重症患者之急性肾损伤  

Acute kidney injury in intensive care unit

作　　者：庄乔琳 尹汇文 唐高骏 Chuang Chiaolin;Yien Hueywen;Tang Gaujun(Department of Medicine,Taipei Veterans General Hospital,Taipei,Taiwan,China;Yang-Ming University School of Medicine,Taipei,Taiwan,China;Surgical Intensive Care Unit,Yang-Ming University Hospital,Taipei,Taiwan,China)

机构地区：[1]台北荣民总医院内科部 [2]阳明大学医学院 [3]阳明大学附设医院外科ICU

出　　处：《中华重症医学电子杂志》2018年第2期123-127,共5页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

摘　　要：重症监护病房中,急性肾损伤的发生率逐年增加,台湾地区全民健康保险研究数据库显示ICU的患者约有10%需要肾脏替代治疗。造成肾损伤主要的原因为脓毒症及低血容积休克,静脉输液补充血管内容积及维持稳定血压及肾灌注为最基本的治疗。由于利尿剂在防止或治疗肾损伤中的角色已淡出,肾脏替代疗法应在无尿期时尽早实施。连续性肾脏替代治疗(CRRT),可以避免洗肾时的低血压发生,持续性低效率每日透析(SLEDD)是一种复合型治疗,结合了CRRT血流动力状态稳定的优点,也具备间歇性肾脏替代治疗节省人力与治疗时间的好处。一个多专科团队能及时矫正即有的疾病,充分的血流动力及营养支持,早期的肾脏替代治疗,可防止多重器官衰竭发生,改善患者的结果 。The incidence of acute kidney injury（AKI） is increasing and up to 10% of total ICU patients need renal replacement therapy. The major causes of AKI are sepsis and hypovolemic shock. Adequate intravascular fluid and stable blood pressure to maintain renal perfusion remain the basis for the managements of AKI. Since the efficacy of diuretics was challenged, renal replacement therapy should be implemented at the early phase of anuria. Continuous renal replacement therapy（CRRT） is preferred to avoid of intradialytic hypotension. Either continuous veno-venous hemofiltration（CVVH） or hybrid therapy using sustained low efficiency daily dialysis（SLEDD） is good choice for the hemodynamic unstable sepsis patients. A multi-disciplinary team approach to correct underlying disease, optimize hemodynamic and nutritional support,backup with early renal replacement intervention can prevent multiple organ failure and improve outcome.

关 键 词：急性肾损伤 连续性肾脏替代治疗 持续性低效率每日透析 

分 类 号：R692[医药卫生—泌尿科学]