CRRT：严重脓毒症与MODS(邱海波).ppt

CRRTdifferencesamongcontinentsBellomo,()RetrospectivecohortstudyPatswithARFandrequireddialysisbetweenApril1,1996,andMarch31,=261CRRT对ARF肾功能恢复的影响-<%%<%%(Can$)3486-51171341Survivor(Costpery)No-RRTRRT$11,192$73,273CritCareMed2003;31:449–455IHDvsCRRTICURRTn=116RRTforoverdosen=7Pre-existingCRFn=16ICURRTforARF/MOFn=66InitialCRRTn=66InitialIHDn=28JackaMJ,IvancinovaX,;52:327-332Munnsetal观察危重急性肾衰竭患者 r下降 25% 7%尿量下降 50% 10%钠排泄分数下降 46% 12%肾功能下降的原因:IHD平均动脉压下降,导致肾脏低灌注,加重肾脏缺血性损伤,延迟急性肾衰竭肾功能的恢复为什么CRRT促进肾功能恢复?160patswithARF:Dailyvsevery-other-dayIHDMeanultrafiltrationvolumeDaily:±-other-day:±(P<).urredinDaily:5±2%Every-other-day:25±5%(P<)TimetorecoveryofrenalfunctionDaily:9±2daysEvery-other-day:16±6DaysP=;346:305-310为什么CRRT有助于肾脏功能的恢复??EffectofRRTdoseonrecoveryofrenalfunction?P=:AprospectiveRCT20ml/h/kg35/ml/kg/h45ml/kg/h95%92%90%N=425SurvivalLancet2000;356:26-30CRRTvsIRRTonreturnofrenalfunctionOnmortalityMortality:WhichisbetterCRRTorIHD?;34:424-:;60:1154--;162:197-202Conclusion: