连续性肾脏替代治疗处方实践与脓毒症血液净化

doi:10.3877/cma.j.issn.2096-1537.2020.03.005

中华重症医学电子杂志 ›› 2020, Vol. 06 ›› Issue (03) : 260 -266. doi: 10.3877/cma.j.issn.2096-1537.2020.03.005

所属专题：重症医学；文献；

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连续性肾脏替代治疗处方实践与脓毒症血液净化

刘娇¹, 王敏敏², 刘永安¹, 杜航向¹, 汪涛¹, 张李迪¹, 陈一竹¹, 陈彦², 陈德昌³^,^†(

)

^1. 201801　上海交通大学医学院附属瑞金医院北院重症医学科
^2. 200031　上海，百特医疗医学治疗发展部
^3. 201801　上海交通大学医学院附属瑞金医院北院重症医学科；201801　上海交通大学医学院附属瑞金医院重症医学科

收稿日期:2020-05-07 出版日期:2020-08-28
通信作者: 陈德昌

Update on prescribing practices of continuous renal replacement therapy and blood purification for sepsis

Jiao Liu¹, Minmin Wang², Yongan Liu¹, Hangxiang Du¹, Tao Wang¹, Lidi Zhang¹, Yizhu Chen¹, Yan Chen², Dechang Chen³^,^†()

^1. Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201801, China
^2. Baxter Healthcare, Shanghai 200031, China

Received:2020-05-07 Published:2020-08-28
Corresponding author: Dechang Chen
About author:
Corresponding author: Chen Dechang, Email: chendechangsh@hotmail.com

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引用本文：

刘娇, 王敏敏, 刘永安, 杜航向, 汪涛, 张李迪, 陈一竹, 陈彦, 陈德昌. 连续性肾脏替代治疗处方实践与脓毒症血液净化[J]. 中华重症医学电子杂志, 2020, 06(03): 260-266.

Jiao Liu, Minmin Wang, Yongan Liu, Hangxiang Du, Tao Wang, Lidi Zhang, Yizhu Chen, Yan Chen, Dechang Chen. Update on prescribing practices of continuous renal replacement therapy and blood purification for sepsis[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2020, 06(03): 260-266.

急性肾损伤（AKI）是临床常见疾患，当并发脓毒症时，住院治疗时间延长，更易进展到慢性肾脏疾病，医疗费用和病死率急剧增加。连续性肾脏替代治疗（CRRT）具有精确稳定控制容量，酸碱电解质平衡和稳定血流动力学的作用，是重症监护病房内肾脏替代治疗的主要模式。本综述重点回顾CRRT在重症AKI和多器官衰竭患者中的应用现状，包括模式、滤器、抗凝、处方和达成剂量、血管通路、开始和停机时机及脓毒症/AKI清除内毒素和细胞因子的研究进展。

关键词: 急性肾损伤, 脓毒症, 吸附, 连续性肾脏替代治疗, 血液净化

Acute renal injury (AKI) is a clinically common disease. When sepsis occurs, the hospitalization time is prolonged, and it is more likely to progress to chronic kidney disease (CKD), dramatically increasing the medical cost and mortality. Continuous renal replacement therapy (CRRT) is the main form of renal replacement therapy (RRT) in intensive care unit, which has the functions of accurate and stable volume control, correction of acid-base electrolyte balance, and stabilization of hemodynamics. This review focuses on the current situation and progress of CRRT in severe AKI, sepsis, and multiple organ failure, including mode, filter, anticoagulation, prescription and dosage, vascular access, timing of start and stop, and the clinical status of blood purification for sepsis.

Key words: Acute renal injury, Sepsis, Adsorbent, Continuous renal replacement therapy, Blood purification

表1 血液净化吸附材质比较

特征	多黏菌素B吸附柱	CytoSorb吸附柱	HA330/380吸附柱	Oxiris滤器
吸附材质	多黏菌素B固定聚苯乙烯衍生纤维	聚苯乙烯二乙烯苯共聚微粒	苯乙烯-二乙烯苯共聚微粒	AN69强化多层线性PEI阳离子聚合物处理及肝素预嫁接
结构	编织纤维	微孔珠	中性大孔树脂	对称结构中空纤维
消毒方式	高压蒸汽	伽马射线	高压蒸汽	ETO环氧乙烷
吸附谱	内毒素	细胞因子	细胞因子	内毒素、细胞因子
吸附模式	离子和疏水作用力	疏水作用力	范德华及疏水作用力	离子作用力
肝素预嫁接	无	无	无	肝素预嫁接具抗血栓功能
CRRT功能	无	无	无	有

表1 血液净化吸附材质比较

特征	多黏菌素B吸附柱	CytoSorb吸附柱	HA330/380吸附柱	Oxiris滤器
吸附材质	多黏菌素B固定聚苯乙烯衍生纤维	聚苯乙烯二乙烯苯共聚微粒	苯乙烯-二乙烯苯共聚微粒	AN69强化多层线性PEI阳离子聚合物处理及肝素预嫁接
结构	编织纤维	微孔珠	中性大孔树脂	对称结构中空纤维
消毒方式	高压蒸汽	伽马射线	高压蒸汽	ETO环氧乙烷
吸附谱	内毒素	细胞因子	细胞因子	内毒素、细胞因子
吸附模式	离子和疏水作用力	疏水作用力	范德华及疏水作用力	离子作用力
肝素预嫁接	无	无	无	肝素预嫁接具抗血栓功能
CRRT功能	无	无	无	有

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[15]	蔡荇, 郑瑞强. 肝素结合蛋白在脓毒症中的应用及研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(04): 487-490.

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Update on prescribing practices of continuous renal replacement therapy and blood purification for sepsis

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Update on prescribing practices of continuous renal replacement therapy and blood purification for sepsis