Bellomo R
Department of Anaesthesia and Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.
New Horiz. 1995 Nov;3(4):732-7.
Continuous hemofiltration was first described as a new form of renal replacement for critically ill patients in the late 1970s. Since then, it has undergone remarkable technical and conceptual modifications and has become a widely used form of dialytic therapy in the ICU. More recent insights into the pathogenesis of sepsis and the role of soluble molecules in the mediation of organ injury during septic shock have led to a resurgence of the concept of blood purification during life-threatening infection. Recent studies have confirmed that cytokine extraction occurs in vivo in humans during continuous hemofiltration and that other smaller, potentially noxious molecules such as platelet-activating factor, complement factors C5a and C3a, and thromboxane are also removed from the circulation of septic patients or animals. Experimental studies have shown that continuous hemofiltration has beneficial hemodynamic effects in septic animals and that such effects may correlate with the intensity of ultrafiltration. Cardiac function also appears to improve and myocardial depressant factors are removed from the circulation. Continuous hemofiltration offers some promise as an adjunctive form of treatment in severe sepsis.
连续血液滤过最初于20世纪70年代末被描述为一种针对危重症患者的新型肾脏替代方式。从那时起，它经历了显著的技术和概念上的改进，并已成为重症监护病房中广泛使用的透析治疗形式。最近对脓毒症发病机制以及可溶性分子在脓毒性休克期间介导器官损伤中的作用的深入了解，使得在危及生命的感染期间血液净化的概念再度兴起。最近的研究证实，在连续血液滤过过程中，人体内会发生细胞因子提取，并且其他一些较小的、潜在有害的分子，如血小板活化因子、补体因子C5a和C3a以及血栓素，也会从脓毒症患者或动物的循环中被清除。实验研究表明，连续血液滤过对脓毒症动物具有有益的血流动力学效应，并且这种效应可能与超滤强度相关。心脏功能似乎也有所改善，心肌抑制因子从循环中被清除。连续血液滤过作为严重脓毒症的辅助治疗形式具有一定前景。
