CKRT Tus Kheej Dose Curve Chart raug tso tawm, nthuav qhia CKRT Kev Tswj Tshuaj Rau Cov Neeg Mob Raum Thaum Ntxov!

Tsawg dua, kab lus no feem ntau ua pov thawj los ntawm cov piv txwv hauv lub neej thiab tshuaj. Hauv kev kho lub raum hloov (RRT) thiab kev kho lub raum tsis tu ncua (CKRT), tib neeg feem ntau sib tham txog qhov zoo tshaj plaws rau kev lim ntshav. Qee cov kws tshawb fawb ntseeg tias tsawg dua, thiab ntau npaum li cas cov tshuaj lim ntshav tuaj yeem ncua sijhawm rov qab los ntawm lub raum ua haujlwm thiab kev pheej hmoo ntawm cov xwm txheej tsis zoo. Nce. Lwm cov kws tshawb fawb ntseeg tias koob tshuaj lim ntshav yuav tsum tau nce ntxiv vim tias kev lim ntshav txaus tuaj yeem tiv thaiv ntau yam tsis zoo. Qee cov kws tshawb fawb ntseeg tias koob tshuaj lim ntshav yuav tsum hloov nrog tus neeg mob tus mob thiab lub sijhawm lim ntshav, thiab cov tshuaj lim ntshav tsim nyog yog yam kws kho mob xav tau.

Nyem rau Cistanche rau mob raum

Tsis ntev los no, cov kws tshawb fawb hauv Tebchaws Meskas tau tshaj tawm qhov kev tshuaj xyuas zaum kawg ntawm AJKD, sib tham txog qhov zoo tshaj plaws koob tshuaj CKRT. Lawv tau hais tias koob tshuaj CKRT yuav tsum muaj lub sijhawm nkhaus. Raws li qhov nkhaus no, qhov zoo tshaj plaws dialysis koob tshuaj ntawm CKRT tuaj yeem tau sai sai los pab cov kws kho mob kwv yees qhov kawg tshwm sim. Kev tswj cov neeg mob uas muaj kab mob raum kawg (ESRD) thiab mob raum raug mob (AKI).

Kev tshuaj xyuas pov thawj

The results of the 2008 and 2009 ATN and Renal replacement therapy studies were published. These two multicenter randomized controlled trials collectively randomly assigned >2; tsis muaj qhov sib txawv ntawm cov nqi thiab lub raum rov qab. Qhov tshwm sim ntawm cov xwm txheej tsis zoo tshwm sim zoo sib xws, tab sis ntau dua hypophosphatemia tshwm sim hauv ob pawg neeg siab. Cov txiaj ntsig no tau coj KDIGO kom pom zoo hauv xyoo 2012 tias koob tshuaj CKRT yuav tsum nyob nruab nrab ntawm 20 thiab 25 mL / kg / h. Qhov koob tshuaj no suav hais tias yog koob tshuaj zoo tshaj plaws ntawm CKRT los ntawm cov tsev kho mob hauv ntau lub tebchaws thiab tau siv rau ntau tshaj 10 xyoo.

Txawm li cas los xij, thaum ob txoj kev tshawb fawb no tseem ceeb, lawv tsis muab cov ntaub ntawv qhia txog kev nyab xeeb qis ntawm CKRT. Txawm hais tias cov kws tshaj lij feem ntau ntseeg tias koob tshuaj lim ntshav<20ml/kg/h is harmful, this value mainly comes from patients with end-stage renal disease and patients with unclear renal disease. Recently, a study from Japan provided new evidence for the effectiveness of low-dose dialysis.

Okamoto et al tau ua qhov kev tshawb fawb rov qab rau ze li 500 tus neeg mob AKI uas tau txais CKRT los ntawm 2012 txog 2021 ntawm ib lub chaw kawm hauv Nyij Pooj. Thawj qhov tshwm sim yog qhov koob tshuaj ntawm CKRT tau txais, txhais hauv thawj qhov kev tshuaj ntsuam raws li qhov sib txawv dichotomous saum toj lossis qis dua qhov hnyav-raws li qhov nruab nrab koob. Cov txiaj ntsig tseem ceeb yog 90-hnub ciaj sia taus tom qab pib CKRT nyob rau hauv ntau qhov sib txawv ntawm Cox regression tsom xam uas tswj tau rau ntau qhov sib txawv ntawm qhov tsis sib xws nrog rau cov pej xeem, lub cev qhov hnyav, qhov ntsuas kab mob hnyav, thiab qhov ntsuas qhov ntsuas.

Yuav luag txhua tus neeg mob tau kuaj pom tias muaj kev raug mob ntawm tubular thiab tau txais postfilter tas li veno-venous hemodiafiltration (dialysate ntxiv rau cov kua hloov pauv ntawm tus nqi ntawm 700 lossis 800 mL / h) thiab cuam tshuam nrog catheter anticoagulation. Hauv kev txheeb xyuas ntau yam, qhov kev pheej hmoo ntawm kev tuag tau nce siab hauv pawg nrog CKRT koob tshuaj qis dua li qhov nruab nrab 13.2 mL / kg / h (aHR=1.73; 95% CI, 1.19 ~ 2.51). Cov txiaj ntsig no tau zoo ib yam hauv kev soj ntsuam rhiab heev nrog rau ntau yam kev txhais lus rau qis lossis siab dua CKRT koob. Cov txiaj ntsig thib ob, suav nrog lub sijhawm siv CKRT, chav saib xyuas mob hnyav [ICU] qhov ntev ntawm kev nyob, thiab tag nrho qhov ntev ntawm kev nyob, tsis sib txawv ntawm cov koob tshuaj.

Txawm li cas los xij, txoj kev tshawb no muaj qee qhov teeb meem, piv txwv li, cov neeg Nyij Pooj muaj qhov hnyav ntawm lub cev hnyav piv nrog cov kev tshawb fawb yav dhau los, thiab qhov koob tshuaj no (13.2 mL / kg / h) yuav tsawg dhau rau cov neeg hnyav. Txawm li cas los xij, txoj kev tshawb no muab cov lus teb rau ntau cov lus nug.

Cov lus teb rau cov lus nug kho mob

Thaum lub sij hawm COVID-19, vim muaj kev cuam tshuam hauv CKRT cov saw hlau, cov neeg mob tuaj yeem raug tshuaj noj tsawg (<20ml/kg/h) CKRT? The answer is maybe in the short term. In addition, low-dose CKRT can reduce the financial pressure on patients. If the CKRT dose standard is reduced by 5ml/kg/h, it means that some dialysis centers can reduce the use of thousands of bags of dialysate every year.

Thaum kawg, qee qhov kev tshawb fawb tau pom tias cov koob tshuaj CKRT uas siab dhau tuaj yeem ua rau cov neeg mob muaj kev pheej hmoo ntawm frailty, ncua kev rov ua haujlwm ntawm lub raum thiab tuaj yeem tshem tawm cov tshuaj tua kab mob ntau dhau. Yog li ntawd, CKRT koob tshuaj tsawg yog ib qho kev kho mob uas tsim nyog xav txog rau cov neeg mob uas yuav rov qab ua haujlwm ntawm lub raum thiab noj tshuaj tua kab mob.

CKRT lub sijhawm teeb tsa

Tau kawg, qhov qis tshaj ntawm kev txo qis tsis yog qhov kws kho mob yuav tsum tsom mus rau. Hloov chaw, lawv yuav tsum tau sau ib koob tshuaj CKRT tus kheej raws li tus neeg mob cov xwm txheej tshwj xeeb. Ntau tus kws tshawb fawb ntseeg tias qhov zoo tshaj plaws CKRT yuav hloov pauv raws sijhawm, thiab kev tshawb fawb yav tom ntej yuav tsum tsom mus rau kev hloov kho lossis tus kheej CKRT ntau npaum li cas los muab cov neeg mob nrog kev kho CKRT meej dua. Raws li cov ntaub ntawv pov thawj uas twb muaj lawm, nws yuav zoo dua los sau cov koob tshuaj CKRT raws li qhov nkhaus nkhaus tsis pub dhau 0 txog 14 hnub tom qab pib ntawm AKI. Nyob rau yav tom ntej, peb yuav tsum tsom mus rau txhua tus neeg mob raum thiab sau tshuaj CKRT rau txhua tus neeg mob raum txhua lub sijhawm.

Daim duab: Dynamic nkhaus ntawm CKRT koob

Lus Cim: Rau cov neeg mob uas xav tau koob tshuaj dynamic, CKRT yuav tsum muaj zog. Cov kev tshawb fawb uas twb muaj lawm qhia tau hais tias cov neeg mob nrog cardiogenic poob siab thiab cardiorenal syndrome yuav pib ntawm CKRT vim diuretic-refractory ntim overload nyob rau hauv qhov chaw ntawm non-oliguric AKI. Tom qab cov neeg mob tau pib noj cov koob tshuaj li niaj zaus ntawm 20 mus rau 25 mL / kg / h, koob tshuaj yuav raug txo nyob rau hauv thawj ob peb hnub, vim CKRT feem ntau yog siv thaum khaws cia cov zis tso zis, qhov seem ntawm lub raum ua haujlwm, thiab qhov yuav tsum tau tshem tawm tsawg kawg nkaus. yuav tsum muaj peev xwm tswj tau. Txawm li cas los xij, nyob rau lub lim tiam tom ntej, tus neeg mob cov zis tso zis maj mam txo kom txog thaum oliguria tsim, thiab cov koob tshuaj maj mam rov qab mus rau qhov chaw ua haujlwm. Tus neeg mob tau txais kev kho mob plawv tom qab tau txais cov ntshav ntim li qub. Cov txheej txheem postoperative yog nyuaj thiab yuav tsum tau txhua yam circulatory kev them nyiaj yug, thiab cov tshuaj tau hloov raws li. Tsis tas li ntawd, rau cov neeg mob hyperkalemia vim rhabdomyolysis, CKRT koob tshuaj kuj yuav tsum tau hloov kho raws li cov qib potassium ion.

Cistanche kho mob raum li cas?

Cistancheyog ib hom tshuaj suav tshuaj ntsuab siv rau ntau pua xyoo los kho ntau yam mob, suav nrograumkab mob. Nws yog muab los ntawm qhuav stems ntawmCistanchedeserticola, ib tsob nroj nyob rau hauv cov suab puam ntawm Tuam Tshoj thiab Mongolia. Lub ntsiab active Cheebtsam ntawm cistanche yogphenylethanoidglycosides, echinacoside cov tshuaj, thiabacteoside, uas tau pom tias muaj txiaj ntsig zoo rauraumnoj 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 tswv yim.

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 cov kab mob hauv lub 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 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.