脓毒症急性肾损伤的研究进展

发布时间：2018-03-22 22:28

本文选题：脓毒症　切入点：感染性休克　出处：《重庆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：脓毒症(sepsis)常并发急性肾损伤(acute kidney injury,AKI),而脓毒症急性肾损伤的高发病率和高病死率是重症医学科目前面临的难点与挑战,相关的研究也取得一定进展,新的观点不断出现,某些争议仍在持续。本文就脓毒症AKI发病机制及防治的研究进展从以下几个观点进行综述:1.脓毒症AKI全球范围内发病率有上升趋势,临床上病死率高,预后差;2.对脓毒症AKI发病机制的认识由单纯关注肾脏的低灌注转向重视微循环,其免疫炎性损伤机制复杂,凝血级联反应激活、缺血再灌注损伤、肾小管上皮细胞凋亡、细胞自噬等多种病理过程在脓毒症AKI的发生中扮演着重要角色;3.在防治方面首要重视维持血流动力学稳定,制定个体化的复苏目标;4.恢复免疫稳态是未来研究的热点,积极控制感染源有利于降低AKI的发生率并改善预后;5.利尿剂、胰岛素等药物及液体种类在脓毒症AKI中的运用;6.重视肺肾交互作用对肾功能的影响;7.RRT的时机仍在持续争议;8.脓毒症中AKI的早期识别。
[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.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R459.7

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