Reynolds H N, Borg U, Belzberg H, Wiles C E
Department of Critical Care, Maryland Institute for Emergency Medical Services Systems, Baltimore 21201-1595.
Crit Care Med. 1991 Nov;19(11):1387-94. doi: 10.1097/00003246-199111000-00015.
To document the efficacy of continuous arteriovenous hemofiltration with dialysis following renal failure, without protein restriction, and to explore the magnitude and clinical applications of total daily urea clearance.
A noncomparative, descriptive account of a case series. Data were collected prospectively and analyzed retrospectively.
A tertiary care facility in a statewide emergency medical services system.
Twenty-eight patients with renal failure were supported by continuous arteriovenous hemofiltration with dialysis in a critical care unit during a 14-month period (21 patients with multitrauma; three patients with soft tissue infections; and four patients with multisystem organ failure who had been transferred from other hospitals). Renal failure was most commonly due to multisystem organ failure or associated with adult respiratory distress syndrome.
Continuous arteriovenous hemofiltration with dialysis days totaled 308 (mean 10.9). All patients received full protein alimentation (mean protein load 131 g/day). The blood urea nitrogen concentration was controlled, generally to 40 to 75 mg/dL (14.3 to 26.7 mmol/L) within 3 to 5 days. Total daily urea clearance ranged from 15 to 21 g/day. Five (18%) of the 28 patients survived.
Continuous arteriovenous hemofiltration with dialysis appears to be effective for the control of blood urea nitrogen and clearance of urea. This modality also permits full protein alimentation. Total daily urea clearance can be calculated easily and may have important clinical uses and implications.
记录在不限制蛋白质摄入的情况下，连续性动静脉血液滤过透析治疗肾衰竭的疗效，并探讨每日总尿素清除率的数值及其临床应用。
对一组病例进行非对照性描述。前瞻性收集数据并进行回顾性分析。
全州紧急医疗服务系统中的一家三级医疗机构。
在14个月期间，28例肾衰竭患者在重症监护病房接受连续性动静脉血液滤过透析治疗（21例多发伤患者；3例软组织感染患者；4例从其他医院转来的多系统器官衰竭患者）。肾衰竭最常见的原因是多系统器官衰竭或与成人呼吸窘迫综合征相关。
连续性动静脉血液滤过透析总天数为308天（平均10.9天）。所有患者均接受全蛋白营养支持（平均蛋白摄入量131克/天）。血尿素氮浓度得到控制，一般在3至5天内降至40至75毫克/分升（14.3至26.7毫摩尔/升）。每日总尿素清除率为15至21克/天。28例患者中有5例（18%）存活。
连续性动静脉血液滤过透析似乎对控制血尿素氮和清除尿素有效。这种治疗方式还允许进行全蛋白营养支持。每日总尿素清除率易于计算，可能具有重要的临床用途和意义。
