CBP在急危重病人的应用2011.06.16.pptVIP

连续性血液净化在急危重病人的应用;一、相关知识的概述;;分子量对清除效率的影响;低通量/高通量膜;血液净化的原理;液体清除原理;超 滤;血液净化的原理;血液净化的原理;血液净化的分类;血液净化的分类;CRRT →CBP;CRRT →CBP;CRRT →CBP;CBP;CBP;CVVH（20世纪80年代） 连续性静脉静脉血液滤过;Ronco等(2002) 提出多器官功能支持治疗(multiple organ support therapy，MOST)一词，将CBP治疗和呼吸机等放在同一地位 ;AKI/ARF的RIFLE分级诊断标准;J Himmelfarb. Kidney International (2007) 71, 971–976. ;;CBP临床应用的指征—肾脏替代;CBP临床应用的指征—肾脏替代;CBP临床应用的指征—脏器支持;CBP临床应用的指征—脏器支持;CBP临床应用的指征—脏器支持;CBP的时机;CBP的时机;CBP的时机;;R.T. Noel Gibney,et al.When Should Renal Replacement Therapy for Acute Kidney Injury Be Initiated and Discontinued?. Blood Purif 2008;26:473–484.;A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury: a systematic review and meta-analysis;;Figure. 90-day survival rate according to the baseline RIFLE classification. P 0.01 compared among the three groups.;CBP的时机;CBP的时机;CBP的模式;CBP的模式;CBP的模式;CBP的模式;CBP的模式;CBP的模式;CBP治疗剂量;CBP治疗剂量;After adjustment for multiple variables, these data provide no evidence for a survival benefit afforded by higher dose RRT. However, more-intensive RRT was associated with a favourable effect on ICU stay and duration of mechanical ventilation among survivors. This result warrants further exploration;CBP治疗剂量;VA/NIH Acute Renal Failure Trial Network*.Intensity of Renal Support in Critically Ill Patients with Acute Kidney Injury. N Engl J Med 2008;359:7-20.;CBP治疗剂量;;CBP治疗剂量;CBP治疗剂量;Zhang ZH, Xu X, Zhu HY.Intensive- vs less-intensive-dose continuous renal replacement therapy for the intensive care unit–related acute kidney injury: A meta-analysis and systematic review. Journal of Critical Care (2010) 25, 595–600.;In conclusion, intensive CRRT cannot provide beneficial effects on mortality and other clinical outcomes including renal function recovery and ICU length of stay, but it will increase the incidence of hypophosphatemia and hypotension.Thus, clinicians should not make any significant changes to their current practice in treating AKI patients in the