Storck M, Hartl W H, Zimmerer E, Inthorn D
Department of Surgery, Ludwig-Maximilians University of Munich, Germany.
Lancet. 1991 Feb 23;337(8739):452-5. doi: 10.1016/0140-6736(91)93393-n.
In a comparison of spontaneous continuous arteriovenous haemofiltration (CAVH) and pump-driven haemofiltration (PDHF) for acute renal failure after surgery, 116 patients admitted to a surgical intensive care unit were assigned CAVH (48) or PDHF (68). The method of assignment was that a patient was treated by PDHF if he or she was the only patient requiring treatment at that time (only one pump was available); any other patient coming to the unit would be treated by CAVH. The groups were slightly unbalanced because there were fewer simultaneous cases than expected. The main endpoints were survival rate, control of uraemia, and additional application of haemodialysis. There were no differences between the patient groups in age, duration of treatment, severity of illness, serum creatinine concentration at the start of treatment, or cause of acute renal failure. Both treatments adequately controlled uraemia and fluid overload. However, the survival rate was significantly higher with PDHF than with CAVH (6 [12.5%] vs 20 [29.4%]; p less than 0.05). The daily ultrafiltrate volume was significantly higher with PDHF than with CAVH (15.7 [95% confidence interval 13.6-17.8] vs 7.0 [6.6-7.4] l/day; p less than 0.05). The volume of ultrafiltrate in patients with ischaemic or sepsis-induced acute renal failure was correlated with the survival rate. This finding suggests that the better survival rate in the PDHF group was due to faster elimination of toxic mediators (of molecular weight 800-1000 daltons) through the filter membrane by high-volume haemofiltration.
在一项比较自发性连续性动静脉血液滤过（CAVH）和泵驱动血液滤过（PDHF）治疗术后急性肾衰竭的研究中，116名入住外科重症监护病房的患者被分配接受CAVH（48例）或PDHF（68例）治疗。分配方法是，如果患者是当时唯一需要治疗的患者（仅有一台泵可用），则采用PDHF治疗；任何其他进入该病房的患者将接受CAVH治疗。由于同时发病的病例比预期少，两组略有不平衡。主要终点指标为生存率、尿毒症控制情况及血液透析的额外应用。患者组在年龄、治疗持续时间、疾病严重程度、治疗开始时的血清肌酐浓度或急性肾衰竭病因方面无差异。两种治疗方法均能充分控制尿毒症和液体超负荷。然而，PDHF组的生存率显著高于CAVH组（6例[12.5%]对20例[29.4%]；p<0.05）。PDHF组的每日超滤量显著高于CAVH组（15.7[95%置信区间13.6 - 17.8]对7.0[6.6 - 7.4]升/天；p<0.05）。缺血性或脓毒症诱导的急性肾衰竭患者的超滤量与生存率相关。这一发现表明，PDHF组生存率较高是由于通过高容量血液滤过经滤过膜更快地清除了分子量为800 - 1000道尔顿的毒性介质。
