CRRT超滤量与疗效评估解析.ppt

* * -Wash-out period between the 2 study sessions- most patients received 2 L/hr CVVH -the MAP, CI, CVP and PAOP did not change significantly over the 8 hours during CVVH or HVHF * The dose of Nad required for the maintenance of the target MAP 70 decreased more during HVHF than CVVH (p=0.02) The 95% confidence interval for the additional effect of a HVHF session on Nad dose was 7.6 +/- 3.2 mcg/min The fall in Nad requirements did not correlate with the falls in body temperature or changes in fluid balance (which were similar for both therapies) * The delta AUC during 0-8 hours was greater for HVHF than CVVH (p.001) -note rapid early decline in blood levels followed by greater recovery of C3a levels after 2 hours during CVVH than HVHF There was only trace amounts of C3a in the UF so adsorption is the major mechanism of removal * The delta AUC for C5a (0-8 hrs) was significantly greater during HVHF than CVVH (p.01) Only trace amount of C5a was detected in UF therefore adsorption was the major mechanism of removal -there was no difference between the delta AUC during CVVH and HVHF for TNF, IL-2, IL-8, IL-10 (IL-6 and IFN-? were not always detected) Rogiers et al 1999 —O— endotoxin —?— CVVH 3 L —?— CVVH 3 + 6 L Rogiers et al 1999 —O— endotoxin —?— CVVH 3 L —?— CVVH 3 + 6 L —O— endotoxin —?— CVVH 3 L —?— CVVH 3 + 6 L Rogiers et al 1999 Mean ± SD Journois et al 1996 对20个行心脏手术的儿童进行随机对照实验 HVHF组超滤率为 5000 (3183—6218) ml/m2 复温时加 750 ml/m2; 对照组只用750 ml/m2 HVHF组在失血量(294 vs 531 ml/m2) 、拔管时间(11 vs 28 hr) 、 P(A-a)O2 (320 vs 551 mmHg) 方面有显著性差异。 Bellomo[4]等证实HVHF（6L）可以清除感染性休克猪血浆中心肌抑制因子，并有效清除感染性休克几MODS中的各种炎症反应介质，尤其是大中分子炎症介质，标准的CVVH仅能清除极少量的炎症介质。 Journois et al 1996 continued……... HVHF 降低 C3a, TNF, IL-10 、 IL-1, IL-6, IL-8髓过氧化物酶的水平 1999年，Oudemans-van Straaten等对306例接受平均超滤率为4l/h的HVHF患者进行回顾性分析，发现低血流动力学患者心指数、血压、每搏输出量均有升高，高血流动力学患者减少多巴胺的剂量仍可使全身血管阻力升高。 2000年，Honore等对20例患者接受短期HVHF治疗的效果进行评价，其中11例有效，达到所有的治疗终点，（心指数、混合静脉血氧饱和度、动脉血pH均增加，肾上腺素剂量减少），28天存活率（9/11）高于无效者（0/9）。 2001年Cole[7]等对