20xx年醫(yī)學(xué)專題—crrt：嚴重膿毒癥與mods(邱海波)(完整版)
【正文】 : 9 177。,Mortality: Which is better CRRT or IHD?,Swzrtz. RD. Comparing continuous HF with HD in patients with severe ARF Am J Kidney 1999。,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，共四十四頁。 2436L/24 h) Late lowvolume hemofiltration (n=36。,Highvolume hemofilitration (HVHF),Ronco C et al. Effects of different doses in CVVH on outcomes of ARF:A prospective RCT,Lancet 2000。,ATN (n=1260),Multicenter RCT in the USA. Patients with ARF randomized to: Intensive Management Strategy: If hemodynamically stable (SOFA CVS score: 02) IHD 6times/week (target Kt/V =1.21.4/session) If hemodynamically unstable (SOFA CVS score: 34) CVVHDF at 35 ml/kg/hr or SLED 6times/week (target Kt/V = 1.21.4/session) Conventional Management Strategy: If hemodynamically stable (SOFA CVS score: 02) IHD 3times/week (target Kt/V =1.21.4/session)。,目的：評估高流量血濾對感染性休克患者(n11)血流動力學(xué)和細胞因子的影響 方法：隨機crossover試驗，患者隨機接受8h HVHF (6L/h) (AN69濾器，1.6m2)或8h CVVH (1L/h) (AN69濾器，1.2m2) 檢測指標：血流動力學(xué)、去甲腎上腺素需要量、血清C3a、C5a、ILILIL10和TNF的含量(h225。,HVCVVH明顯改善感染性休克(xiūk232。,Higher Uf volumes,Higher membrane cutoff,Permeability,Convection,Grootendorst AF et al , 1992 Bellomo R et al, 1998,Leese T et al. 1987 Berlot G et al. 1997,促進介質(zhì)清除/遏制炎癥反應(yīng)(fǎny236。,CVVH + 血漿吸附對感染性休克(xiūk232。ng)總結(jié),CRRT Severe sepsis and MODS?？赡芙档臀Ｖ夭∪说牟∷缆?第四十四頁，共四十四頁。35/ml/kg/h。 delivered duration: 8.43177。,Efficacy of membrane pore size on morbidity and mortality in an immature swine model of Staph. Aureus induced sepsis James R. Matson, Crit Care Med, 26: 730737, 1998,Cutoff 100 KD,第三十七頁，共四十四頁。,脈沖式高容量血液(xu232。ng) HVHF組與CVVH組CVP、CI、 PAWP和液體平衡無差異 維持MAP70mmHg，HVHF組NE劑量顯著低于CVVH NE劑量分別降低10.5ug/min和1.0ug/min P=0.02,高流量(li,RENAL,Multicenter RCT (centers = 35) N= 1500 Australia and New Zealand 25 ml/kg/hr vs. 40 ml/kg/hr of CVVHDF Outcome: all cause mortality at 90
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