CRRT严重脓毒症与MODS邱海波.ppt

CRRT Severe sepsis and MODS 邱海波 东南大学附属中大医院ICU 东南大学急诊与危重医学研究所 1. CRRT vs IRRT 2. Early vs late CRRT 3. High vs normal flow 4.Possible ways to increase mediators clearance Mode of RRT differences among continents Retrospective cohort study Pats with ARF and required dialysis between April 1,1996, and March 31, 1999 2 ICU in Canada. N=261 IHD vs CRRT 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 160 pats with ARF: Daily vs every-other-day IHD Mean ultrafiltration volume Daily: 1.2 ± 0.5 L Every-other-day: 3.5 ± 0.3 L (P 0.001). Hypotension occurred in Daily: 5 ± 2% Every-other-day: 25 ± 5% (P 0.001) Time to recovery of renal function Daily: 9 ± 2 days Every-other-day:16 ± 6 Days P = 0.001 Effect of RRT dose on recovery of renal function? P = NS CRRT vs IRRT on return of renal function On mortality Mortality:Which is better CRRT or IHD? Swzrtz. RD. Comparing continuous HF with HD in patients with severe ARF Am J Kidney 1999; 34: 424 - 432 Mehti. RL. Collaborative Group for Treatment of ARF in ICU:A RCT of continuous versus IHD for ARF. Kidney Int 2001; 60: 1154 - 63 Kellum JA. Continuous versus intermittent RRT. A meta-analysis. Intensive Care Med 2002; 162: 197- 202 1. CRRT vs IRRT 2. Early vs late CRRT 3. High vs normal flow 4.Possible ways to increase mediators clearance 1989－1997：100例创伤后ARF 早期－后期的临界：BUN 60mg/dl 两组病人创伤评分、GCS、发生休克的比例、年龄、性别和创伤分布均无差异 Early vs. Late RRT RCT (n =106) Oliguria ( 30cc/hr) refractory to high-dose furosemide (500mg over 6hrs) Randomized to 3 groups: Early (12h) high-volume hemofiltration (n=35; 72-96L/24 h) Early (12h) low-volume hemofiltration (n=35; 24-36L/24 h) Late low-volume hemofiltration (n=36; 24-36 L/24 h) Dose and Timing of CVVH in ARF 1. CRRT vs IRRT 2. Early vs late CRRT 3. High vs normal flow 4.Possible ways to increase mediators clearance High-volume hemofilitration (HVHF) Ron