【正文】 ml/kg per (≥ μmol/l) or increase to hour for more than 6 hours more than or equal to 150% to 200% ( to 2fold) from baseline 2 Increase in serum creatinine to Less than ml/kg per more than200% to 300% hour for more than 12hours ( 2 to 3fold) frombaseline 3 Increase in serum creatinine to Less than ml/kg per more than300% ( 3fold) from hour for 24 hours or baseline(or serumcreatinine of anuria for 12 hours more than or equato mg/dl [≥ 354 μmol/l] with an acute increaseof at least mg/dl [44 μmol/l]) 適應癥 ? 腎臟疾病 ? 非腎臟疾病 血液凈化標準操作規(guī)程（ 2022 版） 腎臟疾病 ? 重癥急性腎損傷（ AKI） 伴血流動力學不穩(wěn)定和需要持續(xù)清除過多水或毒性物質(zhì)，如 AKI合并嚴重電解質(zhì)紊亂、酸堿代謝失衡、心力衰竭、肺水腫、腦水腫、急性呼吸窘迫綜合征（ ARDS）、外科術(shù)后、嚴重感染等。 ? 無法建立合適的血管通路。 C) ? Clinically significant an oedema (especially lung) ? Drug overdose with dialyzable toxin ? Coagulopathy requiring large amounts of blood products in patient with or at risk of pulmonary oedema/ARDS Any one of these indications constitutes sufficient grounds for considering the initiation of CRRT. Two of the above criteria make CRRT highly desirable. Combined disorders suggest the initiation of CRRT even before some of the abovementioned ?limits? have been reached. *IHD removes potassium more efficiently than , if CRRT is started early enough, hyperkalaemia is easily controlled. ?For example, a fulminant liver failure patient with adult respiratory distress syndrome (ARDS), an international normalized ratio 3 and spontaneous epistaxis. Unless volume is rapidly removed, as fresh frozen plasma is rapidly given, the patient is very likely to develop pulmonary oedema. 治療前患者評估 ? 選擇合適的治療對象，以保證 CRRT 的有效性及安全性。 ? 除 1例外均采用 VV通路， CVVH占 %，%不抗凝，平均劑量為 ，僅%＞ 35ml/kg/h。 Hospital to ICU, duration betweenhospital admission and intensive care unit admission。 ICU, intensive care unit 病人基本情況 Intensive Care Med (2022) 33:1563–1570 CRRT mode Anticoagulation CVVH 531/1006 (%) Unfractionated heparin 429/1000 (%) CVVHDF 342/1006 (%) Sodium citrate 99/1000 (%) CVVHD 132/1006 (%) Nafamostat mesilate 61/1000 (%) CAVHD 1/1006 (%) Lowmolecularweight 44/1000 (%) Dilution site for replacement fluid heparin Predilution 509/870 (%) Prostacyclin 11/1000 (%) Postdilution 361/870 (%) Hirudin 9/1000 (%) Filter material Heparinprotamine 6/1000 (%) Polyacrylonitrile 457/975 (%) Others b 3/1000 (%) Polysulfone 209/975 (%) Combination c 7/1000 (%) Polyamide 164/975 (%) No anticoagulation 331/1000 (%) Cellulose triacetate 89/975 (%) Polymethylmethacrylate 27/975 (%) Polyarylethersulfone 14/975 (%) Cellulose diacetate 11/975 (%) Others a 4/975 (%) a 3 Polyesterpolymeralloy, 1 ethylenevinyl alcohol。25:805813. All Early starters: Late starters: p value (n = 100) BUN 60 mg/d BUN 60 mg/dl (n = 41) (n = 59) BUN prior to CRRT (mg/dl) () () () Serum creatinine prior to CRRT (mg/dl): nonrhabdomyolysis patients (n = 89)a () () () Serum creatinine prior to CRRT (mg/dl) rhabdomyolysis patients only (n = 11) () () () Creatinine clearance prior to CRRT (ml/min)b () () () Albumin prior to CRRT (g/dl)c Oliguric on CRRT day 1 (%) Heart rate (beats/min) Mean blood pressure (mmHg) Cardiac index (l/min per m2) Stroke volume (ml) 85 Oxygen delivery index (ml O2/min per m2) Patients meeting SIRS criteria prior to CRRT (%) Hospital day