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连续性静静脉血液透析：技术问题

Author
Paul M Palevsky, MD
Section Editor
Steve J Schwab, MD
Deputy Editor
Alice M Sheridan, MD
Translators
姜书宁, 副主任医师

引言

连续性肾脏替代疗法(continuous renal replacement therapy, CRRT)是由包括血液滤过(基于对流作用的溶质和液体的清除)和血液透析(基于扩散作用的溶质清除)技术在内的一系列治疗方法组成[1,2]。 (参见“连续性肾脏替代疗法：概述”)

由于与间歇性血液透析相比，这些技术的血液动力学稳定性更好，故在肾衰竭危重症患者的治疗中这些技术更受青睐。尽管一些研究者已提出采用CRRT可改善急性肾衰竭患者的结局，但这一点尚未经前瞻性随机试验证明。

CRRT技术最初利用的是动静脉体外循环，其中的血流受平均动脉压与静脉压之间的梯度所驱动。作为连续性动静脉血液滤过(continuous arteriovenous hemofiltration, CAVH)和连续性动静脉血液透析(continuous arteriovenous hemodialysis, CAVHD)的替代选择，连续性静静脉血液透析(continuous venovenous hemodialysis, CVVHD)研发于20世纪80年代中期[3]。相比动静脉循环提供的血流，CVVHD中使用泵驱动静静脉循环可以获得更高速且更恒定的血流。此外，不再需要大孔径动脉导管，从而避免了动脉血栓形成和动脉出血的风险[4,5]。

本专题将总结有关CVVHD操作技术的内容。关于CRRT的概论和其他治疗方法的技术问题参见其他专题。 (参见“连续性动静脉血液透析：技术要点 ”和“连续性肾脏替代疗法在急性肾损伤(急性肾衰竭)中的应用”)

概述

CVVHD的血管通路通常采用标准的双腔血液透析导管来建立(图 1)。流经体外循环的血流由血泵驱动，血流速度一般保持在100-250mL/min。透析液以与血流相反的方向通过血液滤器/血液透析器。

          

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