John Jacob C, Taha Sara, Bunchman Timothy E
Department of Pediatric Nephrology, Children's Hospital of Richmond at the Virginia Commonwealth University, Richmond, VA, USA.
Kidney Res Clin Pract. 2019 Dec 31;38(4):455-461. doi: 10.23876/j.krcp.19.060.
In the last three decades, significant advances have been made in the care of children requiring renal replacement therapy (RRT). The move from the use of only hemodialysis and peritoneal dialysis to continuous venovenous hemofiltration with or without dialysis (continuous renal replacement therapy, CRRT) has become a mainstay in many intensive care units. The move to CRRT is the result of greater clinical experience as well as advances in equipment, solutions, vascular access, and anticoagulation. CRRT is the mainstay of dialysis in pediatric intensive care unit (PICU) for critically ill children who often have hemodynamic compromise. The advantages of this modality include the ability to promote both solute and fluid clearance in a slow continuous manner. Though data exist suggesting that approximately 25% of children in any PICU may have some degree of renal insufficiency, the true need for RRT is approximately 4% of PICU admissions. This article will review the history as well as the progress being made in the provision of this care in children.
在过去三十年中，儿童肾替代治疗（RRT）的护理取得了重大进展。从仅使用血液透析和腹膜透析到采用伴有或不伴有透析的连续性静脉-静脉血液滤过（连续性肾替代治疗，CRRT），这已成为许多重症监护病房的主要治疗手段。向CRRT的转变是临床经验更丰富以及设备、置换液、血管通路和抗凝技术进步的结果。CRRT是儿科重症监护病房（PICU）中危重症患儿透析治疗的主要手段，这些患儿常伴有血流动力学不稳定。这种治疗方式的优点包括能够以缓慢持续的方式促进溶质和液体清除。尽管有数据表明，任何一家PICU中约25%的儿童可能存在某种程度的肾功能不全，但真正需要RRT的患儿约占PICU住院人数的4%。本文将回顾儿童RRT护理的历史以及目前所取得的进展。
