文档介绍：CRRT的概念与ICU应用内容提要CRRT的历史CRRT的概念与基本原理CRRT的特点CRRT在ICU中的应用指征CRRT在ICU中的应用历史1923首次尝试腹膜透析应用于人类(Ganter-Frg)1941在二战首次认识到ARF综合征1953在朝鲜战争首次应用强化血透(Teschan)1960首次在ARF实行持续血透(Scribner)1967首次在水超负荷时使用超滤(Hendersson)1977在严重水超负荷持续超滤(Kramer)KlinWochenschr1977,55:1121-11221980首次动静脉血滤/(Kramer–Frg)1983ContinuouspumpassistedVenovenousHemofiltration(CVVH)/(Bambauer)1984ContinuousArteriovenousHemodialysis(CAVHD)/(Geronemus)1986ContinuouspumpassistedvenovenousHemodialysis(CVVHD)(Uldall)2000HighVolumeHemofiltration(HVHF)/(Bellomo,Ronco,Journois,Honore)CRRTtherapyoverview CRRT-用于ICU中ARF人工支持治疗一种治疗形式基本治疗目标:消除体液过负荷清除废物和炎症因子纠正电解质失常纠正酸碱平衡给予足够的营养支持CRRTUSEWesternEurope:200000Pts=82000Pts(41%ration)NorthAmerica:155000Pts=29450Pts(19%ration)Canada:11000Pts=4510Pts(41%ration)Asia:80000Pts=14400Pts(18%ration)Autralia:14000Pts=4900Pts(35%ration)Japan:80000Pts=11200Pts(14%ration)Row:75000Pts=16500Pts(22%ration)LatinAmerica:40000Pts=2800Pts(7%ration)2003(195000pts):33%Total:650000PtsARFaredialysedofwhich165000ptsbyCRRT2000(ration:25%)CRRT ARF的一种主要治疗选择??AcuteRenalFailure治疗选择:药物治疗(fluids,diuretics)IntermittentHemodialysis(IHD)腹膜透析PeritonealDialysisContinuousRenalReplacementTherapies(CRRT)CRRT在急性肾衰之外的适应症慢性心衰和水负荷过多多脏衰(MOF)ARDS烧伤的病人肝衰竭Sepsis