CBP在急危重病人的应用.ppt

R.T. Noel Gibney,et al.When Should Renal Replacement Therapy for Acute Kidney Injury Be Initiated and Discontinued?. Blood Purif 2008;26:473–484. A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury: a systematic review and meta-analysis Karvellas et al. Critical Care 2011, 15:R72 Earlier institution of RRT in critically ill patients with AKI may have a beneficial impact on survival Figure. 90-day survival rate according to the baseline RIFLE classification. P 0.01 compared among the three groups. LI WX, CHEN HD, WANG XW,et,al.wenPredictive value of RIFLE classification on prognosis of critically ill patients with acute kidney injury treated with continuous renalreplacement therapy .Chin Med J 2009;122(9):1020-1025. the RIFLE stage may be used to predict 90-day survival rate and the malignant kidney outcome in the critically ill patients with AKI treated with CRRT.Starting CRRT prior to RIFLE-F stage may be the optimal timing. Prospective, multi-center, randomized controlled trials are crucial to confirm its predictive value of RIFLE stage. CBP的时机 既往确定AKI 进行RRT的指标：BUN、sCr、 urine amount 、到ICU的时间、sK﹢等 不仅仅根据生理指标（sCr和BUN值）是否达到尿毒症水平，更要结合患者临床病情（其他脏器功能不全、尿量和血pH值）来确定AKI患者何时开始 RRT治疗，而水负荷比氮质血症更重要 当前越来越倾向于使用simplified RIFLE / AKIN 分期（结合APACHE Ⅱ）来确定介入时机 Bagshaw SM, Gibney RT: Conventional markers of kidney function. Crit Care Med 2008; 36:S152–S158. Marlies Ostermannand René WS Chang.Correlation between parameters at initiation of renal replacement therapy and outcome in patients with acute kidney injury. Critical Care 2009, 13:R175. CBP的时机 目前国内外大量的研究文献和临床实践的经验，都倾向于强调早期介入 目前CBP的停机指征还没有定论。关于CRRT开始及结束时机随机对照研究(EBT)显示，尿量是AKI患者停止CRRT的最可靠指标，在未使用利尿剂时尤其如此，其次为血清血肌酐水平。一般认为患者进入多尿期且肌酐小于265umol/L时考虑停 CBP的模式 CBP的模式 SCUF CVVH CVVHD CVVHDF 血流量（ml/min） 50～100 50～200 50～200 50～200 透析液流量（ml/min） －