1、1会计学CRRT严重脓毒症与严重脓毒症与MODS邱海波邱海波Current opinion in CRRT Current opinion in CRRT Bellomo,et al.2001Understanding Renal Replacement Therapy and Acute Renal Failure in the ICU(The B.E.S.T kidney study)CRRT对对ARF肾功能恢复的影响肾功能恢复的影响CRRTCRRT促进肾功能恢复促进肾功能恢复CRRTIHDPAPACHE II2725.10.10Baseline SCr1361800.002MAP Bef
2、ore RRT74.787.20.001Hosp Mortality71.9%42.2%0.01Renal recovery in hosp80.0%62.5%0.06Duration of RRT14.7d14.5d0.91Cost per week(Can$)3486-51171341Survivor(Cost per y)No-RRT RRT$11,192$73,273Crit Care Med 2003;31:449 455ICU RRTn=116 RRT for overdosen=7Pre-existing CRFn=16ICU RRT for ARF/MOFn=66Initial
3、 CRRTn=66Initial IHDn=28Jacka MJ,Ivancinova X,Gibney RTN.Can J Anaesth 2005;52:327-332为什么为什么CRRT促进肾功能恢复促进肾功能恢复?N Engl J Med 2002;346:305-310为什么为什么CRRTCRRT有助于肾脏功能的恢复？有助于肾脏功能的恢复？Ronco C et al.Effects of different doses in CVVH on outcomes of ARF:A prospective RCT20ml/h/kg 35/ml/kg/h45ml/kg/h95%92%90%N
4、=425SurvivalLancet 2000;356:26-30Conclusion:There is no conclusive evidence to support the superiority of CRRT vs IHD.Both techniques are complimentaryCRRT vs IRRT对危重病患者的影响对危重病患者的影响CRRT可降低危重病患者病死率可降低危重病患者病死率nQuality score 5:definitely equalCRRT vs IRRT对危重病患者的影响对危重病患者的影响CRRT可降低危重病患者病死率可降低危重病患者病死率Hosp
5、ital mortality:CRRT was associated with a reduced risk of hospital death in the six studies in which baseline severity of illness was similar RR 0.48,0.340.69,p0.0005 Intensive Care Med,2002,28:29-37Current opinion in CRRT Current opinion in CRRT 早期后期早期后期CRRT对危重病患者的影响对危重病患者的影响早期或预防性早期或预防性CRRT可降低可降低A
6、RF患者病死率患者病死率Gettings LG.Intensive Care Med,1999,25:805-813早期后期早期后期CRRT对危重病患者的影响对危重病患者的影响早期或预防性早期或预防性CRRT可降低可降低ARF患者病死率患者病死率n生存率明显差异生存率明显差异Gettings LG.Intensive Care Med,1999,25:805-813Bouman et al.Crit Care Med 30:2205-2211,2002 Bouman CS,et al.Critical Care Med 2002;30:2205-221174.3%68.8%75.0%0%20%
7、40%60%80%100%28-Day SurvivalLV-LateLV-EarlyHV-EarlyTreatment Groupn=35SOFA10.32.8n=36SOFA10.61.9n=35SOFA10.12.2Current opinion in CRRT Current opinion in CRRT 20ml/h/kg 35/ml/kg/h45ml/kg/h41%57%58%N=425SurvivalLancet 2000;356:26-305919 ICUadmissionsOliguric ARFN=248Non-oliguric ARFN=130Not randomize
8、d in studyN=142RandomizedIn studyN-106EHVn=35ELVn=35LLVn=36Hemofiltrationn=352No hemofiltrationN=6Bouman CS et al.Effects of early high-volume CVVH on survival and recovery of renal function in IC patients with ARF.Crit Care Med 2002;30:2205(n=106)EHV 74.3%LLV 75%ELV 68.8%No difference renal recover
9、y or 28-d mortality N Engl J Med 2002;346:305-310Survival vs dialysis dose in IHDSurvival vs dialysis dose in IHDCurrent opinion in CRRT Current opinion in CRRT Cole L,et al.Intensive Care Med,2001,27:978-986Mean Norepinephrine DoseMean C3a concentrationMean C5a concentration46.0%46.0%75.0%75.0%70.5
10、%70.5%65.0%65.0%0%0%20%20%40%40%60%60%80%80%100%100%HV-CVVHHHV-CVVHHSOFA-SOFA-PredictedPredictedLOD-LOD-predictedpredictedMODS-MODS-predictedpredictedMortality(%)Mortality(%)Seminars in Dialysis,2006,19(1):69-746420PulseL/hIntensive Care Med(2006)32:713722Intensive Care Med(2003)29:703708Thanks for
11、you attentionCRRT对对ARF肾功能恢复的影响肾功能恢复的影响CRRTCRRT促进肾功能恢复促进肾功能恢复CRRTIHDPAPACHE II2725.10.10Baseline SCr1361800.002MAP Before RRT74.787.20.001Hosp Mortality71.9%42.2%0.01Renal recovery in hosp80.0%62.5%0.06Duration of RRT14.7d14.5d0.91Cost per week(Can$)3486-51171341Survivor(Cost per y)No-RRT RRT$11,192$
12、73,273Crit Care Med 2003;31:449 455Bouman et al.Crit Care Med 30:2205-2211,2002 Current opinion in CRRT Current opinion in CRRT 5919 ICUadmissionsOliguric ARFN=248Non-oliguric ARFN=130Not randomized in studyN=142RandomizedIn studyN-106EHVn=35ELVn=35LLVn=36Hemofiltrationn=352No hemofiltrationN=6Bouman CS et al.Effects of early high-volume CVVH on survival and recovery of renal function in IC patients with ARF.Crit Care Med 2002;30:2205(n=106)Current opinion in CRRT Current opinion in CRRT
