《急性腎衰aki》

1、急性腎功能損傷 Acute kidney injury,蘇州大學附屬兒童醫(yī)院 曹 戌,Definitions,Renal insufficiency： describes a medical condition in which the kidneys fail to adequately filter toxins and waste products from the blood. 腎臟不能有效的清除體內(nèi)的垃圾,Stages of ARI,Stage I： 代償compensation（no signals） Stage II： 不全insufficiency （be ignored） S

2、tage III：氮質(zhì)血癥azotemia （be aggressive） Stage IV：尿毒癥uremia （be fatal,Acute renal insufficiency(ARI) Acute kidney injury (AKI) Acute renal failure (ARF)Acute tubular necrosis (ATN,Acute kidney injury (AKI,It is a rapid loss of kidney function. Its causes are numerous and include low blood volume from a

3、ny cause（水源腎前）, exposure to substances harmful to the kidney（水泵 腎性）, and obstruction of the urinary tract（水管腎后,AKI is diagnosed on the basis of characteristic laboratory findings, such as elevated blood urea nitrogen（尿素氮） and creatinine（肌酐）, or inability of the kidneys to produce sufficient amounts

4、of urine（少尿）. AKI may lead to a number of complications, including metabolic acidosis（代酸）, high potassium（髙鉀） levels, uremia（尿毒癥）, changes in body fluid balance（體液平衡）, and effects to other organ systems（多器官衰竭,Signs and symptoms,loss of appetite 納差, nausea and vomiting fatigue 乏力，headache 頭痛 hyperten

5、sion 高血壓（頑固性） anaemia 貧血 dehydration or edema 脫水、水腫 urine volume normal 1-3ml/Kg/h oliguria 少尿 1ml/Kg/h anuria 無尿 0.5ml/Kg/h,With oliguria oliguria（少尿期） Water intoxication 水中毒 Hyperkalemia 髙鉀 and hypermagnesemia 高鎂 Hyperphosphatemia 高磷, hypocalcemia 低鈉 and Hyponatremia 低氯 Metabolic acidosis 代酸 Azote

6、mia 氮質(zhì)血癥 polyuria（多尿期,Without oliguria Blood urea nitrogen and creatinine,Causes,Prerenal Prerenal causes are those that decrease effective blood flow to the kidney. Intrinsic Sources of damage to the kidney itself are dubbed intrinsic. Postrenal It is a consequence of urinary tract obstruction,Diag

7、nosis,CH and physical examination Urine volume and urine test Blood test Imageology Needling biopsy of kidney,Treatment,Administration of intravenous fluids 記錄24h出入量：尿、糞、引、嘔 量出為入 寧少勿多 寧慢勿快 禁止補鉀 適量補鈉 Hyperkalemia 5.5 Calcium Gluconate葡萄糖酸鈣 抗鉀 Glucose and insulin 葡萄糖和胰島素 轉(zhuǎn)鉀 Furosemide 呋塞米 排鉀 6.5 （fata

8、l）Hemopurification 血液凈化,Treatment,Energy, calory and vitamin Anti-infection Hemopurification: 1、Hemodialysis HD 2、Continuous renal replace treatment CRRT Hemofiltration 3、Peritoneal dialysis PD,Keep in Mind,患兒基礎差、年齡小 手術(shù)創(chuàng)傷大、時間長、出血多 我們應該： 1、看：重點、多次 2、記：記錄24h出入量 3、補：量出為入、微泵輸液 4、測：心電、脈氧 血壓 血、尿常規(guī) 肝腎功能 水電酸堿平衡,