20xx年醫(yī)學(xué)專題—crrt：嚴重膿毒癥與mods(邱海波)-在線瀏覽
2024-10-31 17:01本頁面
【正文】 VVH on outcomes of ARF:A prospective RCT,Lancet 2000。,CRRT vs IRRT on return of renal function On mortality,第九頁，共四十四頁。 34: 424 432 Mehti. RL. Collaborative Group for Treatment of ARF in ICU:A RCT of continuous versus IHD for ARF. Kidney Int 2001。 162: 197 202,Conclusion :There is no conclusive evidence to support the superiority of CRRT vs IHD. Both techniques are complimentary,第十頁，共四十四頁。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，共四十四頁。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，共四十四頁。,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。,早期－后期(h242。ngxiǎn)差異,Gettings LG. Intensive Care Med, 1999, 25: 805813,Outcome Early start 39% survival Late start 20% survival,第十五頁，共四十四頁。 7296L/24 h) Early (12h) lowvolume hemofiltration (n=35。 2436 L/24 h),Bouman et al. Crit Care Med 30:22052211, 2002,第十六頁，共四十四頁。 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。1.9,n=35 SOFA 10.1177。,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,第十八頁，共四十四頁。 356: 26 30,第十九頁，共四十四頁。 30: 2205 (n=106),第二十頁，共四十四頁。,160 pats with ARF: Daily vs everyotherday ID,N Engl J Med 2002。,CRRT: Impact on outcomes,Severity of Disease,Survival rate %,High Dose (CRRT),Low Dose (IHD),The Cleveland Clinic Observation,100,90,80,70,60,50,40,30,20,10,0,第二十三頁，共四十四頁。 If hemodynamically unstable (SOFA CVS score: 34) CVVHDF at 20 ml/kg/hr or SLED 3times/week (target Kt/V = 1.21.4/session),第二十四頁，共四十四頁。,1. CRRT vs IRRT 2. Early vs late CRRT 3. High vs normal flow 4.Possible ways to
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