关键疾病中的 perfusion:在宏循环和微循环之间
1Service of nephrology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.
Current opinion in critical care
|November 6, 2025
概括
整合宏循环和微循环监测工具可以提高对急性损伤 (AKI) 的理解和预防. 新的诊断方法提供了对 perfusion 和 hypoxia 的洞察力,有助于识别可治疗的 AKI 亚表型.
科学领域:
- 关键护理医学 关键护理医学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 血液动力学 血液动力学
背景情况:
- 急性损伤 (AKI) 是重症监护的重大挑战,与高发病率和死亡率有关.
- 目前对AKI的血液动力学监测通常依赖于与脏血液动力学相差较差的中央测量.
研究的目的:
- 审查现有和新兴的工具,以在AKI管理中整合宏观循环和微观循环的观点.
- 通过先进的监测,突出更好地了解和预防AKI的策略.
主要方法:
- 在AKI中审查当前的血液动力学监测技术及其局限性.
- 讨论高级床边超声波 (CEUS,高率,超分辨率) 用于评估脏微循环.
- 包括尿路部分氧气压的监测,以检测骨髓缺氧.
主要成果:
- 中央血液动力学测量不充分反映脏血液动力学.
- 与对比度增强的超声波 (CEUS) 显示,尽管全身流量充足,但 perfusion 功能受损.
- 新兴的超声波技术和尿氧监测提供了对脏微循环和缺氧的详细见解.
结论:
- 多种模式的血液动力学监测可以识别可治疗的AKI亚表型,并指导精确疗法.
- 整合宏循环和微循环数据对于优化AKI管理至关重要.
- 未来的试验应包括来自两种循环领域的机械终点,以提高患者的治疗结果.
相关概念视频
Acute Kidney Injury V: Interprofessional Care
264
Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
264
Acute Kidney Injury II: Pathophysiology
834
Acute kidney injury (AKI) causes are categorized into three primary categories based on the location of the injury: prerenal, intrarenal (or intrinsic), and postrenal causes. This classification guides clinical management and illustrates how different pathways can impair kidney function.Etiology and Pathophysiology of Acute Kidney Injury1. Prerenal causesEtiology: Prerenal Acute Kidney Injury, the most common type, occurs when reduced blood flow to the kidneys decreases filtration capacity...
834
Acute Kidney Injury I: Introduction
500
Introduction:Acute Kidney Injury (AKI) describes a swift decrease in kidney function occurring over hours to days, characterized by the kidneys' failure to remove waste products from the bloodstream. This leads to dangerous complications like metabolic acidosis, fluid overload, and electrolyte imbalances, such as hyperkalemia, which can cause life-threatening arrhythmias. AKI is common in both hospital and outpatient settings, often triggered by dehydration, sepsis, or exposure to nephrotoxic...
500
Acute Kidney Injury IV: Diagnostic Studies and Prevention
238
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
238
Acute Kidney Injury III: Clinical Manifestations
754
Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
754


