiǎn)的患者可選擇前列環(huán)素抗凝，但會(huì)引起血流動(dòng)力學(xué)不穩(wěn)定 (2C) ? 具有高出血風(fēng)險(xiǎn)的患者可采取無(wú)抗凝劑、鹽水沖洗的方法，但引起超濾量增加，透析效率下降及增加了透析膜破裂的風(fēng)險(xiǎn) (2C) KDIGO,2022 Guideline 10： RRT處方 ? 通過(guò)對(duì) RRT劑量的評(píng)估確保透析充分性 (1A) ? 每次 (IHD）或每日（ CRRT)評(píng)估透析劑量及充分性 (1A) ? 推薦伴有多器官功能衰竭的 AKI患者行 CRRT，后稀釋法超濾率 25ml/kg/hr。 KDIGO,2022 The use of diuretics in AKI ? At present, thecurrent evidence does not suggest that furosemide can reduce mortality in patients with AKI. ? a beneficial role for loop diuretics in facilitating discontinuation of RRT in AKI is not evident. KDIGO,2022 甘露醇 ? mannitol is not scientifically justified in the prevention of AKI. KDIGO,2022 Vasodilator therapy: dopamine, fenoldopam, and natriuretic peptides ? We remend not using lowdose dopamine
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