连续性肾替代治疗规范化治疗流程

doi:10.3877/cma.j.issn.2096-1537.2019.01.006

中华重症医学电子杂志 ›› 2019, Vol. 05 ›› Issue (01): 27 -31. doi: 10.3877/cma.j.issn.2096-1537.2019.01.006

所属专题：中国重症基层诊疗流程；指南规范；文献资源库；指南共识；

连续性肾替代治疗规范化治疗流程

杨向红 ¹, 张丽娜 ², 胡波 ³, 郑瑞强 ⁴, 翟茜 ⁵, 虞文魁 ⁶, 隆云 ⁷ ^, ^†(

), 重症基层协作组

^1. 310014 杭州，浙江省人民医院重症医学科
^2. 410008 长沙，中南大学湘雅医院重症医学科
^3. 430071 武汉，武汉大学中南医院重症医学科
^4. 225001 扬州，江苏省苏北人民医院重症医学科
^5. 250012 济南，山东大学齐鲁医院重症医学科
^6. 210000 南京鼓楼医院重症医学科
^7. 100730 北京协和医院重症医学科

收稿日期:2017-12-01 出版日期:2019-02-28
通信作者: 隆云
基金资助:
浙江省医药卫生科技平台项目(2017ZD002); 浙江省科技厅2019年度省重点研发计划项目(2019C03024)

Protocolized care for continuous renal replacement theraphy

Xianghong Yang ¹, Lina Zhang ², Bo Hu ³, Ruiqiang Zheng ⁴, Qian Zhai ⁵, Wenkui Yu ⁶, Yun Long ⁷ ^, ^†( ), Critical Care County Working Group

^1. Department of Critical Care Medicine, Zhejiang Provincial People′s Hospital, Hangzhou 310014, China
^2. Department of Critical Care Medicine, Xiangya Hospital of Centre-south University, Changsha 410008, China
^3. Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
^4. Department of Critical Care Medicine, Subei People′s Hospital of Jiangsu Province, Yangzhou 225001, China
^5. Department of Critical Care Medicine, Qilu Hospital of Shangdong University, Jinan 250012, China
^6. Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Nanjing 210000, China
^7. Department of Critical Care Medicine, Peking Union Medical College Hospital, Beijing 100730, China

Received:2017-12-01 Published:2019-02-28
Corresponding author: Yun Long
About author:
Corresponding author: Long Yun, Email: ly_icu@aliyun.com

全文 ( 17 ) 下载PDF ( 38 )

连续性肾替代治疗（CRRT）是重症患者临床救治的一种常用方法，CRRT的复杂性、重症患者病情千变万化的特点迫切需要建立切实可行的规范化治疗流程，以保证CRRT临床实践的顺利进行。CRRT规范化治疗流程主要包括4大步骤：（1）对是否需要实施CRRT进行评估；（2）对评估后需要实施CRRT的患者开具CRRT处方；（3）CRRT治疗过程中的监测管理和参数调整；（4）CRRT停止时机评估。在CRRT的临床实践中，应严格遵循上述CRRT规范化治疗流程，依据患者的具体病情，开展规范化的CRRT治疗。规范化的CRRT流程也使得CRRT的同质化管理的持续质量改进成为可能。

关键词: 连续性肾替代治疗, 规范化流程CRRT处方, 适应证, 禁忌证, 时机, 治疗模式, 治疗剂量, 治疗参数, 抗凝, 容量管理, 监测

Continous renal replacement theraphy (CRRT) is a strategy of clinical treatment in critically ill patients. Due to the complex of CRRT and variety of patients′ condition, establishment of a feasible and standardized protocol to ensure CRRT practice is needed urgently. The protocolized care includes four steps. First, assessing the indication of CRRT; Second, CRRT prescription; Third, monitoring management and parameters adjustment, and Fourth, evaluating the optimal weaning timing of CRRT. In order to carry out the protocolized care of CRRT in clinical practice, we should follow the these four steps strictly based on patients′ condition. This standardized CRRT protocol will further make continuously quality improvement of homogeneous management.

Key words: Continuous renal replacement theraphy, Protocolized care CRRT prescrption, Indication, Contraindication, Timing, Modality, Dose, Parameter of treatment, Anticoagulation, Fluid management, Monitoring

图1 CRRT规范化治疗流程

1	孙仁华, 黄东胜. 重症血液净化学 [M]. 杭州: 浙江大学出版社, 2015.
2	杨毅, 于凯江. 重症肾脏病学 [M]. 上海: 上海科学技术出版社, 2014.
3	Rosner MH, Ostermann M, Murugan R, et al. Indications and management of mechanical fluid removal in critical illness [J]. Brit J Anaesth, 2014, 113(5): 764-771.
4	Karvellas CJ, Farhat MR, Sajjad I, et al. A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury: a systematic review and meta-analysis [J]. Crit Care, 2011, 15(1): 1-10.
5	Ostermann M, Joannidis M, Pani A, et al. Patient selection and timing of continuous renal replacement therapy [J]. Blood Purif, 2016, 42(3): 224-237.
6	Bagshaw SM, Chakravarthi MR, Ricci Z, et al. Precision continuous renal replacement therapy and solute control [J]. Blood Purif, 2016, 42(3): 238-247.
7	Wald R, Friedrich JO, Bagshaw SM, et al. Optimal mode of clearance in critically ill patients with acute kidney injury (OMAKI)-a pilot randomized controlled trial of hemofiltration versus hemodialysis: a Canadian Critical Care Trials Group project [J]. Crit Care, 2012, 16(5): R205.
8	Khwaja A. KDIGO clinical practice guidelines for acute kidney injury [J]. Nephron Clin Pract, 2012, 120(4): 179-184.
9	陈香美. 血液净化标准操作规程 [M]. 北京: 人民军医出版社, 2010.
10	Murugan R, Hoste E, Mehta RL, et al. Precision fluid management in continuous renal replacement therapy [J]. Blood Purif, 2016, 42(3): 266-278.
11	Morabito S, Pistolesi V, Tritapepe L, et al. Regional citrate anticoagulation for RRTs in critically ill patients with AKI [J]. Clin J Am Soc Nephrol, 2014, 9(12): 2173-2188.
12	Katayama S, Uchino S, Uji M, et al. Factors predicting successful discontinuation of continuous renal replacement therapy [J]. Anaesth Intensive Care, 2016, 44(4): 453-457.
13	Uchino S, Bellomo R, Morimatsu H, et al. Continuous renal replacement therapy: a worldwide practice survey. The beginning and ending supportive therapy for the kidney (B. E. S. T. kidney) investigators [J]. Intensive Care Med, 2007, 33(9): 1563-1570.

[1]	作者. 经食管超声心动图在心脏瓣膜置换术中监测的应用[J]. 中华医学超声杂志（电子版）, 2021, 18(10): 21-26.
[2]	郁明霞, 徐灵, 龚莹莹. 剖宫产术后卵巢静脉血栓诊治分析及文献复习[J]. 中华妇幼临床医学杂志(电子版), 2021, 17(01): 62-67.
[3]	郑智, 丁乙轩, 郭玉霖, 刘爽, 孙海晨, 曹锋, 李非. 早期和延迟腹腔镜胆囊切除术治疗轻度胆源性胰腺炎随机对照研究荟萃分析[J]. 中华普通外科学文献(电子版), 2021, 15(05): 395-400.
[4]	王勇, 靖艳, 李爱然, 高亚明. 腹腔镜结直肠癌根治术不同术中转开腹时机及3年生存期分析[J]. 中华普外科手术学杂志(电子版), 2021, 15(02): 187-190.
[5]	谢岩, 赵丹, 马佳祥, 潘小亮, 陈金发, 白玉龙, 张玮晔, 夏岑灿, 江文诗. 人体组织捐献供者评估[J]. 中华移植杂志(电子版), 2021, 15(03): 156-160.
[6]	冯哲. CRRT治疗重症急性胰腺炎：时机与方案[J]. 中华肾病研究电子杂志, 2021, 10(03): 180-180.
[7]	邬步云, 许雪强, 邢昌赢, 毛慧娟. 2020年血液净化领域临床研究进展[J]. 中华肾病研究电子杂志, 2021, 10(01): 20-24.
[8]	费舟. 强化多模态监测加重继发性脑损伤的危险因素[J]. 中华神经创伤外科电子杂志, 2021, 07(03): 129-131.
[9]	张永明, 许少年, 赵鹏程, 姜国伟, 张圣帮, 丁俊, 钱峰. 神经电生理监测下显微血管减压术治疗左侧面肌痉挛[J]. 中华神经创伤外科电子杂志, 2021, 07(03): 191-192.
[10]	张慧芳, 王瑞兰. 万古霉素在成人危重症患者中的应用进展[J]. 中华重症医学电子杂志, 2021, 07(03): 263-267.
[11]	方一, 吕迪, 周海东, 陈远卓, 孙肖肖, 庄育刚. 心肺联合超声与PICCO对急危重症患者监测结果的相关性[J]. 中华重症医学电子杂志, 2021, 07(02): 110-114.
[12]	吴梦滢, 赵茵. 子痫前期和凝血功能异常[J]. 中华产科急救电子杂志, 2021, 10(03): 147-150.
[13]	周翠香, 郭晓辉. 妊娠合并糖尿病患者胎儿宫内安全监测[J]. 中华产科急救电子杂志, 2021, 10(01): 25-30.
[14]	Sixu Chen, Yiping Lin, Jianyu Hao, Zhanmin Shang. 以食管外症状为主要表现的胃食管反流病诊断方法的研究进展[J]. 中华胃食管反流病电子杂志, 2021, 08(01): 32-36.
[15]	金霞, 夏晓洁, 葛子君, 朱庆堂, 李琳, 李占结, 臧凤. 全员培训模式提高医院感染监测效率的效果评价[J]. 中华卫生应急电子杂志, 2021, 07(03): 146-151.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Protocolized care for continuous renal replacement theraphy