Bellomo R, Mehta R
Department of Anaesthesia and Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.
New Horiz. 1995 Nov;3(4):760-7.
Although acute renal failure (ARF) requiring dialysis affects only approximately 4% to 7% of patients admitted to the ICU, such individuals tend to be the sickest and most challenging patients in the ICU. The presence of ARF dramatically complicates their care and mandates the use of extracorporeal renal replacement therapy (RRT). The use of such therapy, with its technical and physiological demands, further complicates treatment. Not surprisingly, therefore, several controversies surround the management of these patients: the techniques of RRT, the indications and timing for their application, the intensity of their use, the selection of suitable patients, the nature of appropriate monitoring and physiologic targets for their application, the type of specialist best suited for the daily management of such patients, the cost-effectiveness of RRT, and the expansion of its use to treat patients without ARF. In many ways, the response to these controversies has diverged between Europe, Australia, and New Zealand on the one hand, and the United States on the other. In this article, we illustrate these sometimes quite different philosophies by presenting two perspectives (from Australia and the United States) on a number of important issues pertaining to RRT.
尽管需要透析的急性肾衰竭（ARF）仅影响约4%至7%入住重症监护病房（ICU）的患者，但这类患者往往是ICU中病情最严重、治疗难度最大的。ARF的存在极大地使他们的护理变得复杂，并要求使用体外肾脏替代疗法（RRT）。这种疗法因其技术和生理需求，进一步使治疗复杂化。因此，毫不奇怪，围绕这些患者的管理存在一些争议：RRT技术、其应用的指征和时机、使用强度、合适患者的选择、适当监测的性质及其应用的生理目标、最适合日常管理此类患者的专科类型、RRT的成本效益以及将其用于治疗无ARF患者的扩展。在许多方面，欧洲、澳大利亚和新西兰与美国在对这些争议的应对上存在分歧。在本文中，我们通过呈现关于RRT若干重要问题的两种观点（分别来自澳大利亚和美国）来说明这些有时截然不同的理念。
