AKI治疗的液体平衡控制

1、1会计学AKI治疗的液体平衡控制治疗的液体平衡控制Eric A. Crit Care Med 2008; 36:S146S151Eric A. Crit Care Med 2008; 36:S146S151Intensive Care Med 33:15631570, 2007容量状况特征 总体水量、液体分布部位及成分的变化 血管内有效循环血量下降容量过多伴间质水肿血浆胶体渗透压 白蛋白 血管通透性容量状况特征总体水量增加液体分布部位变化成分的异常尿量减少、不变甚至增多 容量过负荷FO干预性治疗：水钠潴留、液体重新分布如：脓毒症休克大量补液以维持血流动力学稳定血管内容量过负荷、间质水肿病因及机

2、制病因及机制生理学作用生理学作用后后 果果系统血压降低系统血压降低入球小动脉收缩入球小动脉收缩出球小动脉扩张出球小动脉扩张肾小球静水压降低肾小球静水压降低GFR降低降低肾间质水肿肾间质水肿外源性压缩外源性压缩肾小管梗阻肾小管梗阻肾小管重吸收衰竭肾小管重吸收衰竭肾小球囊内压增高肾小球囊内压增高GFR降低降低肾血浆流量降低肾血浆流量降低胶体压快速升高胶体压快速升高GFR降低降低有无液体丢失液体正/负平衡眼窝、皮肤、口渴外周水肿肺水肿第三腔液体积聚心功能不全Br J Anaesth 86:754762, 2001Br J Anaesth 86:754762, 2001Br J Anaesth 86:

3、754762, 2001N Engl J Med 345:13681377,2001不伴AKI脓毒症休克液体平衡参考目标Arch Intern Med. 2006;166:2132-213730-45。Arch Intern Med. 2006;166:2132-2137Arch Intern Med. 2006;166:2132-2137AMERICAN JOURNAL OF CRITICAL CARE January 2005, Volume 14, No. 1European Journal of Anaesthesiology 2009, Vol 26 No 11Kidney Int

4、2009; 76:422427Kidney Int 2009; 76:422427Kidney Int 2009; 76:422427Kidney Int 2009; 76:422427Kidney Int 2009; 76:422427Kidney Int 2009; 76:422427Kidney Int 2009; 76:422427Kidney Int 2009; 76:422427Clin J Am Soc Nephrol 1:915919, 2006Bellomo et al, NEJM 2009Progressive improvement as CRRT use has become more widespread55 Represents low dose arm mortalityRENAL研究结果：死亡率研究结果：死亡率49%； 肾存活率肾存活率95%Delivered CRRT Dose: Best Practice Window Kellum and Ronco, Nature Re