文档介绍：1. CRRT vs IRRT
2. Early vs late CRRT
3. High vs normal flow
ways to increase mediators clearance
Current opinion in CRRT
CRRT严重脓毒症与MODS
Retrospective cohort study
Pats with ARF and required dialysis between April 1,1996, and March 31, 1999
2 ICU in Canada.
N=261
CRRT对ARF肾功能恢复的影响 －CRRT促进肾功能恢复
CRRT
IHD
P
APACHE II
27
Baseline SCr
136
180
MAP Before RRT
<
Hosp Mortality
%
%
<
Renal recovery in hosp
%
%
Duration of RRT
Cost per week (Can $)
3486-5117
1341
Survivor (Cost per y)
No-RRT
RRT
$11,192
$73,273
Crit Care Med 2003; 31:449 –455
CRRT严重脓毒症与MODS
IHD vs CRRT
ICU RRT
n=116
RRT for overdose
n=7
Pre-existing CRF
n=16
ICU RRT for ARF/MOF
n=66
Initial CRRT
n=66
Initial IHD
n=28
Jacka MJ, Ivancinova X, Gibney RTN. Can J Anaesth 2005;52:327-332
CRRT严重脓毒症与MODS
Munns et al观察危重急性肾衰竭患者
IHD CRRT
CCr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?
CRRT严重脓毒症与MODS
160 pats with ARF: Daily vs every-other-day IHD
Mean ultrafiltration volume
Daily: ± L
Every-other-day: ± L (P <).
Hypotension occurred in
Daily: 5 ± 2%
Every-other-day: 25 ± 5% (P < )
Time to recovery of renal function
Daily: 9 ± 2 days
Every-other-day:16 ± 6 Days P =
N Engl J Med 2002; 346:305-310
为什么CRRT有助于肾脏功能的恢复？？
CRRT严重脓毒症与MODS
Effect of RRT dose on recovery of renal function?
P = NS
Ronco C et al. Effects of different doses in CVVH on outcomes of ARF:A prospective RCT
20ml/h/kg
35/ml/kg/h
45ml/kg/h
95% 92% 90%
N=425
Survival
Lancet 2000; 356: 26 -30
CRRT严重脓毒症与MODS
CRRT vs IRRT
on return of renal function
On mortality
CRRT严重脓毒症与MODS
Mortality: Which is better CRRT or IHD?
Swzrtz. RD. Comparing continuous HF with HD in