Wendon J, Smithies M, Sheppard M, Bullen K, Tinker J, Bihari D
Department of Intensive Therapy and Medicine, Middlesex Hospital, London, UK.
Intensive Care Med. 1989;15(6):358-63. doi: 10.1007/BF00261493.
Continuous, high volume, venous-venous haemofiltration was used as renal support in 28 critically ill patients with acute renal failure. Fifteen patients survived and were subsequently discharged from the ITU. Although haemofiltration was highly effective in reducing the blood urea and serum creatinine, only survivors demonstrated a significant increase in arterial pH (medians before and at two days 7.28 and 7.49 respectively, p less than 0.005) with a reduction in severity of their illness (median APACHE II scores before and at two days 23 and 16, p less than 0.005). Patients who died remained severely ill and acidotic (median APACHE II scores before and at two days 26 and 28; median arterial pH values 7.32 and 7.31 respectively) and by day two of treatment, marked differences between the patient groups in APACHE II scores, mean arterial pressure, arterial pH and urine flow rate had developed. Haemofiltration with the correction of acute uraemia alone does not necessarily lead to a reduction in the severity of illness which in the critically ill more frequently reflects other organ dysfunction.
28例急性肾衰竭危重症患者采用持续高容量静脉-静脉血液滤过作为肾脏支持治疗。15例患者存活，随后从重症监护病房出院。尽管血液滤过在降低血尿素和血清肌酐方面非常有效，但只有存活患者的动脉pH值显著升高（两天前和两天时的中位数分别为7.28和7.49，p<0.005），病情严重程度降低（两天前和两天时的急性生理与慢性健康状况评分系统II [APACHE II]中位数分别为23和16，p<0.005）。死亡患者病情仍然严重且存在酸中毒（两天前和两天时的APACHE II中位数分别为26和28；动脉pH值中位数分别为7.32和7.31），到治疗第二天，两组患者在APACHE II评分、平均动脉压、动脉pH值和尿流率方面出现了显著差异。单纯通过血液滤过纠正急性尿毒症并不一定会导致病情严重程度降低，在危重症患者中，病情严重程度更常反映其他器官功能障碍。
