最新CRRT and AKI教学讲义ppt课件.ppt

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1、CRRTandAKIAffectingapproximately2to7%ofhospitalizedpatientsandmorethan35%ofcriticallyillpatients.Renal-ReplacementTherapyRequiredin5to6%ofcriticallyillpatientsandisassociatedwithin-hospitalmortalityratesof50to80%.Theoptimaltimingfortheinitiation,method,anddosingofRenal-Repla

2、cementTherapyRemainsuncertainmorethan60yearsafterthefirstclinicaluseofhemodialysisinpatientswithacutekidneyinjury.Inclusioncriteria3)Receivingcareinacriticalcareunit4)Onenonrenalorganfailure(SOFAorgansystemscore≥2)orpresenceofsepsis5)Age≥18years6)Subject/surrogatewillingtopr

3、ovideinformedconsentExclusioncriteriaBaselineserumcreatinine>2mg/dLinmales,>1.5mg/dLinfemalesAcuterenalfailureclinicallybelievedtobeduetoanetiologyotherthanATNMorethan72hourssincemeetingbothofthefollowingconditions:a)FulfillmentofthedefinitionofARF;andb)BUN>100mg/dLExclusion

4、criteria4)Morethanonehemodialysistreatmentormorethan24hourssincestartingCRRT5)Priorkidneytransplant6)Pregnancy7)Prisoner8)Weight>128.5kg9)NoncandidacyforrenalreplacementtherapyExclusioncriteria10)Moribundstate11)Subjectnotexpectedtosurvive28daysbecauseofunderlyingterminalchr

5、onicmedicalcondition12)Comfort-measuresonlystatus13)Participationinaconcurrentinterventionalstudy14)Subject/surrogaterefusal15)PhysicianrefusalRandomlyassignedtooneofthetwotreatmentgroupsbymeansofacentralized,computer-generatedadaptiverandomizationscheme.Randomizationwasstra

6、tifiedaccordingtoandwithinsiteonthebasisoftheSOFAcardiovascularscore(0to2vs.3to4)andbythepresenceorabsenceofoliguriaSOFAscoreSelectionofandtransitionbetweenmethodsofrenal-replacementtherapywerespecifiedintheprotocolIntensiveManagementStrategyIfHmodynamicallystable(SOFAcardio

7、vascularscore0-2)Intermittenthemodialysis6-time/week(everydayexceptsunday)(targetdeliveredspKt/V=1.2-1.4/treatment)Ifhemodynamicallyunstable(SOFAscardiovascularscore3-4)Continuousvenovenoushemodiafiltrationat35mL/Kg/hour;orSustainedlow-efficiencydialysis,6-times/week(everyda

8、yexceptsunday)(targetdeliveredKt/V=1.2-1.4/treatment)ConventionalManagement