Schefold Joerg C, Hasper Dietrich, Jörres Achim
Department of Nephrology and Intensive Care Medicine, Charité Universitatsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.
Blood Purif. 2009;28(2):116-23. doi: 10.1159/000223361. Epub 2009 Jun 5.
Despite substantial advances in our understanding of the pathogenesis of sepsis, the mortality of patients with severe sepsis/septic shock is unacceptably high. The potential role of extracorporeal therapies in the adjunctive treatment of sepsis is highly controversial. The present article reviews the current status of clinical research in this area. Conventional 'renal dose' continuous and discontinuous renal replacement technologies fail to achieve a biologically relevant reduction of target molecules. This may be accomplished by modified approaches, e.g. using high-dose protocols, high cut-off membranes, or (selective or unselective) adsorption techniques; however, their clinical value remains to be established by prospective studies using clinical end points.
尽管我们对脓毒症发病机制的理解有了实质性进展，但严重脓毒症/脓毒性休克患者的死亡率仍高得令人无法接受。体外治疗在脓毒症辅助治疗中的潜在作用极具争议。本文综述了该领域临床研究的现状。传统的“肾脏剂量”连续性和间歇性肾脏替代技术未能实现对目标分子的生物学相关水平的降低。这可以通过改良方法来实现，例如使用高剂量方案、高通量滤过膜或（选择性或非选择性）吸附技术；然而，它们的临床价值仍有待通过使用临床终点的前瞻性研究来确定。
