Oppert M
Klinik für Notfall- und internistische Intensivmedizin, Klinikum Ernst von Bergmann, Charlottenstr. 72, 14467, Potsdam, Deutschland,
Med Klin Intensivmed Notfmed. 2014 Jun;109(5):331-5. doi: 10.1007/s00063-013-0340-1. Epub 2014 May 22.
Acute kidney injury (AKI) is an important organ failure, which has an enormous negative impact on outcome in patients with severe sepsis.
In this paper, the pathophysiological causes as well as noninterventional and interventional (extracorporeal) treatment of patients with AKI and severe sepsis are described.
The cornerstone of noninterventional therapy is infection control and heamodynamic stabilization with fluid resuscitation and vasopressors. In patients with deteriorating AKI, extracorporeal treatment should be started early. Generally, continuous and intermittent modes are considered to be equally effective and possible. In practice, a continuous form is preferred in hemodynamically unstable patients.
The idea that AKI may easily be overcome by starting extracorporeal treatment is no longer true. AKI is much more complex. The dynamic process of the disease should be kept in mind when choosing the correct mode and dose of the extracorporeal treatment. Antibiotic dosage must be adjusted when kidney function is improving or deteriorating.
急性肾损伤（AKI）是一种重要的器官功能衰竭，对严重脓毒症患者的预后有巨大负面影响。
本文描述了AKI合并严重脓毒症患者的病理生理病因以及非介入性和介入性（体外）治疗方法。
非介入性治疗的基石是控制感染以及通过液体复苏和血管加压药实现血流动力学稳定。对于AKI病情恶化的患者，应尽早开始体外治疗。一般来说，连续性和间歇性模式被认为同样有效且可行。在实际操作中，血流动力学不稳定的患者更倾向于采用连续性模式。
认为通过开始体外治疗就能轻易克服AKI的观点已不再正确。AKI要复杂得多。选择正确的体外治疗模式和剂量时应牢记疾病的动态过程。肾功能改善或恶化时必须调整抗生素剂量。
