重症监护急性肾衰竭患者的持续动静脉血液透析和血液滤过

Continuous arteriovenous haemodialysis and haemofiltration in intensive care acute renal failure patients.

作者信息

Alarabi A A, Taube A, Danielson B G, Wikström B

机构信息

Department of Internal Medicine, University of Uppsala, Sweden.

出版信息

Int Urol Nephrol. 1992;24(6):657-64. doi: 10.1007/BF02551303.

DOI:10.1007/BF02551303

PMID:1289277

Abstract

CAVHD and CAVH were compared regarding uraemic control in 13 critically ill intensive care patients with acute renal failure (ARF). Patients' mean age was 60 years. Pretreatment blood urea range was 17-56 mmol/l (33-56 mmol/l in 70% of the patients). All patients received vasopressor drugs, and 92% were on artificial mechanical respiration. From the results of this study both modalities gave adequate uraemic control. There was a notable decrease in the urea and creatinine levels with CAVHD more than with CAVH. There was no statistically significant difference between the two modalities in the urea clearance. However, a significant difference (P < 0.05) in creatinine was obtained with CAVHD. Our results suggest that CAVHD is a useful alternative to CAVH in ARF especially when the blood urea level is > 30 mmol/l. However, a higher dialysate flow rate (e.g. 25 ml/min) should be used if the urea level is more than 40 mmol/l. CAVH should be reserved for ARF patients in whom fluid overload is a major problem.

摘要

对13例患有急性肾衰竭（ARF）的重症监护病房患者进行了连续性动静脉血液滤过透析（CAVHD）和连续性动静脉血液滤过（CAVH）在控制尿毒症方面的比较。患者平均年龄为60岁。治疗前血尿素范围为17 - 56 mmol/L（70%的患者为33 - 56 mmol/L）。所有患者均接受血管升压药物治疗，92%的患者接受人工机械通气。从本研究结果来看，两种方式在控制尿毒症方面均效果良好。CAVHD比CAVH使尿素和肌酐水平下降更显著。两种方式在尿素清除率方面无统计学显著差异。然而，CAVHD在肌酐清除方面有显著差异（P < 0.05）。我们的结果表明，在ARF中，CAVHD是CAVH的一种有用替代方法，尤其是当血尿素水平> 30 mmol/L时。然而，如果尿素水平超过40 mmol/L，应使用更高的透析液流速（例如25 ml/分钟）。CAVH应保留用于存在严重液体过载问题的ARF患者。