患者的持续肾脏替代治疗北京协和杜斌__培训课件.pptVIP

肾脏替代治疗的剂量: Kellum Ronco 425 CVVH 20/h vs. 35-45 ml/kg/h* Bouman 106 CVVH 20ml/kg/h* vs. 48 ml/kg/h Schiffl 160 Alternate day vs. daily hemodialysis Saudan 206 CVVH 25 ml/kg/h vs. CVVHDF 42 ml/kg/h Total (fixed effects) Total (random effects) 1 10 odds ratio Study n treatment groups Favors increased dose Odds Ratio: 1.95 (95% CI 1.48 - 2.58, p 0.001) ARF的治疗剂量: Kellum “Patients with ARF should be treated with at least 35 mL/kg/h of hemofiltration/ hemodiafiltration or daily hemodialysis until or unless ongoing multi-center clinical trials show otherwise.” 肾脏替代治疗的时机 开始RRT的标准 研究 年份 模式 设计 No. 早期 晚期 Parsons 1961 IHD R 33 BUN 120 – 150 BUN 200 Fischer 1966 IHD R 162 BUN ~ 150 BUN 200 Kleinknecht 1972 IHD R 500 BUN 93 BUN 163 Conger 1975 IHD RCT 18 BUN 70 or Scr 5 BUN ~ 150, or Scr ~ 10 Gillum 1996 CRRT RCT 34 Scr 8 BUN ~ 100 or Scr 9 Gettings 1999 CRRT R 100 BUN 60 BUN 60 Bouman 2002 CRRT RCT 106 12 hr after AKI BUN 112, Scr 6.5, or CPE Demirkilic 2004 CRRT R 61 UO 100 ml/8h Scr 5 Elahi 2004 CRRT R 64 UO 100 ml/8h BUN 4, Scr 2.8 Piccinni 2006 CRRT R 80 12h after ICU adm Conventional Liu 2006 IHD CRRT obs 243 BUN 76 BUN 76 Palevsky PM. Indications and timing of renal replacement therapy in acute kidney injury. Crit Care Med 2008; 36[Suppl]: S224-S228 肾脏替代治疗的时机 Palevsky PM. Indications and timing of renal replacement therapy in acute kidney injury. Crit Care Med 2008; 36[Suppl]: S224-S228 80 70 60 50 40 30 20 10 0 Group 1 Group 2 Group 3 Survivors Non Survivors p 0.01 Blood Urea Nitrogen (mg/dl) p 0.01 p 0.01 肾脏替代治疗的时机: Ronco Ronco C, Bellomo R, Homel P, et al. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: A prospective randomised trial. Lancet 2000; 356: 26-30 肾脏替代治疗的时机: Gettings Gettings LG, Reynolds HN, Scalea T, et al. Outcome in post-traumatic acute renal failure when continuous renal replacement therapy is applied early vs l