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 ( 23 ) 下载PDF ( 85 )

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

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Protocolized care for continuous renal replacement theraphy