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中华重症医学电子杂志 ›› 2017, Vol. 03 ›› Issue (03) : 214 -219. doi: 10.3877/cma.j.issn.2096-1537.2017.03.012

所属专题: 重症医学 文献

观点

连续性肾替代治疗:如何做到适宜的抗凝治疗
李元忠1,(), 安丽丽1   
  1. 1. 115007 辽宁营口,辽宁省营口经济技术开发区中心医院重症医学科
  • 收稿日期:2016-12-27 出版日期:2017-08-28
  • 通信作者: 李元忠

Continuous renal replacement therapy: how to appropriate anticoagulation?

Yuanzhong Li1,(), Lili An1   

  1. 1. Department of Critical Care Medicine, Central Hospital of Yingkou Economic and Technological Development Zone, Yingkou 115007, Liaoning Province, China.
  • Received:2016-12-27 Published:2017-08-28
  • Corresponding author: Yuanzhong Li
  • About author:
    Corresponding author: Li Yuanzhong, Email:
引用本文:

李元忠, 安丽丽. 连续性肾替代治疗:如何做到适宜的抗凝治疗[J]. 中华重症医学电子杂志, 2017, 03(03): 214-219.

Yuanzhong Li, Lili An. Continuous renal replacement therapy: how to appropriate anticoagulation?[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2017, 03(03): 214-219.

连续性肾替代治疗(CRRT)是危重患者重要的治疗手段之一,应用的范围越来越广泛,不仅仅局限于急性肾损伤(AKI)时的替代治疗,而且延伸到肾外的多器官功能支持治疗,而选择适宜的抗凝方法是保证实现CRRT理想疗效的关键因素之一。危重患者中,抗凝也是一种挑战,因为相当一部分患者由于重症感染和炎症反应,已经存在严重的出血和凝血的危险。但是如果不给予抗凝,CRRT过滤器的滤过性能会下降且管路的寿命将明显缩短,从而导致治疗效果降低。抗凝方法有很多,每一种抗凝技术都是一柄双刃剑,风险和益处并存,选择抗凝方法时应考虑患者自身的特点和重症监护病房(ICU)的经验与资源。需要量体裁衣,为患者制定个体化精准的抗凝方案。

Continuous renal replacement therapy (CRRT) is one of the most important treatment approaches in critically illpatients. It has been applied widely, not only limited in replacement therapy of acute kidney injury (AKI), but also extended to multiple organ function support therapy. Rational anticoagulation is one of the key points to achieve therapeutic effect. However, in critical patients, it is also a challenge because a large number of patients are under the risk of severe hemorrhage and hemostasis due to serious infection and inflammatory response. No anticoagulation will decrease the filter function and survival, which will impair the treatment effect. There are many anticoagulant methods, among whicheachprotocol is a double-edged sword. Individual anticoagulation approach selection should consider the characteristics of patients and the resources and experiences of the intensive care unit.

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