Nikiforov Iu V, Maksimenko V A, Chudakov I E
Anesteziol Reanimatol. 1995 Jul-Aug(4):38-41.
Criteria for the choice of a method for extracorporeal detoxication (acetate hemodialysis, intermittent or continuous hemofiltration or hemodiafiltration, or plasmapheresis) were defined on the basis of a detailed examination of cardiorespiratory function (central hemodynamics, oxygen-transporting function of the blood) in 88 patients with acute postoperative renal failure (PRF). Multiple organ failure occurred in 90% of the patients examined in the postoperative period. The severity of visceral and metabolic disorders was the principal criterion in the choice of extracorporeal detoxication method. Hemofiltration is the method of choice for the treatment of PRF combined with multiple organ disorders, primarily with acute circulatory, respiratory, and metabolic disorders, due to its stabilizing effect on the hemodynamics and a wide spectrum of pathologic substances removed by it. Acetate hemodialysis is indicated for patients with PRF and slow recovery of renal function only after elimination of grave hemodynamic and respiratory disorders, provided there are no general cerebral symptoms, because of its negative effect on the circulation and oxygen balance of the organism and central nervous system. Plasmapheresis is a pathogenetically valid method for the treatment of the initial stages of PRF in cases with massive intravascular hemolysis and sepsis, which may be combined with other methods for extracorporeal detoxication, if necessary.
在对88例急性术后肾衰竭（PRF）患者的心肺功能（中心血流动力学、血液氧输送功能）进行详细检查的基础上，确定了体外解毒方法（醋酸盐血液透析、间歇性或连续性血液滤过或血液透析滤过、或血浆置换）的选择标准。在术后检查的患者中，90%发生了多器官功能衰竭。内脏和代谢紊乱的严重程度是选择体外解毒方法的主要标准。血液滤过是治疗合并多器官疾病的PRF的首选方法，主要是急性循环、呼吸和代谢紊乱，因为它对血流动力学有稳定作用，且能清除多种病理物质。醋酸盐血液透析仅适用于PRF且在消除严重血流动力学和呼吸紊乱后肾功能恢复缓慢的患者，前提是没有全身脑部症状，因为它对机体的循环和氧平衡以及中枢神经系统有负面影响。血浆置换是治疗PRF初始阶段伴有大量血管内溶血和败血症的一种符合发病机制的有效方法，如有必要，可与其他体外解毒方法联合使用。
