ʱ : 2011ִҵҽʦʵܿĿܸϿʼĶ
ע·cal)Ķ壺1ˮ1ѹ1϶Ҫ λ㹫ʽ
15-20kcal/kg/d30kcal/kg/d35kcal/kg/d40kcal/kg/d 20-25kcal/kg/d35kcal/kg/d40kcal/kg/d45-50kcal/kg/d ÿء(kcal)/kg/d
ʡΪѧԺͰĴDzѧԺಡҪгѪֵ
ͬʱҲӦдС˹ʣرGFR60mL/min/1.73m2ߡ 1kcal=1000cal1000kcal=4.184MJ1MJ=239kcal ȵĹʽλأkg)1000Լ:
0.6Ѫֵmmol/L5.6100011.1
50g50g(൱С50g50gմ50g1gȫʱͷԼ4kcal֯ϳɸ50gɷ25g750g250g60g)ԭͣûԭҪѪϣ180kcal
Ӧȱʱ1molǿԲ2molATP1mol50g(൱ڼ5080kcal
ȫCo2H2oʱɾ3638molATP 250gţ飨൱ڶ300gţ18g1ƿ160kcal 2.˲˵Ӫԭ߶ 1(൱ڻ30218gߣ
18g
ܣһ30kcal/kg/dΪ2000kcal/d ֥齴9gǻ25g)80kcal
Ͷߣ40kcal/kg/dΪ2400kcal/d
500g750g߲(ײˡˡͲˡ²ˡ۲ˡݫߵףΪ1.21.5g/kg/dÿܽΪ80«
100g
ϡƹϡӡ˿ϣ80kcal ʵ⡢ݡˮƷ鼰ƷӦռܵ1.ߵÿ
50%ϡ
Brocaأkg)ߣcm)105 άأӦص㲹VABCDȡ أ(cm)-1000.9 ֹ̺ơ ʵأ
ӦرעƺIJ䡣
жͣ ġС˹ʣGFRʽС˹õ
ʾС
ע֣ص20%ݣڱص20% ˹ָܵ꣬С˹ָÿ˫˹ѪĺָBMIأkgߣcm2 һӳʵָܵꡣˣGFRӦָWHO 90/ӡ
18.524.9 60/ʱĿǰΪѾಡڵ״ǰ25.029.9 ̬ҪˡС15/ʱӦʼȷ30.034.9 ơ
ȷ35.039.9 MDRDಡʳоʽ
ȷ֡40
GFR=1.86Ѫ-1.164䣭0.203ŮݽԴϢͶеͶͶ 0.74
15kcal/kg/d20-25kcal/kg/d30kcal/kg/d35kcal/kg/d ô˹ʽԺܺãಡ
8190374.doc5ҳȫĹ16ҳ
ʲⶨ㹫ʽأkg140䣩72Ѫ弡ֵmg/LŮԣݽ0.85
2009ʽ51
ʽ
һԷμ¼ݣ ˣȡ̵=֧ Ͱ״أ=
껼ߣȡ̵Ͱ״أι=COPD Ժϵͳʷ˥=IJ
׳꣫ȣʪɫ̵=ҶԷ Ӥȡȶ=֧ܷ
礣++)οżʪ졢ʿ=˥ δ˫֫ˮ=˥
ͯԴ̼Կԣؽ=֧ԭ ֧¼ݣ
꣫ԱףԴ=֧ ģΰ¼ݣ
ˣʷ̼Կԣor̵дѪẹ̈Ե룩=ΰ
壩˥ߣ¼ݣ
껼ߣԺϵͳʷϸѪ=˥ PaO2<60mmHg 1ͺ˥
PaO2<60mmHg+PaCO2>50mmHg 2ͺ˥ pH<7.35ж
pH>7.35ж
STι̧=Ĺ Ժϵͳʷʶϰ=Բ
Vl--v6㷺ǰĹ ˲νˡĤסĤסˢVl--v3ǰĹ ¼ݣ
V3Cv6ǰĹ ȡ½=ж֢״
11111AVF±Ĺ?
ԡ̵Ѫж֢״Ʋת=ν 껼ߣʷʹ3-5ӣͻ⣫ST¡ƫߵǣĽλˮƽ=Ľʹ
Ľߵ=ǻҺж֢״ǻҺ=أʮһ˥ߣ¼ݣ
ǻҺĤԴ
ѪѹѣҹβʪǻҺİҺǻҺ=ཬĤǻҺ =˥
ν˲ʷİ=İԴ ˮףˮסضˮס֫ˮסӣǻİ
Һδξ+=˥ ŭţξԣδͶ=Һ ʮĤ¼ݣ
ļ⸺Բ粻Ͷ=խİ عԵ3϶̾ëϸѪܲ+=¾ɽ˲ʴ̼ʵʱ䱡ƻ=ϵ رղȫ ʴ̼Ƶʹ
ʮݿˣ¼ݣ
ߣزպˣ߹ǹۡѪغأ ѪPBp֫ʪ䡢ѹС=ʧѪݿ
ˣDz=߹ǹ
P>100Σ֣R>20/֣Bp9O/70mmHgѹ20mmHg=ˣ㷺ƤףorѩУƫߵġݿ
ʧѹ=
꣫ϸȾ֢״˥Ĵ=ļ ˣλߵǡҺ߸ʧPBpϸ١֫=ݿ θܶӰ=ǻҺѪأ ˥ݿ=Դݿ
ˣѪѹ
ʮģθʳܷ¼ݣ
ߵѪΣվˮƽֲ
ᣫعǺƸУθʳ¶κɫô=ʳԺѣҹѣƽ=Ĺܲȫ
ӯδξԣ˫֫ˮ=Ĺʮ壩θף¼ݣ
ܲȫ
ʳ̼ʹͣ=ԣţʧ¼ݣ
θ
껼ߣĻţͻͻֹECG(QRSͣδʮ
P= ԡϸʹŻѪڱ=θ ʮIJ
ʮߣԽ᳦ף¼ݣ
껼ߣʷʹ30ӣͲ⣫ŧѪ㣫ݣ᳦ʾȫ᳦Ϣ⡱=
8190374.doc6ҳȫĹ16ҳ
ʮˣšֱ²䣨¼ݣ ʹѪɫӲ=Ѫ˨ ʮţӲ¼ݣ
껼ߣҸβʷ֩룫Ƣƶ=Ӳ 껼ߣѪӲ=ʳθѳѪ ʮʯȾݣ
CharcotBǿţ=ʯ֢ŧԵףԻƾ
ʮһף¼ݣ
ʳԵʷ跢ϸʹ䣫Ĥ̼WBcѪӣAST=
ףGrey-TurnerูϰߣCullenϰߣϴˮ=ףѪͣ
ʮ֢βסλѳŤתѳѡǻ׳衢ף¼ݣ ת¸ʹϵѹʹWBCN=β ѪëĤټأ+)ͣʷҸʹ=Уλ
ʷͻͻʹĤ̼¿ɼ=ףԸĤף
ʹ¡͡գ㽶Һƽ=
Ůԣűλ仯ͻ¸ʹϸߵ=ѳŤת
ιʷ״쳣¸ʹŧѪԷʹ+=ǻ
ʮϵͳʳܰθ᳦ֱΰٰ
ϲ̣ѣعǺʹʳӲҭ=ʳܻŰ
ؼᣫӰճĤӲֲ=θ ½űϰ߸ı䣫DZѪcEA=᳦
Ͳʷϸʹأ½AFPBռλ=ΰ
ʹԽԻƾң½ԣ״ңΣʮ·裨¼ݣ
ڵ=ԻƾңͷԴ
ʹѪʹBѪ=·ᣨʮģպˣΡƢʯ
ˣ
50ԣƵѣB=ǰ ϸʷϸʹҼ䣩Ĥ̼ƣʮƶѪ
Ѫ쵰ס=
ʧѪ飨СϸɫƶѪѪ=ȱ߲ʷȫʹǻڳѪ=Ƣ
ƶѪ
вˣĤ̼ǻɫҺ=ƶѪʷƢ״ƶѪòϵ١ַϸ=ٱպˣ ϣ
ˣѪ= ƶѪ֡ƢĤȾHBַϸ=ѪƶѪʮ壩ⲡ¼ݣ
ʮģ̱¼ݣ
ԣѹߣ¸վԣƽСಿλƤĤѪѪС٣飺ϸ࣬=ɹб
ϰ=ITP ʮԸףͲԸסͲԸסʮ壩Ѫ
ͲԸף
ԷȡѪHBPLTͣ=ԷȣȾδѹʹߵʹأ+)Ѫ
ԭ+=ƾԭ飺ԻƾԴ ʮ¼ݣ
ʮߣϸ
лϵͳ˷ܣ״״״T3T4ŧѪ㣫Qأ=кԭԾԴ =
ʮˣ̲¼ݣ
ʮߣ¼ݣ ȡݣѪʷұʷHIV(+=̲ һ٣Ѫߣ֢״= ʮţС
ʮˣϵͳԺǴ¼ݣ
ʲȾʷ꣫Ѫףˮ棩ѪѹŮԣϵͳANA(+˫DNA塢sIn߲C3=С
=SLE
ѪˮףѪѹl=С ʮţʪؽף¼ݣ
ʮ·Ⱦݣ
ܹؽۡԳԹؽףRF(+=ʪؽ ѻŮԣȣ״̼=Ⱦ
ʮ
·ʷ·̼֢ʷʹȣߵʹʷΣDzУ+X= ѪWBc=Է
ʮһCOж
Ůԣʹȣŧ= C0ӴʷѪҺCOHBߣڴӣҺ=C0ж ʮһ˥
ʮлж
ԭGFR½ʵҴл=˥ Żζ̼=лж
8190374.doc7ҳȫĹ16ҳ
ʮŧĤףԼĤף ȣϸУǰضߡеֿ+)ԼҺ=
ʮģѪܼԳѪԹ
껼ߣѪѹʷʶϰλ=ԳѪ
껼ߣѪѹʷTIAʷƫ̱CTδ=Թ
ʮ壩պˣӲĤѪף ˣмڣ--ԣ+CTѪ=ӲĤѪ
ʮӹѳ Ůԣ¾࣫ӹƶѪ=ӹ 飫ҺӴԳѪ= Ůԣǻ飫ǻҺcA125=ǻ飬ѳԴ
ʮߣСк
ȣ/=״ ݣƤԲ= Ѫأ3.5mmol/L=ͼѪ֢
ʮˣӪάDȱѯ¥¼ݣ
겻߸\ȣѪơѪסø=ӪάDȱѯ¥ڣ ʮţСԼ
ͻȣ= ʮ֯ԻŧԸȾ¼ݣ ˺ʹУŧ=Ƥ¼Է֯
ʮһ鷿ס鷿¼ݣ
鷿ʹȣWBCϸ=鷿鷿ף=ŧγ
ϡϼݡһĿбͻʹͨҲû⣬ԭ ԺijijﲿĿһҪúÿ顣ʷɼͲҪ
ҲDZԵĿص㣬ڼܸϰʱϱݣһ60ѡصץҪעԺıԷdz档
㣺ϡݺͽһ顣 Ҫǿ߲࣬ԩǴ1.
ʱ̣ŵԵʣּһҪ һҪдȫҪ ģ
֧IJҪд ժҪԣ9꣬סѪ10죬8 1)֧ϲȾ 壺T36.9,P90/,R24/,BP145/80mmHg2)Է ӪеȣزݣףĤԲףĤƣ3)ԭಡ ԳѪ-״δŧԷճĤ4)Ĺܼ
Ѫ㡣ķ쳣¡2cmѹʹƢδҪעⲡʷṩÿϵͳеļƶ)ڣ˫֫ѹˮס ࣬жϳرƼƣָ٣һ黯飺Hb83g/LRBC2.81012/L֯1.4%WBC11.3̿ɶ϶ʲô 109/LԷҶ82%2%ܰ16%plt207109/L2.ݣ
ESR110mm/hף)RBC10-12/HpWBC1-4/HpһҪòʷиϣϵ˳Ӧг1.01024Сʱ2.2g.ѪBUN36.7mmol/LᵽһЩ弲ϵҪݡ 546.6umol/Lܵ60.9g/L35.4g/L̴3.ϣ
4.5mmol/LC30.48g/LASO800IU/L.ҽѧȫ..վ.ҪΧŲIJλдּһ֣繩 Dz˽⣬Ǿͽļд֡
4.һ飺
ʱ䣺10
ټӹһ£
Ҫ㣺ܷ20) θһCTһ¸Ρǻת)Ƭת) һϼݣ8) Ľʹ24Сʱ̬ĵͼ̬Ѫļø
һ)ϣ4)
պԸˣƢ)ǻ̡BX 1.Сף2) 5.ƣ
2.ܲȫ2) صдԭҲҪΡעⲻҪ֧ƣһЩ
ԤĿ
)ݣ4)
Ҫѵǣÿ궼пѲʷɼͲΪһ̸ 1.СףʲȾٴѪ(ҽȫŵһ20־ȫˡ
ѧȫ)壺Ѫѹ˫ף˫֫ѹˮף һվԣҽԺرתʵϰĿף)ϸ࣬ѪC3ͣASOߡ3
8190374.doc8ҳȫĹ16ҳ
)
2.ܲȫ٣ѪBUNͼߣ1) ϣ5) 1.ף1) 2.Ĥֳף1) 3.ף1) 4.IgA1)
5.ǰܲȫ1) һ飨4) 1.ѪѪʼ飨2) 2.B1) 3.XƬ0.5) 4.Ҫʱ죨0.5)
ġԭ3) 1.Ⱦƣ1) 2.ѹ1)
3.ϸҺˮ1)
ժҪԣ16£Կ15죬ذ3졣 ǰּԿԣȣδƣ2Լأд٣ԣϲ̿ɣ˯Ƿƽȣ23/ա彡1̥1˳ĸι
壺T37.2棬P186/֣R70/֣Bp80/50mmHg.Ӫеȣزݣ꣬ԶλƤԲףȾƤѪ㣬Ƥ֬ӯֲȡȫdzܰͽδͷףĤȾʳѪҽ.ѧȫ.ߣܷ礣٣ȣ+)+)Σ˫οżϸʪĽ粻186/֣룬ƽ3cmѹʹƢδ˫֫Ȱˮס
ʵҼ飺Ѫ棺Hb91g/LRBC5.51012/LWBC12.0