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连续性动静脉血液透析：技术要点

Author
Paul M Palevsky, MD
Section Editor
Steve J Schwab, MD
Deputy Editor
Alice M Sheridan, MD
Translators
葛勤敏, 主任医师

引言

连续性肾脏替代疗法(continuous renal replacement therapy, CRRT)是指以连续的方式进行透析治疗或血液滤过治疗，前者为基于弥散的溶质清除，后者为基于对流的溶质和水清除[1]。这些技术可能会运行12-24小时，尤其是在人员配备齐全的白天运行。

连续性治疗的主要优势是单位时间内溶质或液体清除的速率更低。因此， CRRT的患者耐受性通常优于常规治疗，因为间歇性血液透析的许多并发症都与溶质和液体的快速丢失相关。 (参见“急性肾损伤(急性肾衰竭)的肾脏替代疗法(透析)：新陈代谢及血流动力学注意事项”)

在这些技术中，连续性动静脉血液透析(continuous arteriovenous hemodialysis, CAVHD)可用于治疗急性肾衰竭(acute renal failure, ARF)，尤其是在血流动力学不稳定和分解代谢过度的患者中。本文将总结合理开展CAVHD所需的技术方面的内容。关于所有CRRT类型的讨论参见其他专题。 (参见“连续性肾脏替代疗法：概述”)

概述

CAVHD的研发旨在增加连续性动静脉血液滤过(continuous arteriovenous hemofiltration, CAVH)可实现的溶质清除[2,3]。尽管CAVH可实现很好的容量控制，但其溶质清除常不足以使氮质血症得到令人满意的控制，尤其是在分解代谢过度的患者中。 (参见“连续性肾脏替代疗法在急性肾损伤(急性肾衰竭)中的应用”)

CAVHD与CAVH类似，区别在于前者通过血液滤器持续灌注流向与血流方向相反的透析液，其最常使用的灌注速率为1-2L/h (图 1和图 2)。因此，实施令人满意的CAVHD的技术要求与CAVH相似。

                  

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Literature review current through: 2017-06 . | This topic last updated: 2015-08-18.
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