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连续性肾脏替代疗法在急性肾损伤(急性肾衰竭)中的应用

Author
Thomas A Golper, MD
Section Editor
Steve J Schwab, MD
Deputy Editor
Alice M Sheridan, MD
Translators
陈罡, 主治医师

引言

严重的急性肾损伤[acute kidney injury, AKI，也称急性肾衰竭(acute renal failure, ARF)]患者可能需要透析。大多数患者采用血液透析治疗，根据患者有无高分解代谢，其透析处方也会部分调整。另一可选方案是采用连续性肾脏替代疗法(continuous renal replacement therapy, CRRT)。

间歇性血液透析和连续性肾脏替代疗法的可能区别

血流动力学稳定性 — 每日或隔日的常规血液透析是血流动力学稳定的重症ARF患者的标准透析方案。然而，低血压是常规血液透析最常见的并发症之一，液体和溶质的快速清除是导致低血压的部分原因，因此常规血液透析对低血压或血流动力学不稳定的患者不太可取。相比之下，诸如连续性动静脉血液滤过(continuous arteriovenous hemofiltration, CAVH)或连续性动静脉血液透析(continuous arteriovenous hemodialysis, CAVHD)等CRRT方法的液体和溶质清除速率较慢，低血压少见[1-4]。关于不同类型CRRT的特征的总结参见其他专题。 (参见“连续性肾脏替代疗法：概述”)

CRRT还具有额外的优势，即能有效清除低血压患者体内的多余液体，而血液透析在这类患者中的应用往往受限，因为会进一步降低患者的血压。

血液透析引起的血流动力学相对不稳定与多个因素有关，这点将在别处详细讨论。 (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”)

●溶质的快速清除会导致血浆渗透压骤降，促进渗透性水分向细胞内转移，导致细胞外容量进一步下降(图 1)。血浆渗透压下降本身就是促发低血压的一个因素。

             

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Literature review current through: 2017-06 . | This topic last updated: 2016-07-29.
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