急性腎衰竭與急性腎損傷-0204復(fù)習(xí)課程課件

急性腎衰竭與急性垮損傷20190204急性腎衰竭與急性垮損傷1AcuteKidneyInjury,Mortality,Lengthofstay,andCostsinHospitalizedPatientJAmSocNephrol16:3365-3370,2019100304050910-19SCr(mg/dLChertow等研究表明,血肌酐上升26.5moL可使病死率上升4.1倍。大量臨床研究顯示,腎功能輕度損傷即可導(dǎo)致AKI發(fā)病率及病死率的增加。AcuteKidneyInjury,Mortality2Table1Hospital-acquiredAKl:mortalityandcostassociatedwithselectedchangesinSCrIncreaseinSCrMultivariableorAreaunderIncreasein(mg/dl(95%C)RoCcurvetotalcost0.341(3.1-5.5)0.840565(5.08.5)0.86574991.097(71-13.2)s132002.0164410.3-26)s22023AKl,acutekidneyinjury;Cl,confidenceinterval;OR,oddsratio;ROC,receivingoperatingcharacteristiC;SCr,serumcreatinine住院患者血肌酐的輕微改變即與死亡風(fēng)險和治療費用相關(guān)ChertowGMetal.JAmSocNephrol2019:16:3365-3370Table1Hospital-acquiredAKl:3AKI的定義令1951年,Homerwsmith首次引入了“急性腎衰竭acuterenalfailure,ARF)”這一概念。心近年的研究表明,住院患者血肌酐的輕微改變即與不良預(yù)后相關(guān)◆近年來國際腎臟病及重癥醫(yī)學(xué)界使用急性腎損傷(acutekidneyinjury)替代急性腎衰竭。2019年急性腎損傷網(wǎng)終(acutekidneyinjurynetwork,AKIN)于荷蘭阿姆斯特丹召開了急性腎衰竭研討會,建議將ARF改名為AKI。心AKIN將AKI定義為:AKI是指不超過3個月的腎臟結(jié)構(gòu)或功能的異常,包括血、尿、組織檢測或影像學(xué)方面的腎損傷標志物的異常或腎小球濾過率小于60ml/(min1.73m2)ASoeNephron19:604-60620195:osteEAetal.CriticalCare.10(3):1-102019:RabbHJAKI的定義4aboutakiguidelineadQI(AcuteDialysisQualityInitiative):2019,RIFLEAKIN:2019,modifieddefinitionandstagingsystem.KDIGO:2019,FirstclinicalguidelineforAKIAKIguidelineforAKI:2019UKRenalassociationfinalversion08.03.11.gAKIguidline--KDIGO2019aboutakiguideline5◆在ICU中,AKI的發(fā)病率逐年增加,急性腎損傷的嚴重程度和病死率密切相關(guān)?！粼贗CU中,AKI的發(fā)病率逐年增加,急性腎損傷的嚴6AKI的發(fā)生率和死亡率IncidenceandmortalityofacutekidneyinjuryinselectAuthorSottingDefinitionofaklIncidence-hospitalmortalitySepsisSCrincreaseto2mg/dLNoAKl:2.72%:AKIDmissionsSCrrisefor≤10tAKAD:II%AKE57%Neveu"ICUadmissionswithinSCrto23.5ma/clAKIfromsepsis.74%N2100mg/dLor100%AsepticAKI:45%SCrincreaseto>2mg/dn%t46%,dependingsepsis/SIRS(N-2,527needfordialysis,ordoubingofsomortalitynotreportedPercutaneouscoronaryvarerIncreaseinSCr>0.5mg/dNoAKk:06PCN=8357IncreaseinSCr225%or20.5mg/dLAKE13%ThatsIncreaseinSCr20.5mg/dLIAK:3.3%:AKHD:0.3%AKE22%:NoAKI:1%McCullough"PCI(N-1,826)IncreaseinSCrs25%AKLD:0.8%6AK上7%;AKDD:36%chelacreaseinSCr>25%AKE4%ofentit22cfthosewih2SONotreporteremergencydeptN=1,224]measurementAKD:0%cIncreaseinSCr>%AKlinDMCKD:2.4%NotreportedAKinIVcontast:2.1%Notreportedtoatleast1.2mg/dAKnⅣcontrast:I.3%WaikarSSetal.ClinJAmSeeNephrol2019:3:844-861AKI的發(fā)生率和死亡率7AKI的發(fā)生率和死亡率CardiacsurgeryMehtaNeedfordialysisortedNoAKID:23%AKHD:43.6%itsundergoingCABGncreasein25%25-49%2-4%:19o,2100N=1.391≥100%:5%25-4%%18N=643=:(3AKl:notreportedN=19.89AKID:1.79IncreaseinSCr%AK:3.4%NoAKAKID:1.99IncreaseinSCr220%withinAK:15.6%NAK:1.0%N=591AKID:1.4%AK:120%;AD375%Chertow"5CABGorvalvularsurgeryNeedfordiabyAKHD:II%(30daymortalityN-43,642paredManganoCABGorvalvularsurgeryeaseinSCrcf20.7mg/dLN。AK:0y%=2222loatleast2.0mg/dLAKH:1.47AK:1%AXD:63.8%AKI的發(fā)生率和死亡率8AKI的發(fā)生率和死亡率Incidenceandmortalityofacutekidneyinjuryinselectedconditions(continuedDefinitionofAKcidenceIn-hospitalmortalityiodcmaninoatbaselineAKI,gentamicin.26.3%Bates585seinSCrcf>%toalAK:14SCratleast3.0mg/dL)aspergillosis(N=2391AKD:145%AKID:76%0atheyAminoglycosides(N-243)IncreaseinSCrcf0.5mg/dLNotreportedand100%soverbaselineSmit"GentamicinandAK:19.2%PrintslncreaseinSCrcf220%6AKl:13%bomgroups)NotreportedAKHD:notreportedIncreaseinSCrof>20%AK-12%IncreaseinSCrto>1.7mg/dLdominalaorticsurgeryor30%overbaselineAKD:569AKI的發(fā)生率和死亡率9二、病因和分類腎前性:◆大出血、消化道或皮膚大量失液、液體向第三間隙轉(zhuǎn)移、過渡利尿引起急性血容量不足◆充血性心力衰竭、急性心肌梗死、嚴重心律失常、心臟壓塞、肺栓塞等所致心排量降低;◆全身性疾病、Sepsis、過敏反應(yīng)等引起有效循環(huán)血量減少或重分布,腎血管病變或藥物引起的腎血管阻力增加等病因→腎血流低灌注→腎小球濾過率不能維持正?！倌颉Ｔ缙诠δ苄?。二、病因和分類10急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件11急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件12急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件13急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件14急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件15急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件16急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件17急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件18急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件19急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件20急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件21急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件22急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件23急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件24急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件25急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件26急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件27急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件28急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件29急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件30急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件31急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件32急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件33急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件34急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件35急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件36急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件37急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件38急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件39急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件40急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件41急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件42急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件43急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件44急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件45急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件46急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件47急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件48急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件49急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件50急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件51急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件52急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件53急性腎衰竭與急性垮損傷20190204急性腎衰竭與急性垮損傷54AcuteKidneyInjury,Mortality,Lengthofstay,andCostsinHospitalizedPatientJAmSocNephrol16:3365-3370,2019100304050910-19SCr(mg/dLChertow等研究表明,血肌酐上升26.5moL可使病死率上升4.1倍。大量臨床研究顯示,腎功能輕度損傷即可導(dǎo)致AKI發(fā)病率及病死率的增加。AcuteKidneyInjury,Mortality55Table1Hospital-acquiredAKl:mortalityandcostassociatedwithselectedchangesinSCrIncreaseinSCrMultivariableorAreaunderIncreasein(mg/dl(95%C)RoCcurvetotalcost0.341(3.1-5.5)0.840565(5.08.5)0.86574991.097(71-13.2)s132002.0164410.3-26)s22023AKl,acutekidneyinjury;Cl,confidenceinterval;OR,oddsratio;ROC,receivingoperatingcharacteristiC;SCr,serumcreatinine住院患者血肌酐的輕微改變即與死亡風(fēng)險和治療費用相關(guān)ChertowGMetal.JAmSocNephrol2019:16:3365-3370Table1Hospital-acquiredAKl:56AKI的定義令1951年,Homerwsmith首次引入了“急性腎衰竭acuterenalfailure,ARF)”這一概念。心近年的研究表明,住院患者血肌酐的輕微改變即與不良預(yù)后相關(guān)◆近年來國際腎臟病及重癥醫(yī)學(xué)界使用急性腎損傷(acutekidneyinjury)替代急性腎衰竭。2019年急性腎損傷網(wǎng)終(acutekidneyinjurynetwork,AKIN)于荷蘭阿姆斯特丹召開了急性腎衰竭研討會,建議將ARF改名為AKI。心AKIN將AKI定義為:AKI是指不超過3個月的腎臟結(jié)構(gòu)或功能的異常,包括血、尿、組織檢測或影像學(xué)方面的腎損傷標志物的異常或腎小球濾過率小于60ml/(min1.73m2)ASoeNephron19:604-60620195:osteEAetal.CriticalCare.10(3):1-102019:RabbHJAKI的定義57aboutakiguidelineadQI(AcuteDialysisQualityInitiative):2019,RIFLEAKIN:2019,modifieddefinitionandstagingsystem.KDIGO:2019,FirstclinicalguidelineforAKIAKIguidelineforAKI:2019UKRenalassociationfinalversion08.03.11.gAKIguidline--KDIGO2019aboutakiguideline58◆在ICU中,AKI的發(fā)病率逐年增加,急性腎損傷的嚴重程度和病死率密切相關(guān)?！粼贗CU中,AKI的發(fā)病率逐年增加,急性腎損傷的嚴59AKI的發(fā)生率和死亡率IncidenceandmortalityofacutekidneyinjuryinselectAuthorSottingDefinitionofaklIncidence-hospitalmortalitySepsisSCrincreaseto2mg/dLNoAKl:2.72%:AKIDmissionsSCrrisefor≤10tAKAD:II%AKE57%Neveu"ICUadmissionswithinSCrto23.5ma/clAKIfromsepsis.74%N2100mg/dLor100%AsepticAKI:45%SCrincreaseto>2mg/dn%t46%,dependingsepsis/SIRS(N-2,527needfordialysis,ordoubingofsomortalitynotreportedPercutaneouscoronaryvarerIncreaseinSCr>0.5mg/dNoAKk:06PCN=8357IncreaseinSCr225%or20.5mg/dLAKE13%ThatsIncreaseinSCr20.5mg/dLIAK:3.3%:AKHD:0.3%AKE22%:NoAKI:1%McCullough"PCI(N-1,826)IncreaseinSCrs25%AKLD:0.8%6AK上7%;AKDD:36%chelacreaseinSCr>25%AKE4%ofentit22cfthosewih2SONotreporteremergencydeptN=1,224]measurementAKD:0%cIncreaseinSCr>%AKlinDMCKD:2.4%NotreportedAKinIVcontast:2.1%Notreportedtoatleast1.2mg/dAKnⅣcontrast:I.3%WaikarSSetal.ClinJAmSeeNephrol2019:3:844-861AKI的發(fā)生率和死亡率60AKI的發(fā)生率和死亡率CardiacsurgeryMehtaNeedfordialysisortedNoAKID:23%AKHD:43.6%itsundergoingCABGncreasein25%25-49%2-4%:19o,2100N=1.391≥100%:5%25-4%%18N=643=:(3AKl:notreportedN=19.89AKID:1.79IncreaseinSCr%AK:3.4%NoAKAKID:1.99IncreaseinSCr220%withinAK:15.6%NAK:1.0%N=591AKID:1.4%AK:120%;AD375%Chertow"5CABGorvalvularsurgeryNeedfordiabyAKHD:II%(30daymortalityN-43,642paredManganoCABGorvalvularsurgeryeaseinSCrcf20.7mg/dLN。AK:0y%=2222loatleast2.0mg/dLAKH:1.47AK:1%AXD:63.8%AKI的發(fā)生率和死亡率61AKI的發(fā)生率和死亡率Incidenceandmortalityofacutekidneyinjuryinselectedconditions(continuedDefinitionofAKcidenceIn-hospitalmortalityiodcmaninoatbaselineAKI,gentamicin.26.3%Bates585seinSCrcf>%toalAK:14SCratleast3.0mg/dL)aspergillosis(N=2391AKD:145%AKID:76%0atheyAminoglycosides(N-243)IncreaseinSCrcf0.5mg/dLNotreportedand100%soverbaselineSmit"GentamicinandAK:19.2%PrintslncreaseinSCrcf220%6AKl:13%bomgroups)NotreportedAKHD:notreportedIncreaseinSCrof>20%AK-12%IncreaseinSCrto>1.7mg/dLdominalaorticsurgeryor30%overbaselineAKD:569AKI的發(fā)生率和死亡率62二、病因和分類腎前性:◆大出血、消化道或皮膚大量失液、液體向第三間隙轉(zhuǎn)移、過渡利尿引起急性血容量不足◆充血性心力衰竭、急性心肌梗死、嚴重心律失常、心臟壓塞、肺栓塞等所致心排量降低;◆全身性疾病、Sepsis、過敏反應(yīng)等引起有效循環(huán)血量減少或重分布,腎血管病變或藥物引起的腎血管阻力增加等病因→腎血流低灌注→腎小球濾過率不能維持正?！倌?。早期功能性。二、病因和分類63急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件64急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件65急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件66急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件67急性腎衰竭與急性腎損傷——0204復(fù)習(xí)課程課件