Eding Dawn M, Jelsma Lindsey R, Metz Caryn J, Steen Vanessa S, Wincek Jenifer M
Helen DeVos Children's Hospital, 100 Michigan Street, NE, Grand Rapids, MI 49503, USA.
Crit Care Nurse. 2011 Feb;31(1):64-71. doi: 10.4037/ccn2011757.
Continuous renal replacement therapy (CRRT) allows gradual, precise removal of excess fluid and solutes. Special considerations are necessary for children who require CRRT because of their smaller circulating blood volumes and the potential for hemodynamic instability associated with the initiation of CRRT. In critically ill children, the CRRT circuit is often primed with blood rather than saline to prevent excessive hemodilution. Two innovative techniques have been designed to limit repeated exposure to donated blood, reduce hemodynamic instability associated with priming of the circuit with blood, and limit interruptions in CRRT. A circuit-to-circuit exchange technique offers a safe, effective alternative method for CRRT circuit changes in small children and infants. A concurrent technique that combines CRRT with plasmapheresis is effective in preventing interruptions of therapy when patients require multiple modes of supportive treatment.
连续性肾脏替代治疗（CRRT）能够逐步、精确地清除过多的液体和溶质。对于因循环血容量较小且开始CRRT时存在血流动力学不稳定风险而需要进行CRRT的儿童，需要特殊考虑。在危重症儿童中，CRRT管路通常用血液而非生理盐水预充，以防止过度血液稀释。已经设计了两种创新技术来限制反复接触捐赠血液、减少与用血液预充管路相关的血流动力学不稳定，并限制CRRT的中断。一种管路间交换技术为小儿和婴儿的CRRT管路更换提供了一种安全、有效的替代方法。当患者需要多种支持治疗模式时，一种将CRRT与血浆置换相结合的同步技术可有效防止治疗中断。
