【持续性肾脏替代治疗crrt英文精品课件】acute renal replacement therapy – intermittent vs continuous modality

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1、Acuterenalreplacementtherapy–intermittentvscontinuousmodalityDr.OverviewIntroductionAcuteRRT:ModalitiesCRRTversusIHDCRRTversusSLEDConclusionsIntroductionAcutekidneyinjury(AKI)isFrequentcomplicationofhospitalizationAssociatedwithsubstantialmorbidity,mortalityandhealthcareexpenditur

2、esPrevalence:1–25%andMortality:20–60%associatedwithAKIinhospitalizedpatientsNephronClinPract2009;112:c222–c229IntroductionAlthoughunderstandingoftheepidemiologyofAKIhasimproved,thereareNoproventherapiesthatreversethecourseofestablishedAKIRenalreplacementtherapy(RRT)Keycomponentoft

3、hesupportivecaregiventopatientswithsevereAKINephronClinPract2009;112:c222–c229IntroductionRRTinAKIApprox.4%ofallcriticallyillpatientswillrequireRRTAmongRRT-requiringpatientswhosurvivethecriticalphaseoftheirillness,themajoritywillbefreeofRRTatthetimeofhospitaldischargeJAMA2005;294:

4、813–818,CritCare2005;9:R700–R709.AcuteRRT:ModalitiesRRTModalityChoiceIntermittenthemodialysis(IHD),Continuousrenalreplacementtherapies(CRRT)andSustainedlow-efficiencydialysis(SLED)areprincipalRRTmodalitiesthatareusedintheacutesettingNephronClinPract2009;112:c222–c229AcuteRRT:Modal

5、itiesAlthoughinstitutionalpoliciesmaydeterminethelocalavailabilityofthesemodalities,CRRTandSLEDtendtobeusedinpatientswithgreaterhemodynamicinstabilityThereislikelysubstantialintercentervariabilitywithrespecttohoweachoftheseformsofRRTisutilizedandprescribedAcuteRRT:ModalitiesTable:

6、PracticalcomparisonofacuteRRTmodalitiesNephronClinPract2009;112:c222–c229AcuteRRT:ModalitiesIHDTypicallyadministeredwithconventionaldialysismachinerythatisusedinthechronicdialysispopulationwithsessionlengthrangingfrom3to5hNephronClinPract2009;112:c222–c229AcuteRRT:ModalitiesCRRTIs

7、appliedwithanintendedtreatmenttimeof24handgenerallyrequiresdedicatedmachinesthatoperateatcomparativelylowerbloodanddialysatepumpspeedsHemodialysis(continuousvenovenoushemodialysis,CVVHD),Hemofiltration(continuousvenovenoushemofiltration,CVVH)oraCombinationofthese(continuousvenoven

8、oushemodiafiltration,CVVHDF)Nephr