肾脏保护：灌注压与血流.ppt

肾脏保护 灌注压与血流 AcuteRenalInjury Pre renalreversableabsoluteorrelativerenalhypoperfusionischemicacutetubularnecrosis ATN IntrinsicrenalglomerulartubularvascularinterstitialPost renalobstruction LameireN etal Lancet2005 365 417 30 RIFLECriteriaforAcuteRenalDysfunction Risk Injury Failure Loss ESRD Abrupt 1 7days Increasecreat50 orGFRdecrease 25 EndStageRenalDisease GFRCriteria UrineOutputCriteria UO 3ml kg hx24hrAnuriax12hrs UO 5ml kg hx12hr UO 5ml kg hx3hr Increasecreatx2OrGFRdecrease 50 Increasecreatx3OrGFRdecrease 75 HighSensitivity HighSpecificity PersistentARF completelossofrenalfunction 2weeks Bellomoetal CriticalCare2004 8 R204 212 去甲肾上腺素 去甲肾上腺素 避免使用肾损药物 氨基糖苷类两性霉素糖肽类造影剂 MurphyMB etal Fenoldopam aselectiveperipheraldopamine receptoragonistforthetreatmentofseverehypertension TheNewEnglandJournalofMedicine2001 345 1548 57 MorelliA etal Prophylacticfenoldopamforrenalprotectioninsepsis arandomized double blind placebo controlledpilottrial CriticalCareMedicine2005 33 2451 6 CaimmiPP etal Fenoldopamforrenalprotectioninpatientsundergoingcardiopulmonarybypass JournalofCardiothoracicandVascularAnesthesia2003 17 491 4 LandoniG etal Beneficialimpactoffenoldopamincriticallyillpatientswithoratriskforacuterenalfailure ameta analysisofrandomizedclinicaltrials AmericanJournalofKidneyDiseases2007 49 56 68 HalpennyM etal Theeffectsoffenoldopamonrenalfunctioninpatientsundergoingelectiveaorticsurgery EuropeanJournalofAnaesthesiology2002 19 32 9 Fenoldopamdopamine 1receptoragonist 药物保护 JCardiothoracVascAnesth2009 Jun22 JCardiothoracVascAnesth2008 22 27 33 Fenoldopam减少肾脏替代治疗 Fenoldopam减少死亡率 JCardiothora