Bressolle F, Kinowski J M, de la Coussaye J E, Wynn N, Eledjam J J, Galtier M
Laboratoire de Pharmacocinétique, Faculté de Pharmacie, Montpellier, France.
Clin Pharmacokinet. 1994 Jun;26(6):457-71. doi: 10.2165/00003088-199426060-00004.
Continuous haemofiltration is an extracorporeal technique that is increasingly used to remove fluid, electrolytes, and other waste products from the blood supply of critically ill patients with acute renal failure. Continuous arteriovenous haemofiltration (CAVH), where the blood exits the body from an artery and re-enters through a vein, is widely used. Continuous venovenous haemofiltration (CVVH), where blood both exits and enters through a vein by way of a mechanical pump, avoids problems that result from the variable ultrafiltration rate found during CAVH. Continuous arteriovenous or venovenous haemodiafiltration (CAVHD or CVVHD) combine continuous haemofiltration and haemodialysis. All methods involve ultrafiltration of the patient's blood through a filter that is highly permeable to water and small molecules. Drug elimination by haemofiltration depends mainly on the rate of ultrafiltration, the drug protein binding and the sieving coefficient of the membrane. Because patients undergoing continuous haemofiltration have impaired renal function, dosage reduction is often recommended so that adverse drug reactions are avoided. In contrast, if drug removal by haemofiltration is significant, dosage supplementation may be required to ensure therapeutic efficacy of the drug. Therefore, knowledge of the impact of continuous haemofiltration on drug elimination and the pharmacokinetic profile of drugs is essential to good clinical management. The currently available information on the clinical pharmacokinetic aspects of drug therapy during continuous haemofiltration are summarised. Drugs commonly associated with haemofiltration therapy are tabulated with updated pharmacokinetics and drug-monitoring information.
连续性血液滤过是一种体外技术，越来越多地用于从急性肾衰竭危重症患者的血液供应中清除液体、电解质和其他废物。连续性动静脉血液滤过（CAVH），即血液从动脉流出身体并通过静脉重新进入，被广泛应用。连续性静脉-静脉血液滤过（CVVH），血液通过机械泵经静脉进出，避免了CAVH期间发现的超滤率变化所导致的问题。连续性动静脉或静脉-静脉血液透析滤过（CAVHD或CVVHD）结合了连续性血液滤过和血液透析。所有方法都涉及通过对水和小分子具有高渗透性的滤器对患者血液进行超滤。血液滤过对药物的清除主要取决于超滤率、药物与蛋白的结合以及膜的筛系数。由于接受连续性血液滤过的患者肾功能受损，通常建议减少剂量以避免药物不良反应。相反，如果血液滤过对药物的清除作用显著，则可能需要补充剂量以确保药物的治疗效果。因此，了解连续性血液滤过对药物清除的影响以及药物的药代动力学特征对于良好的临床管理至关重要。本文总结了目前关于连续性血液滤过期间药物治疗临床药代动力学方面的可用信息。将通常与血液滤过治疗相关的药物制成表格，并提供更新的药代动力学和药物监测信息。
