连续性肾脏替代治疗急性肾损伤的时机模式及剂量

The timing,mode and dose of continuous renal replacement therapy in the treatment of acute kidney injury.

急性肾损伤(AKI)在临床尤其在重症监护室十分常见,但仍缺乏有效的内科治疗手段,其病死率居高不下。连续性肾脏替代治疗具有血流动力学稳定、精确控制容量平衡、缓慢持续清除毒素、清除炎症介质、调节免疫功能等多项优势,是目前治疗重症AKI的重要方法,也是危重患者救治领域的研究热点。它自应用于AKI治疗以来,不断发展,已衍生出多种新型治疗模式,但其具体治疗处方及与间断性血液透析的疗效比较等方面尚存争议。文章将就连续性肾脏替代治疗AKI的时机、模式及剂量做一综述。

While acute kidney injury （AKI） is an extraordinarily common condition in clinical practices, especially in intensive care unit （ICU）, the case fatality rate remains high due to lacking of effective medical treatment. Continuous renal replacement therapy （CRRT） possesses many advantages in stable hemodynamics, accu- rate volume control, slow but persistent clearance of toxicity and inflammatory mediators, and modulation of im- mune function, and is therefore considered as a major treatment of AKI. Ever since its introduction in treatment of AKI, CRRT has been developing so that several various novel treatment modes of CRRT are derived. However, there remains controversial as to the specific treatment regimens and efficacy of CRRT compared with intermittent hemodialysis. This article reviews the timing, mode and dose of CRRT.