Sorkine P, Halpern P, Scarlat A, Weinbroum A, Silbiger A, Setton A, Rudick V
Department of Anesthesiology and Critical Care, Tel Aviv Medical Center, Ichilov Hospital, Israel.
Clin Intensive Care. 1994;5(6):293-5.
To evaluate the short-term metabolic and haemodynamic effects of continuous veno-venous haemofiltration (CVVH) in critically ill patients with acute renal failure (ARF).
Prospective study of nine consecutive critically ill patients with established acute oliguric renal failure.
A general ICU in an 800-bed university hospital.
Critically ill patients, mean age 56 +/- 6 years. Four had multi-organ failure, one had acute haemolytic uraemic syndrome, one had idiopathic lactic acidosis, two had haemorrhagic pancreatitis and one had urinary sepsis.
All patients were mechanically ventilated with arterial and pulmonary artery catheters in situ.
Oxygen consumption (VO2), CO2 production (VCO2) resting energy expenditure (REE), continuous blood pressure, heart rate, central venous pressure (CVP), pulmonary artery pressure (PAP), and cardiac output (CO), as well as tidal and minute volumes, end-tidal CO2 and arterial blood gases, were continuously measured for one hour prior to and one hour following the institution of CVVH. Body temperature, arterial blood pressure, heart rate, CVP and pulmonary artery catheter data remained stable throughout the study period. Prior to CVVH, VO2 was 326 +/- 33 ml/min, VCO2 was 245 +/- 27 ml/min and REE was 2241 +/- 231 kcal/24 hours. Following institution of CVVH, VO2 was 324 +/- 33 ml/min, VCO2 was 244 +/- 27 ml/min and REE was 2227 +/- 230 kcal/24 hours.
CVVH does not affect metabolic rate and haemodynamic stability in critically ill patients. The lack of any effect on the metabolic rate and haemodynamic parameters in such patients may have significant clinical importance and it further attests to the suitability of CVVH for the treatment of critically ill patients.
评估连续性静脉-静脉血液滤过（CVVH）对急性肾衰竭（ARF）危重症患者的短期代谢及血流动力学影响。
对9例确诊为急性少尿型肾衰竭的连续危重症患者进行前瞻性研究。
一所拥有800张床位的大学医院的综合重症监护病房。
危重症患者，平均年龄56±6岁。4例有多器官功能衰竭，1例有急性溶血性尿毒症综合征，1例有特发性乳酸酸中毒，2例有出血性胰腺炎，1例有泌尿道败血症。
所有患者均采用机械通气，动脉和肺动脉导管在位。
在开始CVVH前1小时和开始后1小时连续测量氧耗量（VO2）、二氧化碳生成量（VCO2）、静息能量消耗（REE）、连续血压、心率、中心静脉压（CVP）、肺动脉压（PAP）和心输出量（CO），以及潮气量和分钟通气量、呼气末二氧化碳和动脉血气。在整个研究期间，体温、动脉血压、心率、CVP和肺动脉导管数据保持稳定。在CVVH之前，VO2为326±33 ml/min，VCO2为245±27 ml/min，REE为2241±231 kcal/24小时。在开始CVVH后，VO2为324±33 ml/min，VCO2为244±27 ml/min，REE为2227±230 kcal/24小时。
CVVH不影响危重症患者的代谢率和血流动力学稳定性。对这类患者的代谢率和血流动力学参数无任何影响可能具有重要的临床意义，这进一步证明了CVVH对危重症患者治疗的适用性。
