CRRT的适应症(席修明)概要.doc

CRRT的适应症 席修明 美国社区中ARF的发病率 急性肾功能衰竭的流行病 统计2001年全美国出院病人，根据ICD-9-CM的诊断标准 共收院患者，ARF患者558032， 平均19.2/1000 平均住院天数-不同器官衰竭Clin J Am Soc Nephrol 2006;1:43-51 CRRT 的临床应用多种多样 欧洲、澳洲和亚洲 ICU 的病人几乎是唯一的选择（澳洲90%） Mehta 1996调查美国2000名肾脏病医生，应用CRRT的ARF病人小于25% 1 Liano F Kidney International 1996；50：811-818 2 ColeL Am J Respir Crit Care Med 2000;162:191-196 3 Mehta RL American J of Nephrology 1999; 19:377-382 B.E.S.T. Kidney analyzes data from 54 centers in 23 countries around the world. In this first international epidemiological study of current practice in RRT, Rinaldo Bellomo and other investigators have examined nearly 30,000 ICU patients and found close to 2,000 patients with ARF. Remarkably, the incidence of ARF is quite similar across regions, although treatment patterns and outcome vary. Vol. 294 No. 7, August 17, 2005 ??JAMA ???Online Features Acute Renal Failure in Critically Ill Patients A Multinational, Multicenter Study  Regional difference in choice of RRT(Best kidney study) Difference of practice for RRT in the world(Best kidney study) Who manages renal replacement therapy in the ICU ?(From 54 centers in the BEST kidney study) IRRT CRRT Who prescribes RRT? Nephrologists 22(40.7%) 11(20.4%) Intensivists 12(22.2%) 32(59.3%) Both 14 (25.9%) 11(20.4%) Not available 6(11.1%) Who primes circuit? Dialysis nurses 36(66.7%) 9(16.7%) ICU nurses 7(13%) 32(59.3%) Nephrologists 0 2(3.7%) Intensivists 1(1.9%) 6(11.1%) Management of severe acute renal