Bellomo R, Farmer M, Boyce N
Department of Medicine, Monash Medical Centre, Clayton, Victoria, Australia.
Resuscitation. 1994 Oct;28(2):123-31. doi: 10.1016/0300-9572(94)90084-1.
To study the impact of continuous hemodiafiltration (CHD) on the morbidity and mortality of acute combined respiratory and renal failure in critically ill patients.
Prospective clinical study.
Intensive Care Unit of a tertiary institution.
One-hundred fifteen critically ill patients with combined acute respiratory and renal failure.
Treatment of all patients with either continuous arteriovenous hemodiafiltration (CAVHD) or continuous venovenous hemodiafiltration (CVVHD).
Assessment of illness severity, measurement of plasma urea, serum creatinine, electrolytes and arterial blood gases prior to and during treatment. Duration of oliguria, ICU stay, hospital stay, and final outcome.
One hundred fifteen critically ill patients with combined respiratory and renal failure (mean APACHE II score, 28.1; mean number of failing organs, 4.1) were studied. Thirty-five were treated with CAVHD and 80 with CVVHD for a mean treatment duration of 13.1 days per patient (range 2-47). Blood urea concentration fell from a mean of 29.4 mmol/l to a mean of 19.1 mmol/l (P < 0.001) and the serum creatinine concentration fell from a mean of 520 mumol/l to a mean of 374 mumol/l after 24 h of therapy (P < 0.001). The A-a gradient fell from a mean of 301 mmHg to a mean of 242 mmHg (P < 0.05). Despite the high degree of illness severity and the need for vasoactive drug infusion in 105 patients (91.3%), survival to hospital discharge was achieved in 33 patients (28.7%). For patients who required > 72 h of combined mechanical ventilation, survival was 22% (22 of 100 patients). Complications of continuous hemodiafiltration were few and all related to arterial vascular access.
In critically ill patients with combined acute respiratory and renal failure, continuous hemodiafiltration controlled azotemia without hypotension and with early improvement in gas exchange. PATIENTS treated with this approach achieved promising survival rates. Our findings support the view that CHD is safe and effective and that it offers important advantages over intermittent hemodialysis. It may be the dialytic therapy of choice in critically ill patients with combined acute respiratory and renal failure.
研究持续血液透析滤过（CHD）对重症患者急性呼吸与肾衰竭发病率及死亡率的影响。
前瞻性临床研究。
一家三级医疗机构的重症监护病房。
115例合并急性呼吸与肾衰竭的重症患者。
所有患者均采用持续动静脉血液透析滤过（CAVHD）或持续静脉-静脉血液透析滤过（CVVHD）治疗。
治疗前及治疗期间评估病情严重程度，检测血浆尿素、血清肌酐、电解质及动脉血气。少尿持续时间、重症监护病房（ICU）住院时间、住院时间及最终结局。
对115例合并呼吸与肾衰竭的重症患者（急性生理与慢性健康状况评分系统II [APACHE II]平均分值为28.1；平均衰竭器官数为4.1）进行了研究。35例接受CAVHD治疗，80例接受CVVHD治疗，每位患者平均治疗时间为13.1天（范围为2 - 47天）。治疗24小时后，血尿素浓度从平均29.4 mmol/L降至平均19.1 mmol/L（P < 0.001），血清肌酐浓度从平均520 μmol/L降至平均374 μmol/L（P < 0.001）。肺泡-动脉血氧分压差（A-a梯度）从平均301 mmHg降至平均242 mmHg（P < 0.05）。尽管病情严重程度高，且105例患者（91.3%）需要血管活性药物输注，但仍有33例患者（28.7%）存活至出院。对于需要机械通气超过72小时的患者，生存率为22%（100例患者中的22例）。持续血液透析滤过的并发症较少，且均与动脉血管通路有关。
在合并急性呼吸与肾衰竭的重症患者中，持续血液透析滤过可控制氮质血症，无低血压发生，且气体交换可早期改善。采用这种方法治疗的患者生存率可观。我们的研究结果支持以下观点，即CHD安全有效，且与间歇性血液透析相比具有重要优势。它可能是合并急性呼吸与肾衰竭的重症患者的透析治疗选择。
