连续脏替代疗法:2025年核心课程
J Pedro Teixeira1, Swapnil Hiremath2, Abdulghani Omar Kabli2
1Divisions of Nephrology and Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico.
概括
连续置换疗法 (CKRT) 是急性损伤 (AKI) 严重病患者的标准,尽管在间歇性KRT上缺乏已证明的生存益处. 本综述涵盖了CKRT的原则,处方和护理.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 密集护理医学 密集护理医学
- 关键的护理关键的护理
背景情况:
- 危急病患者通常需要脏替代疗法 (KRT).
- 连续KRT (CKRT) 是在重症监护室 (ICU) 血液动力学不稳定的患者的首选方法.
- 尽管在间歇性KRT上存在未经证实的生存优势,但CKRT是急性损伤 (AKI) 在休克,脑损伤和肝衰竭中的标准.
研究的目的:
- 审查重症监护中CKRT的原则和应用.
- 为指导CKRT的处方,包括时间,剂量,接入和抗凝药.
- 突出对CKRT患者多学科护理的重要组成部分.
主要方法:
- 审查CKRT的物理化学原理.
- 关于CKRT启动,剂量,血管访问和抗凝固的开端试验的总结.
- 讨论CKRT处方和多学科护理的实际方面.
主要成果:
- 在重症患者中,CKRT被广泛采用为AKI的标准护理.
- 与间歇性KRT相比,证据并不总是显示CKRT的生存率或恢复率优于CKRT.
- 预计随着器官支持疗法的扩大,CKRT的使用将增加.
结论:
- 在复杂的ICU患者中,CKRT是AKI的基石疗法.
- 最佳的CKRT管理需要了解其原则,基于证据的处方和全面的护理.
- 包括药物剂量,营养和康复在内的多学科护理对于高价值的CKRT提供至关重要.
相关概念视频
01:20Renal Corpuscle
1.1K
The glomerulus and Bowman's capsule are two essential components of the nephron, which is the functional unit of the kidney. These microscopic structures play a critical role in the process of blood filtration to produce urine.
Glomerulus: Structure and Function
The glomerulus is a tiny, intricate network of capillaries located at the beginning of the nephron. It's enveloped by the Bowman's capsule and receives its blood supply from an afferent arteriole, which divides into numerous...
Glomerulus: Structure and Function
The glomerulus is a tiny, intricate network of capillaries located at the beginning of the nephron. It's enveloped by the Bowman's capsule and receives its blood supply from an afferent arteriole, which divides into numerous...
1.1K
01:15Renal Drug Excretion: Overview
65
As primary excretory organs, the kidneys maintain homeostasis by removing waste substances from the bloodstream. They comprise over a million units called nephrons, which serve as the kidney's functional units.
A nephron consists of two primary structures: the renal corpuscle and the renal tubule. The renal corpuscle contains the glomerulus, a network of capillaries where the first step of renal excretion, glomerular filtration, occurs. Blood pressure forces water, ions, and small molecules...
A nephron consists of two primary structures: the renal corpuscle and the renal tubule. The renal corpuscle contains the glomerulus, a network of capillaries where the first step of renal excretion, glomerular filtration, occurs. Blood pressure forces water, ions, and small molecules...
65
01:45Kidney Structure
66.8K
The kidneys are two large bean-shaped organs located in the upper abdomen. They filter the blood several times a day to remove toxins and rebalance water and electrolytes of the circulatory system via the renal veins. The kidneys receive blood directly from the heart via the renal arteries. These arteries enter the kidney at the hilum, the concave surface of the bean, where they branch and divide into smaller vessels and capillaries.
66.8K
01:06Renal Drug Clearance: Overview
66
Renal clearance is a crucial parameter in pharmacokinetics that quantifies the rate at which the kidneys excrete a drug. It represents a constant fraction of the central volume of distribution containing the drug that the kidney eliminates per unit of time.
Renal clearance can be calculated using different methods. One approach is to divide the urinary drug excretion rate by the plasma drug concentration. This method directly measures renal clearance, indicating the kidneys' efficiency in...
Renal clearance can be calculated using different methods. One approach is to divide the urinary drug excretion rate by the plasma drug concentration. This method directly measures renal clearance, indicating the kidneys' efficiency in...
66
01:11Renal Failure: Dose Adjustments
34
In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
34
01:25Renal Drug Excretion: Tubular Reabsorption
49
Tubular reabsorption, a process occurring post-glomerular filtration of drugs in the renal tubule, is a critical determinant of drug half-life. During the process of renal excretion, as the glomerular filtrate progresses to the distal convoluted tubule (DCT), drugs that are highly permeable, lipophilic, and nonionized undergo passive reabsorption from the tubular fluid into the surrounding peritubular capillaries. This reabsorption process restricts their elimination through the kidneys. This...
49