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心衰合并肾衰 - 心肾综合症 PowerPoint PPT Presentation


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心衰合并肾衰 - 心肾综合症. 白求恩国际和平医院心血管内科 赵玉英 1 37-8439-8089 y [email protected] 我们的困惑. 慢性心衰往往被肾功能不全复杂化:利尿效果差、 ACEI 或 ARB 被迫停用,容易产生地高辛中毒等 急性失代偿性心衰,由于肾功能恶化或利尿剂抵抗,使病情复杂化,预后更差。没有尿我们束手无策。 随着心血管系统疾病及肾脏病发生及发展机制的深入研究及生化等方面的发展,人们越来越多的将目光聚焦在心脏及肾脏共患疾病上,即 心肾综合征。. 心肾综合症 Cardiorenal Syndrome CRS.

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心衰合并肾衰 - 心肾综合症

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137-8439-8089

[email protected]


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  • ACEIARB


Cardiorenal syndrome crs

Cardiorenal Syndrome CRS

(CRS )

JAm Coll cardiol 2008;52;1527-1539


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ADHERE107920Scr>2mg/dl176.8mol/l30Ccr


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  • SOLVDGFR<60ml/min/1.73m240%

  • PRIME-2 GFR<44ml/min>76ml/min4RR2.85P<0.0001

  • PRAISERR1.37P=0.0041.39P=0.0421.51P=0.034

  • 0.3mg/dl630%>103

Jask, J Card Failure 2003; 9: 227


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  • 20~30%CKD)

  • 50%CKD

    Clin Med,2002,2:195-200

CKD10

>20%


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CRS

  • BNP


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CRS

  • C1h

  • 1


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(Ronco)

CRS 1

CRS 2

CRS 3)

CRS 4

CRS 5

JAm Coll cardiol 2008;52;1527-1539


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  • Ronco


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AKI),

ACEIAKI

Crit Care Med,2008,36:S75-88


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CRS

Crit Care Med,2008,36:S75-88


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  • GFR

  • ACEIARB

  • SOLVDPRAISE/

Gregg CAm J Med 2006119s17


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CRS

  • CRS

  • 3-5g/kg.mim,

  • 3 g/kg/min1800 18,300 ng/l,


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CRS

  • CRS

Lancet2005;366:1622-1632


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CRS

ACEI

CRSACEI

JAm Coll cardiol 2008;51;1419-1428


Crs i

CRSI

ADHFADHF

ADHF


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CRSI


Crs i1

CRSI

BG9719)


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25

ACSCRS


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CRS

  • CRS

  • ACEI50%

JAm Coll cardiol 2003;42;201-208


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CRS

CIBIS-(

LVEF< 35%,NYHA /<300umol/L

eGFR<45,45-60,60-7575 ml/min.1.73m2

Cockcroft-Gault)

European Journal of H eart Failure 2010;12;607-616


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CRS

  • Rh-Erythropoietin CRS BNP

    ------- Am Heart J 2007;154:e9-e15

  • CRT

    ----In J Cardiol 2007;122:10-16


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6-1035

CRS

RIFLE Criteria


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acute kidney injury AKI)

ASAIO J1996;42:M911-915


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CRS

renal support


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5K/DOQI )


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(

505

52501025

/10-20

Am J Kindey Dis 1998;32:S112-9


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CRS

  • CKDACEI

  • 210mol/LeGFR<3045ml/min


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CRS

ACEI/ARB:1530ACEI/ARB

eGFR<60ml/minACEI/ARB

eGFR<30ml/minACEI/ARB


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CRS

eGFR<50ml/min

eGFR<30ml/LACEIARB


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CRS


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,CRS


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Thank You


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