本文選題：膿毒癥　切入點(diǎn)：感染性休克　出處：《重慶醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：膿毒癥(sepsis)常并發(fā)急性腎損傷(acute kidney injury,AKI),而膿毒癥急性腎損傷的高發(fā)病率和高病死率是重癥醫(yī)學(xué)科目前面臨的難點(diǎn)與挑戰(zhàn),相關(guān)的研究也取得一定進(jìn)展,新的觀點(diǎn)不斷出現(xiàn),某些爭議仍在持續(xù)。本文就膿毒癥AKI發(fā)病機(jī)制及防治的研究進(jìn)展從以下幾個(gè)觀點(diǎn)進(jìn)行綜述:1.膿毒癥AKI全球范圍內(nèi)發(fā)病率有上升趨勢,臨床上病死率高,預(yù)后差;2.對(duì)膿毒癥AKI發(fā)病機(jī)制的認(rèn)識(shí)由單純關(guān)注腎臟的低灌注轉(zhuǎn)向重視微循環(huán),其免疫炎性損傷機(jī)制復(fù)雜,凝血級(jí)聯(lián)反應(yīng)激活、缺血再灌注損傷、腎小管上皮細(xì)胞凋亡、細(xì)胞自噬等多種病理過程在膿毒癥AKI的發(fā)生中扮演著重要角色;3.在防治方面首要重視維持血流動(dòng)力學(xué)穩(wěn)定,制定個(gè)體化的復(fù)蘇目標(biāo);4.恢復(fù)免疫穩(wěn)態(tài)是未來研究的熱點(diǎn),積極控制感染源有利于降低AKI的發(fā)生率并改善預(yù)后;5.利尿劑、胰島素等藥物及液體種類在膿毒癥AKI中的運(yùn)用;6.重視肺腎交互作用對(duì)腎功能的影響;7.RRT的時(shí)機(jī)仍在持續(xù)爭議;8.膿毒癥中AKI的早期識(shí)別。
[Abstract]:Sepsis (sepsis) is often complicated with acute kidney injury.And the high morbidity and mortality of acute renal injury in sepsis are the difficulties and challenges faced by the department of intensive medicine at present, and some progress has been made in related research, and new ideas have been emerging. Some controversies are still continuing. This article reviews the pathogenesis and prevention and treatment of sepsis AKI from the following viewpoints: 1. The incidence of sepsis AKI in the world has a rising trend, and the clinical mortality is high. 2.The understanding of the pathogenesis of sepsis AKI has changed from focusing on renal hypoperfusion to focusing on microcirculation. The mechanism of immune inflammatory injury is complicated, coagulation cascade reaction is activated, ischemia-reperfusion injury, renal tubular epithelial cell apoptosis. Autophagy and other pathological processes play an important role in the pathogenesis of sepsis AKI. In the prevention and treatment, the primary attention is to maintain hemodynamic stability, and the goal of individualized resuscitation. 4. Restoration of immune homeostasis is a hot topic in the future. Active control of the source of infection can reduce the incidence of AKI and improve the prognosis. Application of Insulin and other drugs and liquids in septic AKI 6.The time to pay attention to the effect of Pulmonary and Renal interaction on Renal function 7.RRT is still controversial. The early recognition of AKI in sepsis.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R459.7

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