Kumar V A, Craig M, Depner T A, Yeun J Y
Department of Medicine, Division of Nephrology, University of California Davis, Sacramento 95817, USA.
Am J Kidney Dis. 2000 Aug;36(2):294-300. doi: 10.1053/ajkd.2000.8973.
Continuous venovenous hemofiltration (CVVH) is an effective form of renal replacement therapy for acute renal failure (ARF) that offers greater hemodynamic stability and better volume control than conventional hemodialysis in the critically ill, hypotensive patient. However, the application of CVVH in the intensive care unit (ICU) has several disadvantages, including intensive nursing requirements, continuous anticoagulation, patient immobility, and expense. We describe a new approach to the treatment of ARF in the ICU, which we have termed extended daily dialysis (EDD). In this study, EDD was compared with CVVH in 42 patients: 25 patients were treated with EDD for a total of 367 treatment days, and 17 patients were treated with CVVH for a total of 113 days. Median treatment time per day was 7.5 hours for EDD (range, 6 to 8 hours, 25th to 75th percentile) versus 19.5 hours for CVVH (range, 13.4 to 24 hours; P < 0.001). Mean arterial blood pressures (MAPs) did not differ significantly for patients treated with EDD when measured predialysis (median MAP, 70 versus 67 mm Hg for CVVH; P = 0.078), midway through daily treatment (70 versus 68 mm Hg for CVVH; P = 0.083), or at the end of treatment (71 versus 69 mm Hg for CVVH; P = 0.07). Net daily ultrafiltration was similar for the two treatment modalities (EDD, median, 3,000 mL/d; range, 1,763 to 4,445 mL/d; CVVH, 3,028 mL/d; range, 1,785 to 4,707 mL/d; P = 0.514). Anticoagulation requirements were significantly less for patients treated with EDD (median dose of heparin, 4,000 U/d; range, 0 to 5,800 U/d versus 21,100 U/d; range, 8,825 to 31,275 U/d for patients treated with CVVH; P < 0.001). We found that EDD eliminated the need for constant supervision of the dialysis machine by a subspecialty dialysis nurse, allowing one nurse to manage more than one treatment. Overall, EDD was well tolerated by the majority of patients, offered many of the same benefits provided by CVVH, and was technically easier to perform.
持续静静脉血液滤过（CVVH）是治疗急性肾衰竭（ARF）的一种有效肾脏替代疗法，对于危重症、低血压患者，它比传统血液透析具有更好的血流动力学稳定性和容量控制。然而，在重症监护病房（ICU）应用CVVH存在一些缺点，包括护理要求高、需持续抗凝、患者需制动以及费用高。我们描述了一种在ICU治疗ARF的新方法，我们称之为延长每日透析（EDD）。在本研究中，对42例患者的EDD和CVVH进行了比较：25例患者接受EDD治疗，共治疗367天，17例患者接受CVVH治疗，共治疗113天。EDD每天的中位治疗时间为7.5小时（范围为6至8小时，第25至75百分位数），而CVVH为19.5小时（范围为13.4至24小时；P<0.001）。接受EDD治疗的患者在透析前（中位平均动脉压[MAP]，EDD为70mmHg，CVVH为67mmHg；P = 0.078）、每日治疗中途（EDD为70mmHg，CVVH为68mmHg；P = 0.083）或治疗结束时（EDD为71mmHg，CVVH为69mmHg；P = 0.07）测量的MAP差异无统计学意义。两种治疗方式的每日净超滤量相似（EDD，中位值为3000mL/d；范围为1763至4445mL/d；CVVH为3028mL/d；范围为1785至4707mL/d；P = 0.514）。接受EDD治疗的患者抗凝需求明显较少（肝素中位剂量，EDD为4000U/d；范围为0至5800U/d，而接受CVVH治疗的患者为21100U/d；范围为8825至31275U/d；P<0.001）。我们发现EDD无需专科透析护士持续监控透析机，一名护士可管理不止一次治疗。总体而言，大多数患者对EDD耐受性良好，具有CVVH提供的许多相同益处，且技术上更易于操作。
