Bellomo R, Farmer M, Boyce N
Department of Medicine, Monash Medical Centre, Clayton, Victoria, Australia.
J Intensive Care Med. 1995 Jul-Aug;10(4):187-92. doi: 10.1177/088506669501000405.
We studied the biochemical and the clinical consequences of the application of continuous venovenous hemodiafiltration to the management of acute renal failure in critically ill patients. One hundred consecutive surgical and medical ICU patients with acute renal failure were entered into a prospective clinical study at an intensive care unit of tertiary institution.
included assessment of illness severity by APACHE II score on admission and by organ failure score prior to initiation of renal replacement therapy; treatment of patients with continuous venovenous hemodiafiltration; and measurement of biochemical variables prior to and after therapy. Outcome assessment included incidence of complications, duration of oliguria, duration of intensive care and hospital stays, and survival to hospital discharge.
included the following: mean patient age was 60.9 years (range 21-81 yr); mean APACHE II score, 28.6 (95% confidence interval; 27.4-29.8); and number of failing organs, mean, 4.1 (95% confidence interval; 3.8-4.4). At commencement of continuous venovenous hemofiltration with dialysis, 79% of patients were receiving inotropic drugs and 72% were septic, and, in 35%, bacteremia or fungemia was demonstrated. Renal replacement therapy was applied for a mean duration of 186.2 hours (95% confidence interval; 149.2-223.7), with a mean hourly net ultrafiltrate production of 621 mL (95% confidence interval; 594-648) and a mean urea clearance of 28.1 mL/min (95% confidence interval; 26.7-29.5). Azotemia was controlled in all patients (plasma urea < 30 mmol/L). During the more than 18,000 hours of treatment, there was no therapy-associated hemodynamic instability. Complications were rare. They included two cases of hemofilter rupture with minor blood loss and a single case of bleeding at the site of the vascular-access catheter. Forty-three patients survived to ICU discharge, and 40 survived to hospital discharge. Continuous venovenous hemodiafiltration is a safe and an effective form of renal replacement therapy in critically ill patients. In such patients, who have a high predicted mortality rate, it was associated with a 40% survival rate. These findings suggests that continuous venovenous hemodiafiltration may be ideally suited to patients with multisystem organ failure with acute renal failure.
我们研究了连续性静脉-静脉血液透析滤过在危重症患者急性肾衰竭管理中的生化及临床影响。在一家三级医疗机构的重症监护病房，对100例连续入选的急性肾衰竭外科和内科ICU患者进行了一项前瞻性临床研究。
包括入院时通过急性生理与慢性健康状况评分系统（APACHE II）评分以及开始肾脏替代治疗前通过器官衰竭评分评估疾病严重程度；对患者进行连续性静脉-静脉血液透析滤过治疗；以及治疗前后测量生化指标。结局评估包括并发症发生率、少尿持续时间、重症监护及住院时间以及出院生存率。
如下所示：患者平均年龄为60.9岁（范围21 - 81岁）；APACHE II评分平均为28.6（95%置信区间：27.4 - 29.8）；衰竭器官数量平均为4.1个（95%置信区间：3.8 - 4.4）。在开始连续性静脉-静脉血液透析滤过治疗时，79%的患者正在接受血管活性药物治疗，72%的患者存在脓毒症，35%的患者证实有菌血症或真菌血症。肾脏替代治疗的平均持续时间为186.2小时（95%置信区间：149.2 - 223.7），每小时净超滤量平均为621毫升（95%置信区间：594 - 648），尿素清除率平均为28.1毫升/分钟（95%置信区间：26.7 - 29.5）。所有患者的氮质血症均得到控制（血浆尿素<30 mmol/L）。在超过18000小时的治疗过程中，未出现与治疗相关的血流动力学不稳定情况。并发症罕见。包括2例血液滤过器破裂伴少量失血以及1例血管通路导管部位出血。43例患者存活至从ICU出院，40例患者存活至出院。连续性静脉-静脉血液透析滤过是危重症患者一种安全有效的肾脏替代治疗方式。在这类预计死亡率较高的患者中，其生存率为40%。这些发现表明连续性静脉-静脉血液透析滤过可能非常适合多系统器官衰竭合并急性肾衰竭的患者。
