连续性肾脏替代治疗在中国的发展历程与展望

The retrospective and prospective views on the development of continuous renal replacement therapy in China

连续性肾脏替代治疗技术自20世纪60年代开始,不断革新,模式从连续性动脉静脉血液滤过到静脉静脉血液滤过,更加安全、有效,并从肾衰竭向多器官功能支持治疗方向发展,在危重症领域也具有重要作用。目前连续性肾脏替代治疗已从肾脏科向重症医学科普及,与体外膜肺的组合对于严重急性呼吸窘迫综合征具有积极治疗作用。但国内连续性肾脏替代治疗的大型随机对照研究尚匮乏,相关技术及产品开发不足,未来尚需对不同膜材料的影响、肾脏替代治疗启动时机、个体化治疗等进行探索。

Continuous renal replacement therapy (CRRT) technology began in the 1960s and has undergone continuous innovation from then on. The therapy mode has changed from continuous arterio-venous hemofiltration to veno-venous hemofiltration that becomes more safe and efficient. The therapeutic indication of CRRT has expanded from renal failure to multi-organ functional failure, suggesting that it also plays an important role in critical care medicine. Currently, it is widely used in emergency department. CRRT combined with extracorporeal membrane oxygenation is effective for patients with severe acute respiratory distress syndrome. However, the large-scale and randomized controlled studies on CRRT and the development of CRRTrelated technology and products are yet insufficient in China. The effects of different membrane materials, the appropriate time for CRRT, and the individualized therapy for patients are expected to be developed in the nearly future.