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頁籤選單縮合
題名 | 重症病患急性腎衰竭的腎臟替代性治療=Renal Replacement Therapy for Critically Illness Patients |
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作者 | 林杰樑; | 書刊名 | 中華民國重症醫學雜誌 |
卷期 | 6:3 民93 |
頁次 | 頁242-249 |
分類號 | 415.815 |
關鍵詞 | 腎臟替代性治療; 重症病患; 急性腎衰竭; 連續活動性腹膜透析; 血液透析; 連續性腎臟替代性治療; 緩慢持續性每天透析治療; Renal replacement therapy; Critically ill patients; Acute renal failure; Intermittent hemodialysis; Continuous renal replacement therapy; Slow extended daily dialysis; |
語文 | 中文(Chinese) |
中文摘要 | 在目前的急重症病患併有急性腎衰竭的治療,仍以腹膜透析(PD)、間斷性血液透析(IHD)、連續性腎臟替代性治療(CRRT)等腎臟替代性療法為主。最近在國外的醫學中心,已開始使用兼具HD及CRRT優勢的,所謂緩慢持續性每天透析治療(SLED),來治療的併有急性腎衰竭的急重症病患。有關此急重症病患併有急性腎衰竭的治療方面,醫學的最新發展,簡述如下:IHD的使用,初步的醫學證據顯示,每天血液透析,較之隔天血液透析方式,可改善及重症病患的存活率。有些學者甚至認為每天血液透析的方式,較CRRT存活率好。利用低溫、高鈣、高鈉的透析液或以血漿、生理食鹽水充滿循環管路,都可避免IHD時的血壓下降。腹膜透析在CRRT普遍後,漸漸少人使用。最近臨床試驗的證據顯示,CRRT在急重症病患的存活率較腹膜透析為佳。CRRT方面,最近往多功能性發展,加入不同的裝置,可以治療各種不同的疾病、敗血症及中毒。但其實用性,仍有待未來證實。SLED初步結果發現,其效果與CRRT相當,但有CRRT及IHD沒有的優點;是否會取代CRRT,仍有待未來研究證實。雖然急性腎衰竭的死亡率,近十年來幾乎沒有改變,但個人深信醫者積極的態度及努力,仍然能夠挽救不少急重症病患的生命。 |
英文摘要 | The renal replacement therapy in critically ill patients with acute renal failure (ARF) includes peritoneal dialysis (PD), intermittent hemodialysis (IHD), Continuous renal replacement therapy (CRRT) and slow extended daily dialysis (SLED). IHD is used bicarbonate dialysate with synthetic membranes, prescribed daily for anuric patients. Filling of the extracorporeal circuit with stored plasma or saline solution before the start of dialysis, as well as hypernatremic dialysis with profiling, lower dialysate temperature and higher ionized calcium concentration have been used to prevent harmful hypotensive episodes either at the start or during IHD. Daily hemodialysis was demonstrated improvement of survival in critically ill patients in a recent study. Continuous renal replacement therapy (CRRT) in adults was used primarily for hypotensive patients who might not tolerate standard haemodialysis. In addition, CRRT may have multiple therapeutic potentials especially in sepsis because several techniques are available today. All newborns and infants in whom peritoneal dialysis was not possible were treated by continuous procedures. However, the survival rate of critically ill adults treated with PD was worse than those treated with CRRT in a recent controlled trial. SLED is an acceptable compromise between IHD and CRRT, but the efficacy is needed further evaluations. I suggest that the most promising approach to critically ill patients with ARF would be the combination of CRRT or SLED in the hypotensive patients followed by daily IHD thereafter. Although the mortality rate of ARF patients is still high, I believe that aggressive attitude and treatment for all critical patients who needed dialysis may save a lot of lives. |
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