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急性肾损伤(急性肾衰竭)的肾脏替代疗法(透析)：肾功能的恢复和血液透析膜的影响

Author
Thomas A Golper, MD
Section Editors
Steve J Schwab, MD
Paul M Palevsky, MD
Deputy Editor
Alice M Sheridan, MD
Translators
王艳秋, 副主任医师，副教授

引言

严重急性肾衰竭的患者可能需要透析。此类患者的死亡常与出血或感染相关。由于这些问题可以被尿毒症加剧，有人提出在有明显尿毒症证据前就开始透析可能改善生存情况。但也有证据表明透析可使肾功能的恢复延迟，使该问题变得复杂。

本专题将总结透析是否延迟肾功能的恢复及不同血液透析膜对肾功能恢复的影响等相关问题。有关急性肾损伤支持治疗的概述也见此专题。

急性肾衰竭透析的适应证、最佳时机、最佳剂量以及急性肾衰竭透析相关的代谢和血流动力学改变将单独讨论。 (参见“成人急性肾损伤的肾脏替代疗法(透析)：适应证、时机及透析剂量”和“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”)

支持治疗

在讨论急性肾衰竭透析之前，需要先概述已经确诊急性肾衰竭患者的非透析处理的一般问题。已经确诊的急性肾衰竭的基本治疗目标是维持液体和电解质平衡、避免使用肾毒性药物、保证充足的营养、治疗感染、纠正可逆转的肾前性因素(比如，低血容量)和肾后性因素、密切监测以及给予合适的药物剂量[1]。

高钾血症和液体过剩更可能发生于少尿患者。通过限制钾摄入、避免使用含钾和保钾药物及高钾血症的恰当治疗，可最大程度地减小高钾血症引发的问题。虽然高钾血症和代谢性酸中毒最初可通过药物治疗，但对于急性肾衰竭患者，要充分控制这些异常通常需要透析。 (参见“成人高钾血症的临床表现”和“成人高钾血症的治疗和预防”和‘透析适应证’)

          

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Literature review current through: 2017-06 . | This topic last updated: 2016-12-16.
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