Renal Replacement Therapy For Acute Kidney Injury? Phau ntawv qhia kom nyeem nws sai!

Renal replacement therapy (RRT) yog ib txoj hauv kev tseem ceeb ntawm kev kho mob raum raug mob (AKI). Txoj kev kho mob RRT zoo tshaj plaws rau cov neeg mob AKI yog maj mam tshem tawm cov co toxins, kho qhov sib npaug, thiab tsis txhob muaj qhov hloov pauv loj hauv hemodynamics ntau li ntau tau. Simulate cov txheej txheem physiological ntawm tib neeg lub raum. Hais txog kev hloov lub raum rau AKI, "Suav Cov Kev Cai Qhia Txog Kev Kho Mob rau Kev Mob Raum Mob" feem ntau ua rau cov lus pom zoo hauv qab no.

Nyem rau Cistanche rau mob raum

Kev xaiv thiab kev saib xyuas ntawm vascular nkag hauv AKI

1. Rau cov neeg mob AKI uas npaj yuav tau txais RRT, nws raug nquahu kom cov kws kho mob tshwj xeeb cuam tshuam los soj ntsuam cov xwm txheej tam sim no thiab RRT txoj kev npaj, thiab tsim cov phiaj xwm nkag mus rau vascular (1C).

2. Before catheterization, ultrasound must be used to evaluate the vascular conditions of the proposed catheterization site. The right internal jugular vein and femoral vein are recommended as the preferred catheterization sites. Indwelling subclavian vein catheters are not recommended (1A). For patients with a body mass index (BMI) >28.4kg / m2, sab hauv jugular leeg yog pom zoo raws li qhov nyiam catheter tso chaw. Rau cov neeg mob uas muaj BMI<24.0 kg/m2, the femoral vein is recommended as the preferred catheter placement site (2B). The femoral vein is recommended as the preferred catheterization site for patients with known severe respiratory tract disease (1C).

3. Rau cov neeg mob uas xav tau lub sijhawm RRT<1 month, it is recommended to use dialysis catheters (NCC) without tunnels and polyester sleeves as vascular access; for patients with expected RRT time >3 lub hlis, lossis cov neeg mob uas xav tau RRT mus sij hawm ntev, nws raug nquahu kom siv cov tshuaj lim ntshav nrog Tunneled thiab Dacron-sheathed dialysis catheters (TCCs) raws li vascular nkag lossis hloov tam sim ntawm NCCs nrog TCCs (1A).

4. Nws raug pom zoo tias cov neeg laus ib txwm siv lub dual-lumen NCC nrog ib ncig ntawm 10 mus rau 12 Fr lossis dual-lumen TCC nrog lub voj voog ntawm 11 txog 14 Fr raws li cov vascular nkag rau RRT (1B).

5. Nws raug nquahu kom ua puncture thiab catheterization los tsim kom muaj vascular nkag mus rau hauv chav ua haujlwm tsis muaj menyuam lossis chav ua haujlwm raws li ECG saib xyuas (1A); rau AKI cov neeg mob hauv ICU, nws raug nquahu kom ua catheterization ntawm txaj txaj raws li cov qauv kev ua haujlwm tsis muaj menyuam (2B).

6. Nws raug nquahu kom ua qhov puncture thiab catheterization los tsim kom muaj vascular nkag hauv ultrasound localization lossis real-time ultrasound kev taw qhia; Tom qab ua tiav ntawm catheterization, lub hauv siab los yog lub plab radiography raug coj mus rau paub meej tias txoj hauj lwm ntawm lub catheter taub (1A).

7. Nws raug nquahu kom saib xyuas ntawm qhov chaw catheter puncture thiab qhov chaw nres nkoj sab nraud ntawm TCC ua ntej txhua qhov kev kho cov ntshav purification, thiab siv cov txheej txheem sealing uas tsim nyog los muab cov raj xa dej tom qab txhua qhov kev kho mob (1A); Nws raug nquahu kom siv cov kua dej sib khi zoo tib yam nrog cov ntsiab lus ntawm 10 mg / ml lossis siab dua. Heparin tov los yog 4% mus rau 30% citric acid tov yog siv los ua ib qho kev ntsuas xauv los tiv thaiv intracatheter thrombosis (1B).

8. Nyob rau hauv cov ntaub ntawv ntawm lub catheter tsis zoo, nws raug nquahu kom siv tsawg kawg yog 5 000~10000 U/ml ib leeg-chain urokinase los yog 1~2 mg/ml cov ntaub so ntswg plasminogen activator (t-PA) ntawm qhov chaw ntawm kev txiav txim. tawm tsis zoo catheter txoj hauj lwm. Kev kho mob thrombolytic. Yog tias kev kho mob thrombolytic tsis muaj txiaj ntsig, nws raug pom zoo kom ua nyob rau hauv situ catheter hloov raws li cov lus qhia kev taw qhia tom qab tsis suav cov catheter tip thrombus (2B).

9. Yog tias muaj kab mob ntsig txog catheter tshwm sim, NCC cov neeg mob raug pom zoo kom tshem lub catheter tam sim ntawd thiab muab cov catheter tip cultured. Yog tias cov neeg mob TCC tsuas muaj kab mob sab nraud ntawm qhov ncauj, kev kho mob hauv zos thiab cov kab mob hauv lub cev tuaj yeem raug txiav txim siab. Yog hais tias muaj qhov tunnel- thiab catheter-related bacteremia, nws raug nquahu kom tshem lub catheter tam sim ntawd. Tshem lub catheter. Yog tias tus neeg mob xav tau kev kho ntshav kom huv mus ntxiv, nws raug nquahu kom rov siv NCC los tsim cov hlab ntsha tom qab hloov txoj haujlwm. Yog tias tus neeg mob tseem muaj cov tsos mob ntawm cov kab mob hauv lub cev tom qab extubation, nws raug nquahu kom siv cov tshuaj tua kab mob rhiab rau 1 mus rau 2 lub lis piam ntawm kev kho mob raws li kab lis kev cai (2B).

Anticoagulation therapy rau kev lim ntshav hauv AKI cov neeg mob

1. Rau cov neeg mob AKI uas xav tau kev lim ntshav, tus neeg mob lub coagulation txheej txheem yuav tsum tau soj ntsuam ua ntej kev kho cov ntshav purification, thiab cov tshuaj anticoagulants thiab lawv cov koob tshuaj yuav tsum raug xaiv kom tsim nyog (kev pom zoo kws tshaj lij).

2. Rau cov neeg mob uas muaj hypercoagulant kev ua si thiab/los yog thromboembolic txaus ntshai los yog kab mob, tshwj tsis yog rau cov neeg mob uas muaj contraindications rau heparin tshuaj, nws raug nquahu kom siv unfractionated heparin los yog tsawg molecular hnyav heparin; yog tias tsim nyog, unfractionated heparin lossis qis molecular hnyav heparin tuaj yeem siv los ua kev kho mob anticoagulant (2B). Rau cov neeg mob uas muaj yav dhau los lossis ua ke ntawm heparin-induced thrombocytopenia (HIT), tshwj tsis yog rau cov neeg mob uas muaj contraindications rau citrate lossis argatroban, nws raug nquahu kom xaiv cov tshuaj pleev xim citrate lossis argatroban rau anticoagulation; siv danaparin sodium nrog ceev faj; Fondaparinux tsis pom zoo (1A).

3. Rau cov neeg mob uas muaj ntshav siab los yog ntshav siab, tsis suav nrog cov neeg mob uas muaj contraindications rau citrate, tshuaj pleev xim citrate anticoagulation yog nyiam (1A); rau cov neeg mob uas muaj contraindications rau citrate, tsis suav nrog cov contraindications rau argatroban, nws raug nquahu kom xaiv argatroban (2B); rau cov neeg mob uas muaj contraindications rau citrate los yog argatroban, tshwj tsis yog rau nafamostat mesylate contraindications, nws raug nquahu kom xaiv nafamostat mesylate; Yog tias feem ntau yog contraindicated, kev kho ntshav purification tuaj yeem ua yam tsis muaj cov tshuaj tiv thaiv coagulants (2B).

4. Nws raug pom zoo tias cov koob tshuaj anticoagulant raug xaiv ib tus zuj zus thiab hloov kho raws li kev soj ntsuam cov txiaj ntsig ntawm tus neeg mob lub cev sab hauv thiab lub cev tsis muaj zog ntawm lub cev thaum lub sijhawm kho cov ntshav purification thiab cov txheej txheem hauv coagulation tom qab kev kho mob (kev pom zoo ntawm kws kho mob).

5. Thaum muaj xwm txheej tsis zoo tshwm sim thaum lub sij hawm kho anticoagulation, tus neeg mob lub coagulation txheej xwm yuav tsum tau rov ntsuam xyuas, cov tshuaj anticoagulant thiab lawv cov tshuaj yuav tsum tau rov xaiv dua, thiab cov kev phiv tshuaj yuav tsum tau kho (kev pom zoo kws txawj).

Lub sijhawm pib thiab nres RRT hauv cov neeg mob AKI

1. Indications for emergency RRT in AKI: volume overload, hyperkalemia (serum potassium >6.5 mmol / L), cov tsos mob ntawm uremic, suav nrog uremic pericarditis, uremic encephalopathy lossis lwm yam tsis tau piav qhia hauv kev nco qab, cov metabolism hauv kev sib deev muaj zog acidosis (pH).<7.1) (expert consensus).

2. Kev pib ntxov ntawm kev kho RRT tsis pom zoo rau cov neeg mob AKI (1B).

3. Lub sijhawm pib RRT rau AKI nyob ntawm tus neeg mob qhov kev kuaj mob thiab cov xwm txheej ntawm tus kabmob (cov kws tshaj lij pom zoo).

4. Thaum AKI tus neeg mob lub raum ua haujlwm rov qab los ua kom tau raws li tus neeg mob cov kev xav tau lossis thaum RRT thiab cov hom phiaj kev kho mob tsis sib haum, kev txiav txim siab ntawm kev kho RRT tuaj yeem txiav txim siab (kev pom zoo ntawm kws tshaj lij).

Kev xaiv thiab siv hom RRT hauv AKI cov neeg mob, thiab cov hauv paus ntsiab lus ntawm kev xaiv hom kev kho mob

1. Tsis muaj qhov sib txawv ntawm cov txiaj ntsig kev kho mob ntawm intermittent hemodialysis (IHD) thiab kev kho lub raum tsis tu ncua (CRRT) hauv cov neeg mob AKI (1B).

2. Rau cov neeg mob uas tsis muaj zog hemodynamic, CRRT raug pom zoo siv IHD (1B).

Kev kho mob hemodialysis

1. Recommended indications for IHD treatment include: serum potassium >6.0mmol/L or persistent tissue damage, such as rhabdomyolysis, crush injury, etc.; serum potassium >5.5 mmol / L; hnyav metabolic acid tseem nyob tom qab alkali supplementation kho Poisoning (pH<7.2); severe volume overload despite high-dose diuretic therapy; hemodynamically stable AKI patients (1A).

2. Nws raug pom zoo tias contraindications rau IHD suav nrog: cov neeg mob uas muaj hemodynamic instability, nce intracranial siab, thiab cerebral edema tshwm sim los ntawm ntau yam ua rau (2D).

3. Txoj kev npaj kho mob IHD tau pom zoo yog 3 zaug hauv ib lub lis piam lossis ib zaug txhua hnub, thiab cov tshuaj kho mob lim ntshav muaj qhov ntsuas urea clearance (Kt/V) ntau dua lossis sib npaug li 1.2/time (1B).

Kev kho CRRT

1. Cov lus qhia pom zoo rau CRRT suav nrog AKI cov neeg mob uas muaj hemodynamic tsis ruaj khov lossis AKI cov neeg mob uas muaj siab intracranial siab thiab dav cerebral edema tshwm sim los ntawm mob hlwb raug mob lossis lwm yam ua rau (2B).

2. Tsis muaj contraindications kiag li rau CRRT. Nws raug pom zoo tias yuav tsum tau siv nrog ceev faj hauv cov xwm txheej hauv qab no: (1) Tsis tuaj yeem tsim kom muaj kev nkag mus rau vascular tsim nyog; (2) Hypotension uas nyuaj rau kho; (3) Cachexia, xws li cov qog nqaij hlav malignant nrog cov kab mob metastasis (3D).

3. Qhov pom zoo CRRT hloov cov kua dej ntws yog 20 ~ 25 ml·kg-1·h-1 (2B).

Tshwj xeeb ntshav purification technology

1. Nws raug pom zoo tias kev ncua ntev RRT (PIRRT) yog qhov tsim nyog rau cov neeg mob AKI uas tsis muaj zog hemodynamically tsis tuaj yeem tiv taus tus txheej txheem IHD kho thiab yuav tsum tau lim ntshav (2D).

2. CRRT, suav nrog PIRRT, tau pom zoo rau AKI cov neeg mob uas muaj siab intracranial siab tshwm sim los ntawm mob hlwb raug mob lossis lwm yam ua rau (2D).

3. SLED tuaj yeem siv rau hemodynamically unstable AKI (2B), tom qab phais AKI (2C), thiab AKI hnyav ua ke nrog cov qog (2C).

Combination Blood Purification Treatment

1. Nws tsis pom zoo kom siv ob lub CRRT li hauv koob los ua kom tiav hybrid ntshav purification hom (2A).

2. Endotoxin adsorption thev naus laus zis tau pom zoo rau cov neeg mob sepsis lossis septic shock kis los ntawm cov kab mob Gram-negative, tshwj xeeb tshaj yog cov neeg mob septic shock thiab AKI tom qab phais plab (2B).

3. niaj hnub siv cov ntim hemofiltration tsis pom zoo rau cov neeg mob septic AKI (1A).

4. Hemoperfusion thiab plasma adsorption thev naus laus zis tuaj yeem siv los tshem tawm cov protein-bound toxins lossis nruab nrab-rau-loj molecular toxins los ntawm lub cev (2C).

5. Extracorporeal CO2 scavenging thev naus laus zis tuaj yeem siv rau hauv cov neeg mob uas muaj qhov nyuaj-rau-txhim kho hypercapnia ua ke nrog AKI los pab txo cov cua ntsig txog lub ntsws (2C).

6. Artificial daim siab thev naus laus zis tuaj yeem siv rau AKI cov neeg mob siab tsis ua haujlwm (2C).

7. Plasma exchange and double-membrane plasma exchange (DFPP) tuaj yeem siv los tshem tawm cov protein-bound toxins lossis macromolecular co toxins los ntawm lub cev, thiab DFPP tuaj yeem siv los tshem tawm cov ntshav lipids (2B).

peritoneal lim ntshav

1. Nws raug pom zoo tias kev kho mob peritoneal dialysis ua tau rau cov neeg mob AKI hauv qab no, suav nrog: (1) Hemodialysis lossis CRRT tsis muaj nyob hauv thaj chaw uas tus neeg mob AKI nyob; (2) Muaj kev pheej hmoo los ntshav; (3) Tsis muaj vascular nkag; (4) Lub plawv tsis ua haujlwm tsis zoo hauv kev kho tshuaj Thiab cov neeg uas xav tau kev lim ntshav; (5) Cov neeg mob uas muaj kab mob cirrhosis thiab ntau cov ascites (2D).

2. Kev kho peritoneal dialysis tsis pom zoo rau cov neeg mob AKI hauv qab no, suav nrog: (1) nrog keeb kwm ntawm kev phais plab dhau los; (2) nrog thoracoperitoneal to, plab kab mob, los yog plab phab ntsa cellulitis; (3) mob hnyav heev; (4) Cov neeg mob uas muaj kev nce siab hauv cov ntshav ntshav (2D).

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.