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*,*,*,*,*,*,单击此处编辑母版标题样式,*,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,CRRT影响AKI剩余肾功能吗?,Outline,AKI 的流行病学,剩余肾功能的概念及临床意义,CRRT对剩余肾功能的影响及可能机制,小结,ARF,的现状,-,发生率逐年增加,Community-based incidence rates(per 100 000 person-years)of non dialysis requiring ARF by calendar year,Kidney Int,2007;72(2):208212,Community-based incidence rates(per 100 000 person-years)of dialysis-requiring ARF by calendar year,ARF,病死率居高不下,J Am Soc Nephrol,2006;17:11431150,ARF,、,ARF-D,的发病率仍呈上升趋势,ARF,病死率随时间尽管呈下降趋势,但是仍然高达,25-40%,Prospective observational study,September 2000 to December 2001 at 54 hospitals,in 23 countries,Of 29 269 critically ill patients admitted during the study period,1738(5.7%;95%CI 5.5%-6.0%)had ARF during their ICU stay,including 1260 who were treated with RRT,JAMA.2005;294:813-818,The criteria for ARF,:,少尿,(12,小时,200ml),或,/,和血尿素氮高于,84 mg/dL(30 mmol/L),Mortality with acute kidney failure,JAMA.2005;294:813-818,Overall hospital mortality was 60.3%,RIFLE criteria:incidence and associated mortality,Critical Care 2006,10:R73,5383 critically ill patients in 7 ICUs,AKI occurred in 67%of patients,Mortality:,hazard ratio of 2.7,Has mortality from acute renal failure decreased?,The American Journal of Medicine(2005)118,827832,Reported mortality rates of patients with acute renal failure from 1956 to 2003-,A systematic review of the literature-47years,80 were included in our review with a total of 15 897 patients,Epidemiology of AKI,Blood Purif 2021;31:159171,Multicenter Italian Study,RIFLE-Based Data,Outline,AKI 的流行病学,剩余肾功能的概念及临床意义,CRRT对剩余肾功能的影响及可能机制,小结,剩余肾功能,(Residual renal function RRF),定义:是指肾脏受到损伤后健存肾单位的残留功能,包括去除毒素、调节水电解质和酸碱平衡以及多种内分泌功能,剩余肾功能与生存率,Nephrol Dial Transplant 2005;20:396403,Nephrol Dial Transplant.2021;26(9):2978-83.,剩余肾功能与AKI长期预后正相关,Intensity of Renal Support,不改善,AKI,病死率,N Engl J Med 2021;359:7-20.,N Engl J Med 2021;361:1627-38.,Once an organ is injured,Try and assist a failing organ by treating the underlying cause,Try to force that organ to work harder may not be the best approach,Rest the injured organ should be sensible,Avoid significant adverse events,Critical Care 2021,16:317,在维持性透析患者中影响,RRF,的因素,血压,年龄,性别,种族,药物,钙磷代谢,脂质代谢,内分泌激素水平,肾脏替代治疗相关因素腹膜透析or血透、透析膜等,其他,J Am Soc Nephrol.2000 Mar;11:556-64.,Outline,AKI 的流行病学,剩余肾功能的概念及临床意义,CRRT对剩余肾功能的影响及可能机制,小结,CRRT,特点,稳定的血流动力学,持续稳定的控制氮质血症和水电/酸碱平衡,能够不断去除循环中的毒素或中分子物质,按需提供营养补充和药物治疗,CRRT vs IRRT,IHD,PD,CRRT,Hemodynamic stability,+,+,Osmo pressure stability,+,+,Fluid removal,+,+,+,Correction of acidosis,+,+,+,Unlimited PN/EN,+,Clearances,Small solutes(500d),+,+,Mediator removal,+?,Access morbidity,+,+,+,Anticoagulation needs,+,+,Simplicity,+,+,+,Recovery of renal function,-In theory,Remove fluid and,solute slowly,More stable,Haemodynamics,May help to revovery,of renal function,CRRT,Rapid fluid removal,May lead to hypotension,With potential for,further renal injury and,prolongation of ARF,IRRT,Nephrology Dialysis Transplantation 1997;12(5):8702,Compared to IRRT,CRRT can help to raise MAP,The Cochrane Library 2021,Issue 3,CRRT decreases the requiring of pressor,The Cochrane Library 2021,Issue 3,CRRT is associated with more stable haemodynamics than IRRT,Retrospective cohort study,Pats with ARF and required dialysis between April 1,1996,and March 31,1999,2,ICU in Canada.,N=,261,CRRT,IHD,P,APACHE II,27,25.1,0.10,Baseline SCr,136,180,0.002,MAP Before RRT,74.7,87.2,0.001,Hosp Mortality,71.9%,42.2%,0.01,Renal recovery in hosp,80.0%,62.5%,0.06,Duration of RRT,14.7d,14.5d,0.91,Cost per week(Can$),3486-5117,1341,Survivor(Cost per y),No-RRT,RRT,$11,192,$73,273,CRRT,对,ARF,肾功能恢复的影响,CRRT,促进肾功能恢复,Crit Care Med 2003;31:449 455,CRRT,:肾功能恢复,32 ICU,n=2202,1102 Survived 90 days,CVVH:94485.7%,IHD:15814.3%,Intensive Care Med(2007)33:773780,慢性透析,8.3%,慢性透析,16.5%,944 CRRT,1102,存活,90,天,78,90,天内
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