【持续性肾脏替代治疗crrt英文精品课件】prevention and treatment of acute renal failure in sepsis

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1、PreventionandTreatmentofAcuteRenalFailureinSepsisANS.DEVRIESEJAmSocNephrol14:792–805,2003Supervisor:主治醫師李博仁Reporter:住院醫師巫文平VGHTC-9211IntroductionARF:Commoncomplicationofsepsisandcarriesanominousprognosis.MortalityofARF:SepticARF:74.5%ARFnotrelatedtosepsis:45.2%ARF:Incr

2、easesmorbidityandmortalityofsepsis.PreventionandTreatmentofAcuteRenalFailureinSepsisTreatmentwithFluids,Vasopressors,andDiureticsSpecificPharmacologicTreatmentDialyticTreatmentConclusionTreatmentwithFluids,Vasopressors,andDiureticsVolumeExpansionVasopressorsLow-DoseDopa

3、mineDiureticsI.VolumeExpansionOptimizationofsystemichemodynamicsandeffectiveintravascularvolumeimportanttopreventARFinptswithsepsis.Whatconstitutesoptimalhemodynamicsremainslargelyundefined.I.VolumeExpansion3systematicreviewsofrandomizedcontrolledtrialscomparingcrystall

4、oidswithcolloidsyieldedconflictingresults.Thenatureandtargetsofanoptimalfluidresuscitationregimencontinuetobeanunresolvedissue.II.VasopressorsWhenappropriatevolumeexpansionfailstorestoreBPinptswithsepsis,vasopressorsareindicated.Physicianshavebeenconcernedabouttheirusef

5、orfearthatintrarenalvasoconstrictionwouldabrogatethebenefitsofincreasedBP.NorepinephrineInaptwithsepsis,characterizedbysystemicvasodilatationandimpairedrenalautoregulation,NorepinephrineadministrationmaybeexpectedtoimproveRBF.Severalnon-controlledstudiesinptswithsepsisN

6、orepinephrineaugmentedurineoutput&GFRAprospectiveobservationalstudyin97ptswithsepticshocklowermortalityinptstreatedwithnorepinephrinethanthosewithothervasopressorsmainlyhigh-dosedopamineVasopressinVasopressin,ahormonesecretedbytheposteriorpituitary,increasessystemicvasc

7、ularresistancethroughactivationofV1a-receptorsonvascularsmoothmusclecells.Arandomizedtrialin24ptswithsepticshockdemonstratedthata4-hinfusionofargininevasopressinImprovedurineoutput&creatinineclearancewithsimilareffectsonBPandcardiacoutput,ascomparedwithnorepinephrine.II

8、.VasopressorsVasopressorscanbeusedsafelytorestoreBPwithoutcompromisingrenalfunctioninpatientswithsepticshock.N