肾脏保护：灌注压与血流.ppt

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,*,肾脏保护：灌注压与血流,Acute Renal Injury,Pre-renal,reversable absolute or relative renal hypoperfusion,ischemic acute tubular necrosis(ATN),Intrinsic renal,glomerular,tubular,vascular,interstitial,Post-renal,obstruction,Lameire N,et al.Lancet 2005;365:417-30,RIFLE Criteria for Acute Renal Dysfunction,Risk,Injury,Failure,Loss,ESRD,Abrupt(1-7 days),Increase creat 50%or GFR decrease 25%,End Stage Renal Disease,GFR Criteria*,Urine Output Criteria,UO .3ml/kg/h,x 24 hr,Anuria x 12 hrs,UO .5ml/kg/h,x 12 hr,UO 50%,Increase creat x3,Or GFR decrease,75%,High,Sensitivity,High,Specificity,Persistent ARF*=complete loss of renal function 2 weeks,Bellomo et al.Critical Care 2004;8:R204-212,去甲肾上腺素,去甲肾上腺素,避免使用肾损药物,氨基糖苷类,两性霉素,糖肽类,造影剂,Murphy MB,et al.Fenoldopam:a selective peripheral dopamine-receptor agonist for the treatment of severe hypertension.The New England Journal of Medicine 2001;345:,1548,57.,Morelli A,et al.,Prophylactic fenoldopam for renal protection in sepsis:a randomized,double-blind,placebo-controlled pilot trial.,Critical Care Medicine 2005;33:2451,6.,Caimmi PP,et al.,Fenoldopam for renal protection in patients undergoing cardiopulmonary bypass.Journal of Cardiothoracic and Vascular Anesthesia 2003;17:491,4.,Landoni G,et al.,Beneficial impact of fenoldopam in critically ill patients with or at risk for acute renal failure:a meta-analysis of randomized clinical trials.American Journal of Kidney Diseases 2007;49:56,68.,Halpenny M,et al.The effects of fenoldopam on renal function in patients undergoing elective aortic surgery.European Journal of Anaesthesiology 2002;19:32,9.,Fenoldopam,dopamine-1 receptor agonist,药物保护？,J,Cardiothorac Vasc Anesth 2009;,Jun 22.,J,Cardiothorac Vasc Anesth 2008;,22:27-33,Fenoldopam,减少肾脏替代治疗,Fenoldopam,减少死亡率,J,Cardiothorac Vasc Anesth 2008;,22:27-33,小结,肾功能损害与预后密切相关,肾血流与灌注压,ICU,必需重视,肾保护药物？,上医医未病之病；,中医医欲病之病；,下医医已病之病。,