Bellomo R, Parkin G, Love J, Boyce N
Department of Medicine, Monash Medical Centre, Clayton, Victoria, Australia.
Am J Nephrol. 1992;12(4):240-5. doi: 10.1159/000168452.
We have prospectively investigated the effect of a flexible approach to the management of acute renal failure in critically ill patients based on continuous haemodiafiltration (CHD). Fifty critically ill patients (mean APACHE II score 28.1, range 18-37), with a mean age of 59.5 years, were treated with continuous arteriovenous haemodiafiltration (CAVHD) and/or continuous venovenous haemodiafiltration (CVVHD). CHD achieved excellent haemodynamic stability and control of azotaemia in all patients and permitted aggressive parenteral nutrition. The mean blood urea concentration fell from 33.9 mmol/l (95% confidence interval, CI, 29.1-38.7) to a plateau of 17 mmol/l (95% CI 14.3-19.7) after 72 h of therapy despite persistent anuria and the parenteral administration of 0.3 g/kday of protein nitrogen (mean urea clearance: 24.2 ml/min; 95% CI 22.9-25.5). No supplemental dialytic therapy was required during the 9,485 h of treatment. All clinically significant complications related to vascular access (14%). Twenty-two patients (44%) survived to be discharged from the ICU. CHD is relatively safe and effective in the management of acute renal failure in the critically ill.
我们前瞻性地研究了基于连续性血液透析滤过（CHD）的灵活方法对危重症患者急性肾衰竭管理的效果。五十例危重症患者（急性生理与慢性健康状况评分系统II [APACHE II]平均评分为28.1，范围为18 - 37），平均年龄59.5岁，接受了连续性动静脉血液透析滤过（CAVHD）和/或连续性静脉-静脉血液透析滤过（CVVHD）治疗。CHD在所有患者中均实现了出色的血流动力学稳定性和氮质血症控制，并允许积极的肠外营养。尽管持续无尿且每日肠外给予0.3 g/kg的蛋白质氮，但治疗72小时后平均血尿素浓度从33.9 mmol/L（95%置信区间[CI]，29.1 - 38.7）降至稳定水平17 mmol/L（95% CI 14.3 - 19.7）（平均尿素清除率：24.2 ml/min；95% CI 22.9 - 25.5）。在9485小时的治疗期间无需补充透析治疗。所有与血管通路相关的具有临床意义的并发症发生率为14%。22例患者（44%）存活至从重症监护病房出院。CHD在危重症患者急性肾衰竭的管理中相对安全有效。
