Clinical Practice Guidelines For Acute raum Injury In ChinaⅥ

Cov lus nug 9: Kev kho noj zaub mov txhawb rau AKI

【Cov lus pom zoo】

1. Nws raug pom zoo kom muab kev kho mob rau cov neeg mob AKI los ntawm kev noj zaub mov zoo (1B).

2. Nws raug pom zoo tias tag nrho lub zog noj ntawm AKI cov neeg mob yog 20 ~ 30 kcal·kg-1·d-1 (2C).

3. Nws raug pom zoo kom noj cov protein ntau ntawm cov neeg mob uas tsis muaj catabolism siab thiab AKI uas tsis xav tau kev kho mob lim ntshav yog 0.8 ~ 1.0 g·kg-1·d -1; Cov neeg mob uas xav tau RRT thiab siab catabolism yuav tsum tsim nyog nce lawv cov protein kom tsawg (2D).

4. Nws raug nquahu kom tswj cov ntshav qab zib<10 mmol/L to prevent renal damage related to hyperglycemia (1B).

5. Nws raug pom zoo kom muab cov vitamin E ntxiv ua ntej qhov sib txawv ntawm tus neeg sawv cev tiv thaiv kom tsis txhob muaj qhov sib txawv ntawm tus neeg saib xyuas AKI (1B).

Nyem rau Cistanche rau mob raum

Kev noj zaub mov zoo tuaj yeem ua rau muaj txiaj ntsig zoo ntawm kev txo cov kab mob peptic ulcers thiab plab hnyuv los ntshav los ntawm AKI kev ntxhov siab thiab pab tiv thaiv cov hnyuv mucosa ntawm AKI cov neeg mob, tiv thaiv kab mob translocation, thiab tiv thaiv lwm yam hauv nruab nrog cev. Kev tshawb fawb ntau qhov chaw los ntawm 30 ICUs hauv Australia tau qhia tias kev noj zaub mov zoo yog qhov tiv thaiv zoo rau cov neeg mob AKI; ib qho kev tshawb fawb RCT tau pom tias kev noj zaub mov zoo tuaj yeem txhim kho qhov kev mob tshwm sim ntawm cov neeg mob hnyav RRT (CRRT) . Cov txiaj ntsig ntawm kev tshawb fawb RCT uas suav nrog 474 cov neeg mob hnyav tau pom tias kev noj tshuaj txhua hnub ntawm 100 g ntawm cov amino acids tsis ua rau lub sijhawm rov qab los ntawm lub raum ua haujlwm thiab txo qhov xav tau RRT. Yog li, niaj hnub parenteral amino acid supplementation tsis pom zoo rau cov neeg mob AKI.

Kev tshawb nrhiav rov qab suav nrog 50 cov neeg mob uas muaj AKI pom tias qhov kev noj caloric sib raug rau kev ua tiav cov pa nitrogen me me lossis me me zoo nitrogen tshuav yog kwv yees li 25 kcal·kg-1·d-1. Cov txiaj ntsig ntawm lwm RCT pom tau tias piv nrog lub zog noj ntawm 30 kcal·kg-1·d-1, siab zog kom tsawg (40 kcal·kg-1·d -1) tsis ua rau muaj kev cuam tshuam loj dua rau cov neeg mob AKI. Zoo nitrogen tshuav nyiaj li cas, tab sis nce qhov tshwm sim ntawm hyperglycemia, hypertriglyceridemia thiab dej load. KDIGO cov lus qhia pom zoo kom noj lub zog ntawm 20 txog 30 kcal·kg{{12}·d-1 rau cov neeg mob AKI. Cov ntsiab lus carbohydrate yog 3 ~ 5 g·kg-1·d-1, thiab cov ntsiab lus rog yog 0.8 ~ 1.0 g·kg-1·d-1.

2012 KDIGO Cov Lus Qhia thiab 2016 Japanese AKI Clinical Practice Guidelines ob leeg pom zoo kom noj cov protein ntau ntawm 0.8 ~ 1.0 g·kg-1·d-1 rau AKI cov neeg mob nyob rau hauv lub xeev tsis-hypercatalytic thiab tsis-RRT. Kev noj cov protein ntau tuaj yeem ua rau acidosis thiab azotemia thiab ua kom cov ntshav lim ntshav nce ntxiv. Nyob rau hauv lub xeev siab decomposition, xws li sepsis thiab raug mob, cov neeg mob 'AKI feem ntau hnyav dua, thiab cov protein hloov pauv thiab cov nitrogen xav tau nce. Kev noj zaub mov kom tsim nyog tuaj yeem txo qis nitrogen.

The regulation of blood sugar is beneficial to the occurrence and prognosis of AKI. An RCT study including 1,548 patients showed that strict blood sugar control can reduce the incidence of AKI in ICU patients, reduce the RRT treatment rate of AKI patients by 41%, and improve survival rates, which is related to hyperglycemia (>10 mmol / L. Hauv kev sib piv, cov ntshav qabzib<8.3 mmol/L can improve the prognosis of AKI. While controlling blood sugar, in order to avoid the risk of hypoglycemia, the expert group recommends a moderate blood sugar lowering target (<10 mmol/L) for critically ill patients.

Cov kev tshawb fawb RCT yav dhau los tau pom tias cov tshuaj vitamin E ntxiv rau lub sijhawm luv luv ua ntej qhov sib txawv ntawm tus neeg sawv cev tuaj yeem txo qhov tshwm sim ntawm qhov sib txawv ntawm tus neeg saib xyuas AKI. Tam sim no qhia txog kev siv tshuaj: -tocopherol 300 mg / d lossis -tocopherol 350 mg / d, noj tsis tu ncua los ntawm 5 hnub ua ntej kev phais mus rau 2 hnub tom qab kev phais; los yog 600 mg 12 teev ua ntej kev phais, 400 mg 2 teev ua ntej kev phais vitamin E tau noj ntawm qhov ncauj. Yog li, pawg kws tshaj lij pom zoo kom siv cov vitamin E ntxiv ua ntej qhov sib txawv ntawm tus neeg sawv cev tiv thaiv qhov tshwm sim ntawm qhov sib txawv ntawm tus neeg saib xyuas AKI.

Cov Lus Nug Txog Kev Kho Mob 10: Volume Management hauv AKI

Qhov ntim ntawm cov neeg mob AKI yog qhov nyuaj thiab hloov pauv hloov pauv. Kev ntsuas tseeb ntawm cov xwm txheej ntim nrog rau kev tswj cov kua dej tsim nyog thiab kev ua kom zoo ntawm tus neeg mob hemodynamics ua lub luag haujlwm tseem ceeb hauv kev rov ua haujlwm ntawm lub raum.

1. Kev ntsuas qhov muaj peev xwm

Kev ntsuas qhov ntsuas qhov ntim tau piav qhia hauv Ntu 3 Hemodynamic Monitoring.

2. Kev ntsuas peev txheej

【Cov lus pom zoo】

1. Rau cov neeg mob uas muaj kev pheej hmoo siab ntawm AKI uas tsis yog hemorrhagic shock, nws raug nquahu kom siv isotonic crystalloid rehydration es tsis txhob colloid (albumin, hydroxyethyl starch) rau ntim expansion (1B); Nws raug pom zoo tias albumin tuaj yeem siv rau hauv cov neeg mob hepatorenal syndrome (2B).

2. Crystalloid resuscitation tuaj yeem txiav txim siab thaum pib cov kua resuscitation. Nws raug nquahu kom siv cov ntsev sib npaug ua ntej. Cov tshuaj chloride hauv cov ntshav yuav tsum tau saib xyuas kom tsis txhob muaj hyperchloremia (1B); refractory shock uas yog ntim teb tab sis tsis teb rau crystalloids. Rau cov neeg mob, me me ntawm colloids yuav raug txiav txim siab thaum ntxov resuscitation (2B).

3. Nws raug pom zoo tias thawj zaug ua kom cov kua dej txaus thiab kev tswj xyuas cov kua dej tom ntej (CLFM) yuav tsum tau ua ke los tswj kev ceev thiab kev siv cov kua dej ntau npaum li cas (2B).

Cov kev tshawb fawb tau pom tias cov dej loj loj ntawm cov kua qaub los yog cov kua dej resuscitation siv cov tshuaj enzymatic tuaj yeem ua rau cov kua qaub dilutive hyperchloremic acidosis thiab ua rau muaj kev pheej hmoo ntawm lub raum puas. Hauv SMART (Isotonic Solutions thiab Major Adverse Renal Events Trial) sim, kev nyab xeeb ntawm cov ntsev ib txwm muaj thiab cov ntsev ntsev sib npaug tau muab piv. Cov txiaj ntsig tau pom tias cov pab pawg ntsev ntsev sib npaug tau qis dua qhov tshwm sim ntawm lub raum tsis zoo. Tom qab ntawd, Self et al.'s meta-analysis cov txiaj ntsig kuj tau pom tias siv cov ntsev sib npaug rau cov kua dej resuscitation zoo dua li cov ntsev ib txwm nyob rau hauv cov ntsiab lus ntawm cov neeg mob tuag, kev nce qib ntawm lub raum raug mob, tso zis, thiab RRT cov cai.

Ntau qhov kev tshawb fawb RCT thiab cov kev tshuaj xyuas zoo tau pom tias cov khoom siv dag zog tau raug pov thawj tias yog nephrotoxic, thiab ob qho tib si hydroxyethyl starch thiab gelatin tuaj yeem ua rau muaj kev pheej hmoo ntawm AKI, kev siv RRT, thiab kev tuag ntawm AKI cov neeg mob. Txawm hais tias kev siv cov khoom siv colloids yuav tsum tau zam, kev siv cov colloids sparingly thaum lub sij hawm resuscitation thaum ntxov yuav raug txiav txim siab nyob rau hauv cov neeg mob uas muaj zog refractory shocks uas yog cov kua dej thiab tsis teb rau crystalloids. Txoj kev tshawb fawb SAFE thiab ALBIOS txoj kev tshawb fawb pom tias tsis muaj qhov sib txawv ntawm cov nyhuv ntawm cov kua dej resuscitation siv 4%, 5% lossis 20% albumin piv nrog crystalloids, tab sis cov txiaj ntsig zoo dua tseem tsis tau txiav txim siab, thaum lwm qhov kev tshuaj ntsuam meta thiab rov qab los. Cov kev tshawb fawb tau pom tias albumin tam sim no pom zoo rau cov neeg mob uas muaj hepatorenal syndrome, uas tuaj yeem txo qhov tshwm sim thiab kev tuag ntawm AKI.

Hauv kev xyaum kho mob, rau AKI thiab cov neeg mob uas muaj kev pheej hmoo siab nrog AKI, qhov tseem ceeb tshaj yog muab tso rau ntawm tus kheej cov kua dej infusion ntau npaum li cas thiab tus nqi. Kev tshuaj xyuas rov qab los txhawm rau txiav txim siab txog qhov cuam tshuam ntawm kev tswj cov kua dej ntawm cov txiaj ntsig ntawm cov neeg mob uas muaj septic shock thiab AKI, nrog rau cov kua dej pib tsim nyog (AIFR) txhais tau tias yog kev tswj hwm ntau dua lossis sib npaug li 20 ml / kg ntawm cov kua dej thawj zaug tom qab pib kho vasopressor. . Hauv 6 teev, ncav cuag CVP Ntau dua lossis sib npaug li 8 mmHg. CLFM txhais tau tias yog cov kua dej ntws tawm thiab cov dej ntws tawm los yog qhov ntsuas tsis zoo ntawm lub cev ntsuas dej tsawg kawg 2 hnub sib law liag hauv thawj 7 hnub tom qab qhov pib ntawm septic shock. Cov txiaj ntsig ntawm kev tshawb fawb tau pom tias cov neeg mob uas tau txais kev sib koom ua ke AIFR thiab CLFM muaj qhov kev tuag tsawg tshaj plaws.

Cistanche kho mob raum li cas?

Cistanche yog cov tshuaj suav tshuaj ntsuab siv rau ntau pua xyoo los kho ntau yam mob, suav nrog kab mob raum. Nws yog muab los ntawm cov stems qhuav ntawm Cistanche deserticola, ib tsob nroj nyob rau hauv cov suab puam ntawm Tuam Tshoj thiab Mongolia. Cov khoom tseem ceeb ntawm cistanche yog phenylethanoid glycosides, echinacoside, thiab acteoside, uas tau pom tias muaj txiaj ntsig zoo rau lub raum noj qab haus huv.

Kab mob raum, tseem hu ua kab mob raum, hais txog ib yam mob uas lub raum ua haujlwm tsis zoo. Qhov no tuaj yeem ua rau muaj cov khoom pov tseg thiab cov co toxins hauv lub cev, ua rau muaj ntau yam tsos mob thiab teeb meem. Cistanche tuaj yeem pab kho mob raum ase los ntawm ntau lub tshuab.

Ua ntej, cistanche tau pom tias muaj cov nyhuv diuretic, txhais tau tias nws tuaj yeem ua rau cov zis ntau ntxiv thiab pab tshem tawm cov khoom pov tseg ntawm lub cev. Qhov no tuaj yeem pab txo lub nra ntawm lub raum thiab tiv thaiv kev tsim cov co toxins. Los ntawm kev txhawb nqa diuresis, cistanche kuj tseem tuaj yeem pab txo qis ntshav siab, ib qho teeb meem ntawm cov kab mob raum.

Ntxiv mus, cistanche tau pom tias muaj cov teebmeem antioxidant. Kev ntxhov siab oxidative, tshwm sim los ntawm qhov tsis sib xws ntawm kev tsim cov dawb radicals thiab lub cev tiv thaiv antioxidant, ua lub luag haujlwm tseem ceeb hauv kev mob raum. ies pab neutralize dawb radicals thiab txo Oxidative kev nyuaj siab, yog li tiv thaiv lub raum los ntawm kev puas tsuaj. Cov phenylethanoid glycosides pom hauv cistanche tau tshwj xeeb hauv kev tshem tawm cov dawb radicals thiab inhibiting lipid peroxidation.

Tsis tas li ntawd, cistanche tau pom tias muaj cov nyhuv anti-inflammatory. Kev mob yog lwm yam tseem ceeb hauv kev loj hlob thiab kev loj hlob ntawm cov kab mob raum. Cistanche's anti-inflammatory zog pab txo cov zus tau tej cov pro-inflammatory cytokines thiab inhibit qhov ua kom o yuav tsum tau txoj kev, yog li alleviating o nyob rau hauv lub raum.

Tsis tas li ntawd, cistanche tau pom tias muaj cov teebmeem immunomodulatory. Hauv kab mob raum, lub cev tiv thaiv kab mob tuaj yeem ua rau tsis zoo, ua rau muaj kev mob ntau dhau thiab cov ntaub so ntswg puas. Cistanche pab tswj lub cev tiv thaiv kab mob los ntawm kev hloov kho kev tsim khoom thiab kev ua haujlwm ntawm lub cev tiv thaiv kab mob, xws li T hlwb thiab macrophages. Txoj cai tiv thaiv kab mob no pab txo qhov mob thiab tiv thaiv kev puas tsuaj ntxiv rau lub raum.

Ntxiv mus, cistanche tau pom los txhim kho lub raum kev ua haujlwm los ntawm kev txhawb nqa kev tsim kho ntawm lub raum hlab nrog cov hlwb. Lub raum tubular epithelial hlwb ua lub luag haujlwm tseem ceeb hauv kev pom thiab rov nqus cov khoom pov tseg thiab electrolytes. Hauv kab mob raum, cov hlwb no tuaj yeem raug puas tsuaj, ua rau lub raum ua haujlwm puas. Cistanche lub peev xwm los txhawb kev tsim kho ntawm cov hlwb no pab kho lub raum kom zoo thiab txhim kho lub raum tag nrho.

Ntxiv nrog rau cov kev cuam tshuam ncaj qha rau lub raum, cistanche tau pom tias muaj txiaj ntsig zoo rau lwm yam kabmob thiab lub cev hauv lub cev. Txoj hauv kev zoo rau kev noj qab haus huv no tseem ceeb tshwj xeeb hauv cov kab mob raum, vim tias tus mob feem ntau cuam tshuam rau ntau lub cev thiab lub cev. che tau pom tias muaj kev tiv thaiv rau lub siab, lub plawv, thiab cov hlab ntsha, uas feem ntau cuam tshuam los ntawm kab mob raum. Los ntawm kev txhawb nqa kev noj qab haus huv ntawm cov kabmob no, cistanche pab txhim kho lub raum tag nrho thiab tiv thaiv kev mob ntxiv.

Hauv kev xaus, cistanche yog cov tshuaj suav tshuaj ntsuab siv rau ntau pua xyoo los kho mob raum. Nws cov active Cheebtsam muaj diuretic, antioxidant, anti-inflammatory, immunomodulatory, thiab regenerative teebmeem, uas pab txhim kho lub raum ua haujlwm thiab tiv thaiv ob lub raum los ntawm kev puas tsuaj ntxiv. , cistanche muaj txiaj ntsig zoo rau lwm yam kabmob thiab lub cev, ua rau nws txoj hauv kev zoo rau kev kho mob raum.