Ricci Zaccaria, Ronco Claudio
Department of Anesthesiology and Intensive Care, University of Rome, La Sapienza, viale del Policlinico 155, 00161 Rome, Italy.
Crit Care Clin. 2005 Apr;21(2):357-66. doi: 10.1016/j.ccc.2005.01.007.
Improved survival of critically ill acute renal failure patients can be correlated with therapy dose. The overall solute elimination can be measured by the product of clearance and time (Kt), which is usually normalized for the volume of distribution (V) of the solute as "Kt/V." Setting a Kt/V threshold of 1.4 can guide clinicians toward adequate treatment. This is a slightly higher prescription than the current value for chronic dialysis. However, the true uraemic toxins probably diffuse among body compartments less readily than urea and, as such, the frequency of renal replacement therapy should be more important to its efficiency, and should be optimal with continuous therapy. In the absence of an optimal dialysis dose, it can only be recommended that the prescription should exceed that calculated to be "adequate."
危重症急性肾衰竭患者生存率的提高与治疗剂量相关。总体溶质清除率可通过清除率与时间的乘积（Kt）来衡量，该乘积通常针对溶质的分布容积（V）进行标准化，即“Kt/V”。设定Kt/V阈值为1.4可指导临床医生进行充分治疗。这一处方略高于目前慢性透析的数值。然而，真正的尿毒症毒素在体内各腔隙间的扩散可能不如尿素那样容易，因此，肾脏替代治疗的频率对其疗效可能更为重要，持续治疗应是最佳选择。在缺乏最佳透析剂量的情况下，只能建议处方剂量应超过计算得出的“充分”剂量。
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