Ronco C, Ricci Z, Bellomo R
Department of Nephrology, St Bortolo Hospital, Vicenza, Italy.
EDTNA ERCA J. 2002;Suppl 2:13-8. doi: 10.1111/j.1755-6686.2002.tb00249.x.
There is growing interest in extracorporeal blood purification therapies (EBPT) as adjuvants in the complex therapy of sepsis and multiple organ dysfunction syndrome (MODS). Nowadays the only routinely used purification technique is 'renal replacement therapy' (RRT) during acute renal failure (ARF), one of the almost inevitable and deadly components of MODS. RRT has been the first and still is the most utilised and effective type of EBPT. Evidence is growing about its ability to maintain homeostatic balance in critically ill patients, and specifically in septic patients with MODS. Clinical trials have been recently designed to modify or improve these therapies. In detail, the following issues have been currently addressed: effects on blood purification provided by different therapies, adequacy of prescription and delivery of therapy, toxins and solutes to be removed with these techniques. Based on these speculations we will briefly review the current understanding of these issues and the rationale for application of RRT in the intensive care unit (ICU). In particular, we will focus on the importance of increased ultrafiltration volume and its impact on mortality in the general ICU population and in septic patients.
作为脓毒症和多器官功能障碍综合征（MODS）综合治疗中的辅助手段，体外血液净化疗法（EBPT）越来越受到关注。如今，在急性肾衰竭（ARF）期间，唯一常规使用的净化技术是“肾脏替代疗法”（RRT），ARF是MODS几乎不可避免的致命组成部分之一。RRT一直是且仍然是使用最广泛、最有效的EBPT类型。越来越多的证据表明，它有能力在重症患者中，特别是在患有MODS的脓毒症患者中维持体内平衡。最近已经设计了临床试验来改进或优化这些疗法。具体而言，目前已经探讨了以下问题：不同疗法对血液净化的影响、治疗方案的合理性和实施情况、使用这些技术需要清除的毒素和溶质。基于这些推测，我们将简要回顾目前对这些问题的认识以及在重症监护病房（ICU）应用RRT的理论依据。特别是，我们将关注增加超滤量的重要性及其对普通ICU患者和脓毒症患者死亡率的影响。
