急性肾衰aki.ppt

急性肾功能损伤Acutekidneyinjury 苏州大学附属儿童医院曹戌 Definitions Renalinsufficiency describesamedicalconditioninwhichthekidneysfailtoadequatelyfiltertoxinsandwasteproductsfromtheblood 肾脏不能有效的清除体内的垃圾 StagesofARI StageI 代偿compensation nosignals StageII 不全insufficiency beignored StageIII 氮质血症azotemia beaggressive StageIV 尿毒症uremia befatal Acuterenalinsufficiency ARI Acutekidneyinjury AKI Acuterenalfailure ARF Acutetubularnecrosis ATN Acutekidneyinjury AKI Itisarapidlossofkidneyfunction Itscausesarenumerousandincludelowbloodvolumefromanycause 水源 肾前 exposuretosubstancesharmfultothekidney 水泵 肾性 andobstructionoftheurinarytract 水管 肾后 AKIisdiagnosedonthebasisofcharacteristiclaboratoryfindings suchaselevatedbloodureanitrogen 尿素氮 andcreatinine 肌酐 orinabilityofthekidneystoproducesufficientamountsofurine 少尿 AKImayleadtoanumberofcomplications includingmetabolicacidosis 代酸 highpotassium 髙钾 levels uremia 尿毒症 changesinbodyfluidbalance 体液平衡 andeffectstootherorgansystems 多器官衰竭 Signsandsymptoms lossofappetite纳差 nauseaandvomiting fatigue乏力 headache头痛 hypertension高血压 顽固性 anaemia贫血 dehydrationoredema脱水 水肿 urinevolumenormal1 3ml Kg holiguria少尿 1ml Kg hanuria无尿 0 5ml Kg h Witholiguriaoliguria 少尿期 Waterintoxication水中毒Hyperkalemia髙钾andhypermagnesemia高镁Hyperphosphatemia高磷 hypocalcemia低钠andHyponatremia低氯Metabolicacidosis代酸Azotemia氮质血症polyuria 多尿期 WithoutoliguriaBloodureanitrogenandcreatinine Causes PrerenalPrerenalcausesarethosethatdecreaseeffectivebloodflowtothekidney IntrinsicSourcesofdamagetothekidneyitselfaredubbedintrinsic PostrenalItisaconsequenceofurinarytractobstruction Diagnosis CHandphysicalexamination Urinevolumeandurinetest Bloodtest Imageology Needlingbiopsyofkidney Treatment Administrationofintravenousfluids记录24h出入量 尿 粪 引 呕量出为入宁少勿多宁慢勿快禁止补钾适量补钠 Hyperkalemia 5 5CalciumGluconate葡萄糖酸钙抗钾Glucoseandinsulin葡萄糖和胰岛素转钾Furosemide呋塞米排钾 6 5 fatal Hemopurification血液净化 Treatment Energy caloryandvitamin Anti infection Hemopurification 1 HemodialysisHD2 ContinuousrenalreplacetreatmentCRRTHemofiltration3 PeritonealdialysisPD KeepinMind 患儿基础差 年龄小手术创伤大 时间长 出血多我们应该 1 看 重点 多次2 记 记录24h出入量3 补 量出为入