CRRT：严重脓毒症与MODS.pptVIP

CRRT Severe sepsis and MODS;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?;CRRT vs IRRT on return of renal function On mortality;Mortality:Which is better CRRT or IHD?;CRRT vs IRRT对危重病患者的影响－CRRT可降低危重病患者病死率;CRRT vs IRRT对危重病患者的影响－CRRT可降低危重病患者病死率;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 ;早期－后期CRRT对危重病患者的影响－早期或预防性CRRT可降低ARF患者病死率;Early vs. Late RRT;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〕;RCT of HVHF in Septic Shock;EHV 74.3%;160 pats with ARF: Daily vs every-other-day ID;CRRT: Impact on out es;ATN 〔n=1260〕;RENAL;1. CRRT vs IRRT 2. Early vs late CRRT 3. High vs normal flow 4.Possible ways to increase mediators clearance ;Higher Uf volumes;HVHF;目的：评估高流量血滤对感染性休克患者〔n-11〕血流动力学和细胞因子的影响 方法：随机cross-over试验，患者随机接受8h HVHF 〔6L/h〕 〔AN69滤器，1.6m2〕或8h CVVH 〔1L/h〕 〔AN69滤器，1.2m2〕 检测指标：血流动力学、去甲肾上腺素需要??、血清C3a、C5a、IL-2、IL-8、IL-10和TNF的含量 HVHF组与CVVH组CVP、CI、 PAWP和液体平衡无差异 维持MAP70mmHg，HVHF组NE剂量显著低于CVVH NE剂量分别降低10.5ug/min和1.0ug/min P=0.02;Mean Norep