20xx年醫(yī)學(xué)專題—crrt：嚴(yán)重膿毒癥與mods(邱海波)-文庫(kù)吧
2025-10-17 17:01 本頁(yè)面
【正文】 4 63 Kellum JA. Continuous versus intermittent RRT. A metaanalysis. Intensive Care Med 2002。 162: 197 202,Conclusion :There is no conclusive evidence to support the superiority of CRRT vs IHD. Both techniques are complimentary,第十頁(yè)，共四十四頁(yè)。,CRRT vs IRRT對(duì)危重病患者(hu224。nzhě)的影響 －CRRT可降低危重病患者病死率,Quality score 5: definitely equal,第十一頁(yè)，共四十四頁(yè)。,CRRT vs IRRT對(duì)危重病患者(hu224。nzhě)的影響 －CRRT可降低危重病患者病死率,Hospital mortality: CRRT was associated with a reduced risk of hospital death in the six studies in which baseline severity of illness was similar RR 0.48, 0.34–0.69, p0.0005,Intensive Care Med, 2002, 28: 2937,第十二頁(yè)，共四十四頁(yè)。,1. CRRT vs IRRT 2. Early vs late CRRT 3. High vs normal flow 4.Possible ways to increase mediators clearance,Current opinion in CRRT,第十三頁(yè)，共四十四頁(yè)。,1989－1997：100例創(chuàng)傷(chuāngshāng)后ARF 早期－后期的臨界：BUN 60mg/dl 兩組病人創(chuàng)傷評(píng)分、GCS、發(fā)生休克的比例、年齡、性別和創(chuàng)傷分布均無差異,早期－后期(h242。uqī)CRRT對(duì)危重病患者的影響 －早期或預(yù)防性CRRT可降低ARF患者病死率,Gettings LG. Intensive Care Med, 1999, 25: 805813,第十四頁(yè)，共四十四頁(yè)。,早期－后期(h242。uqī)CRRT對(duì)危重病患者的影響 －早期或預(yù)防性CRRT可降低ARF患者病死率,生存率－明顯(m237。ngxiǎn)差異,Gettings LG. Intensive Care Med, 1999, 25: 805813,Outcome Early start 39% survival Late start 20% survival,第十五頁(yè)，共四十四頁(yè)。,Early vs. Late RRT,RCT (n =106) Oliguria ( 30cc/hr) refractory to highdose furosemide (500mg over 6hrs) Randomized to 3 groups: Early (12h) highvolume hemofiltration (n=35。 7296L/24 h) Early (12h) lowvolume hemofiltration (n=35。 2436L/24 h) Late lowvolume hemofiltration (n=36。 2436 L/24 h),Bouman et al. Crit Care Med 30:22052211, 2002,第十六頁(yè)，共四十四頁(yè)。,Dose and Timing of CVVH in ARF,Bouman CS, et al. Critical Care Med 2002。 30:22052211,,,74.3%,68.8%,75.0%,0%,20%,40%,60%,80%,100%,28Day Survival,LVLate,LVEarly,HVEarly,Treatment Group,n=35 SOFA 10.3177。2.8,n=36 SOFA 10.6177。1.9,n=35 SOFA 10.1177。2.2,第十七頁(yè)，共四十四頁(yè)。,1. CRRT vs IRRT 2. Early vs late CRRT 3. High vs normal flow 4.Possible ways to increase mediators clearance,Current opi
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