切换至 "中华医学电子期刊资源库"

第五届中国出版政府奖音像电子网络出版物奖提名奖

中国科技核心期刊

中国科学引文数据库(CSCD)来源期刊

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

专家论坛

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. 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. 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:
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/OL]. 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/OL]. 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。

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.

表1 血液净化吸附材质比较
1
Kramer P, Wigger W, Reiger J, et al. Arteriovenous haemofiltration: a new and simple method for treatment of overhydrated patients resistant to diuretics [J]. Klin Wochenschr, 1977, 55: 1121-1122.
2
deVeber GA. Peter Robert Uldall 1935-1995 [J]. Nephrol Dial Transplant, 1996, 11: 902-903.
3
Bellomo R, Ronco C, Mehta RL. Nomenclature for continuous renal replacement therapies [J]. Am J Kidney Dis, 1996, 28(5): S2-S7.
4
Ronco C, Ricci Z. Renal replacement therapies: physiological review [J]. Intensive Care Med, 2008, 34(12): 2139-2146.
5
Macedo E, Mehta RL. Continuous dialysis therapies: core curriculum 2016 [J]. Am J Kidney Dis, 2016, 68(4): 645-657.
6
Ronco C, 张凌, 陆任华, 等. 重症肾脏替代治疗和血液净化技术的标准化术语命名 [J]. 华西医学杂志, 2018, 33(7): 782-796.
7
Ronco C, Bellomo R, Homel P, et al. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial [J]. Lancet, 2000, 356(9223): 26-30.
8
Bouman CS, Oudemans-Van Straaten HM, et al. Effects of early highvolume continuous venovenous hemofiltration on survival and recovery of renal function in intensive care patients with acute renal failure: a prospective, randomized trial [J]. Crit Care Med, 2002, 30(10): 2205-2211.
9
Tolwani AJ, Campbell RC, Stofan BS, et al. Standard versus highdose CVVHDF for ICU-related acute renal failure [J]. J Am Soc Nephrol, 2008, 19(6): 1233-1238.
10
Palevsky PM, Zhang JH, Connor TZ, et al. VA/NIH Acute Renal Failure Trial Network: intensity of renal support in critically ill patients with acute kidney injury [J]. N Engl J Med, 2008, 359(1): 7-20.
11
Bellomo R, Cass A, Cole L, et al. RENAL Replacement Therapy Study Investigators, Intensity of continuous renal-replacement therapy in critically ill patients [J]. N Engl J Med, 2009, 361(17): 1627-1638.
12
Joannes-Boyau O, Honore PM, Perez P, et al. High-volume versus standard-volume haemofiltration for septic shock patients with acute kidney injury (IVOIRE study): a multicentre randomized controlled trial [J]. Intensive Care Med, 2013, 39: 1535-1546.
13
Van Wert R, Friedrich JO, Scales DC, et al. High-dose renal replacement therapy for acute kidney injury: systematic review and meta-analysis [J]. Crit Care Med, 2010, 38(5): 1360-1369.
14
Clark E, Molnar AO, Joannes-Boyau O, et al. High-volume hemofiltration for septic acute kidney injury: a systematic review and meta-analysis [J]. Crit Care, 2014, 18(1): R7.
15
Heintz BH, Matzke GR, Dager WE. Antimicrobial dosing concepts and recommendations for critically ill adult patients receiving continuous renal replacement therapy or intermittent hemodialysis [J]. Pharmacotherapy, 2009, 29(5): 562-577.
16
Cano NJM, Aparicio M, Brunori G, et al. ESPEN guidelines on parenteral nutrition: adult renal failure [J]. Clin Nutr, 2009, 28: 401-414.
17
Van de Wetering J, Westendorp RG, Van der Hoeven JG, et al. Heparin use in continuous renal replacement procedures: the struggle between filter coagulation and patient hemorrhage [J]. J Am Soc Nephrol, 1996, 7(1): 145-150.
18
Kindgen-Milles D, Brandenburger T, Dimski T. Regional citrate anticoagulation for continuous renal replacement therapy [J]. Curr Opin Crit Care, 2018, 24(6): 450-454.
19
Schneider AG, Journois D, Rimmelé T. Complications of regional citrate anticoagulation: accumulation or overload? [J]. Crit Care, 2017, 21: 281.
20
Bai M, Zhou M, He L, et al. Citrate versus heparin anticoagulation for continuous renal replacement therapy: an updated meta-analysis of RCTs [J]. ICM, 2015, 41(12): 2098-2110.
21
Borg R, Ugboma D, Walker DM, et al. Evaluating the safety and efficacy of regional citrate compared to systemic heparin as anticoagulation for continuous renal replacement therapy in critically ill patients: a service evaluation following a change in practice [J]. J Intensive Care Soc, 2017, 18(3): 184-192.
22
Kidney Disease Improving Global Outcome KDIGO. Acute kidney injury work group: KDIGO clinical practice guideline for acute kidney injury [J]. Kidney Int Suppl, 2012, 2: 1-138.
23
Zhou Y, Zhou F, Wang X, et al. Practice of Extracorporeal Therapies for Septic Acute Kidney Injury Patients in Intensive Care Units in Mainland China [J]. Blood Purif, 2019, 47(suppl 3): 1-6.
24
Joannidis M, Straaten HM. Clinical review: patency of the circuit in continuous renal replacement therapy [J]. Crit Care, 2007, 11: 218.
25
Hackbarth R, Bunchman TE, Chua AN, et al.The effect of vascular access location and size on circuit survival in pediatric continuous renal replacement therapy: a report from the PPCRRT registry [J]. Int J Artif Organs, 2007, 30(12): 1116-1121.
26
Gaudry S, Hajage D, Schortgen F, et al. Initiation strategies for renal-replacement therapy in the intensive care unit [J]. N Engl J Med, 2016, 375: 122-133.
27
Zarbock A, Kellum JA, Schmidt C, et al. Effect of early vs delayed initiation of renal replacement therapy on mortality in critically Ill patientswith acute kidney injury: the ELAIN randomized clinical trial [J]. JAMA, 2016, 315(20): 2190-2199.
28
Yang X, Tu W, Zheng JL, et al. A comparison of early versus late initiation of renal replacement therapy for acute kidney injury in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials [J]. BMC Nephrol, 2017, 18: 264.
29
Lai TS, Shiao CC, Wang JJ, et al. Earlier versus later initiation of renal replacement therapy among critically ill patients with acute kidney injury: a systematic review and meta-analysis of randomized controlled trials [J]. Ann Intensive Care, 2017, 7: 38.
30
Zou H, Hong Q, Gaosi XU. Early versus late initiation of renal replacement therapy impacts mortality in patients with acute kidney injury post cardiac surgery: a meta-analysis [J]. Crit Care, 2017, 21: 150.
31
Barbar SD, Clere-Jehl R, Bourredjem A, et al. for the IDEAL-ICU trial investigators and the CRICS TRIGGERSEP network. Timing of renal-replacement therapy in patients with acute kidney injury and sepsis [J]. N Engl J Med, 2018, 379: 1431-1442.
32
Fayad AI, Buamscha DG, Ciapponi A. Timing of renal replacement therapy initiation for acute kidney injury [J]. Cochrane Syst Rev, 2018, 12: 10612.
33
Ostermann M, Joannidis M, Pani A, et al. 17th acute disease quality initiative (ADQI) Consensus Group: patient selection and timing of continuous renal replacement therapy [J]. Blood Purif, 2016, 42: 224-237.
34
Viallet N, Brunot V, Kuster N, et al. Daily urinary creatinine predicts the weaning of renal replacement therapy in ICU acute kidney injury patients [J]. Ann Intensive Care, 2016, 6: 71.
35
Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3) [J]. JAMA, 2016, 315: 801-810.
36
van Vught LA, Klein Klouwenberg PM, Spitoni C, et al. Incidence, risk factors, and attributable mortality of secondary infections in the intensive care unit after admission for sepsis [J]. JAMA, 2016, 315: 1469-1479.
37
Padkin A, Goldfrad C, Brady AR, et al. Epidemiology of severe sepsis occurring in the first 24 h in intensive care units in England, Wales, and Northern Ireland [J]. Crit Care Med, 2003, 31: 2332-2338.
38
Mayr FB, Yende S, Linde-Zwirble WT, et al. Infection rate and acute organ dysfunction risk as explanations for racial differences in severe sepsis [J]. JAMA, 2010, 303(24): 2495-2503.
39
Mehta RL, Bouchard J, Soroko SB, et al. Sepsis as a cause and consequence of acute kidney injury: program to improve care in acute renal disease[J]. Intensive Care Med, 2011, 37: 241-248.
40
Bellomoa R, Ramanb J, Ronco C. Intensive care unit management of the critically ill patient with fluid overload after open heart surgery[J]. Cardiology, 2001, 96: 169-176.
41
Ronco C. Evolution of technology for continuous renal replacement therapy: forty years of continuous renal replacement therapy[J]. Contrib Nephrol, 2018,194: 1-14.
42
Pinsky MR, Vincent JL, Deviere J, et al. Serum cytokine levels in human septic shock. Relation to multiple-system organ failure and mortality [J]. Chest,1993, 103: 565-575.
43
Marshall JC. Endotoxin in the pathogenesis of sepsis [J]. Contrib Nephrol. 2010, 167: 1-13.
44
Mera S, Tatulescu D, Cismaru C, et al. Multiplex cytokine profiling in patients with sepsis [J]. APMIS, 2011, 119: 155-163.
45
Oberholzer A, Souza SM, Tschoeke SK, et al. Plasma cytokine measurements augment prognostic scores as indicators of outcome in patients with severe sepsis [J]. Shock, 2005, 23: 488-493.
46
Ronco C, Tetta C, Mariano F, et al. Interpreting the mechanisms of continuous renal replacement therapy in sepsis: the peak concentration hypothesis [J]. Artif Organs, 2003, 27(9): 792-801.
47
Zhou F, Peng Z, Murugan R, Kellum JA. Blood purification and mortality in sepsis: a meta-analysis of randomized trials [J]. Crit Care Med, 2013, 41: 2209-2220.
48
Lee CT, Tu YK, Yeh YC, et al. Effects of polymyxin B hemoperfusion on hemodynamics and prognosis in septic shock patients [J]. J Crit Care, 2018, 43: 202-206.
49
Klein DJ, Foster D, Walker PM, et al. Polymyxin B hemoperfusion in endotoxemic septic shock patients without extreme endotoxemia: a post hoc analysis of the EUPHRATES trial [J]. Intensive Care Med, 2018, 44: 2205-2212.
50
Fujii T, Ganeko R, Kataoka Y, et al. Polymyxin B-immobilized hemoperfusion and mortality in critically ill adult patients with sepsis/septic shock: a systematic review with meta-analysis and trial sequential analysis [J]. Intensive Care Med, 2018, 44: 167-178.
51
Friesecke S, Stecher SS, Gross S, et al. Extracorporeal cytokine elimination as rescue therapy in refractory septic shock: a prospective single-center study [J]. J Artif Organs, 2017, 20: 252-259.
52
Schadler D, Pausch C, Heise D, et al. The effect of a novel extracorporeal cytokine hemoadsorption device on IL-6 elimination in septic patients: a randomized controlled trial [J]. PLoS One, 2017, 12: e0187015.
53
Zuccari S, Damiani E, Domizi R, et al. Changes in cytokines, haemodynamics and microcirculation in patients with sepsis/septic shock undergoing continuous renal replacement therapy and blood purification with CytoSorb [J]. Blood Purif, 2020, 49: 107-113.
54
Haase M, Silvester W, Uchino S, et al. A pilot study of high-adsorption hemofiltration in human septic shock [J]. Int J Artif Organs, 2007, 30: 108-117.
55
Shiga H, Hirasawa H, Nishida O, et al. Continuous hemodiafiltration with a cytokine-adsorbing hemofilter in patients with septic shock: a preliminary report [J]. Blood Purif, 2014, 38: 211-218.
56
Doi K, Iwagami M, Yoshida E, et al. Associations of polyethylenimine-coated AN69ST membrane in continuous renal replacement therapy with the intensive care outcomes: observations from a claims database from Japan [J]. Blood Purif, 2017, 44: 184-192.
57
Monard C, Rimmele T, Ronco C. Extracorporeal therapies for sepsis [J]. Blood Purif, 2019, 47(suppl 3): 2-15.
58
Malard B, Lambert C, Kellum JA. In vitro comparison of the adsorption of inflammatory mediators by blood purification devices [J]. Intensive Care Med Exp, 2018, 6(1): 12.
59
Shum HP, Chan KC, Kwan MC, et al. Application of endotoxin and cytokine adsorption haemofilter in septic acute kidney injury due to Gram-negative bacterial infection [J]. Hong Kong Med J, 2013, 19: 491-497.
60
Turani F, Belli AB, Martni SM, et al. Oxiris membrane decreases endotoxin during RRT in septic patients with basal EAA>0.6[A] [J]. Crit Care, 2016, 20(Suppl 2): P196.
61
Victor Schwindenhammer, Thibaut Girardot, et al. oXiris® use in septic shock: Experience of two French centres [J]. Blood Purif, 2019, 47(suppl 3): 1-7.
62
Zhang L, Tang GKY, Liu S, et al. Hemofilter with adsorptive capabilities: case report series [J]. Blood Purif, 2019, 47(suppl 3): 45-50.
63
张春, 孙博睿, 林婷等. oXiris滤器在脓毒性休克治疗中的应用:来自单中心的经验 [J]. 中华危重病急救医学, 2019, 31(12): 1531-1534.
64
Turani F, Barchetta R, Falco M, et al. Continuous renal replacement therapy with the adsorbing filter oXiris in septic patients: a case series [J]. Blood Purif, 2019, 47(suppl 3): 54-58.
65
Broman ME, Hansson F, Vincent JL, et al. Endotoxin and cytokine reducing properties of the oXiris membrane in patients with septic shock: a randomized crossover double-blind study [J]. PLoS One, 2019, 14(8): e0220444.
66
Ma J, Xia P, Zhou YZ, et al. Potential effect of blood purification therapy in reducing cytokine storm as a late complication of critically ill COVID-19 [J]. Clin Immunol, 2020, 214: 108408.
67
Yang Y, Shi J, Ge SW, et al. Effect of continuous renal replacement therapy on all-cause mortality in COVID-19 patients undergoing invasive mechanical ventilation: a retrospective cohort study[2020-05-01].

URL    
68
刘娇, 周昱, 王敏敏, 等. 连续性肾脏替代治疗在新型冠状病毒肺炎中的应用[J]. 中华危重病急救医学, 2020, 32(5): 618-621.
69
杨向红, 孙仁华, 赵鸣雁, 等. 重症新型冠状病毒肺炎患者血液净化治疗流程的专家建议 [J]. 中华医学杂志, 2020,100.
70
中国医师协会肾脏内科医师分会. 新型冠状病毒肺炎合并肾损伤的预防和诊治专家建议 [J/OL] . 中华医学杂志, 2020, 100 (2020-06-15). DOI: 10.3760/cma.j.cn112137-20200525-01652.[网络预发表].

URL    
71
中华医学会肾脏病学分会, 中国研究型医院学会肾脏病学专业委员会. 特殊血液净化技术应用于重症新型冠状病毒肺炎的专家共识 [J/OL] . 中华内科杂志,2020,59 (2020-06-10).DOI: 10.3760/cma.j.cn112138-20200306-00202.[网络预发表].

URL    
[1] 庄燕, 戴林峰, 张海东, 陈秋华, 聂清芳. 脓毒症患者早期生存影响因素及Cox 风险预测模型构建[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(05): 372-378.
[2] 杨瑾, 刘雪克, 张媛媛, 金钧, 韦瑶. 肠道微生物来源石胆酸对脓毒症相关肝损伤的保护作用[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(04): 265-274.
[3] 杜霞, 马梦青, 曹长春. 造影剂诱导的急性肾损伤的发病机制及干预靶点研究进展[J/OL]. 中华肾病研究电子杂志, 2024, 13(05): 279-282.
[4] 郭俊楠, 林惠, 任艺林, 乔晞. 氨基酸代谢异常在急性肾损伤向慢性肾脏病转变中的作用研究进展[J/OL]. 中华肾病研究电子杂志, 2024, 13(05): 283-287.
[5] 袁楠, 黄梦杰, 白云凤, 李晓帆, 罗从娟, 陈健文. 急性肾损伤-慢性肾脏病转化小鼠模型制备的教学要点及学习效果分析[J/OL]. 中华肾病研究电子杂志, 2024, 13(04): 226-230.
[6] 成人脓毒症患者β-内酰胺类抗生素延长输注专家共识编写组. 成人脓毒症患者β-内酰胺类抗生素延长输注专家共识[J/OL]. 中华重症医学电子杂志, 2024, 10(04): 313-324.
[7] 邱英鹏, 李欣雨, 邱海波, 刘松桥, 张凌, 于湘友, 秦秉玉, 蒲莹莹, 赵佳钰, 刘永军, 肖月, 杨毅. 连续性肾脏替代治疗质量控制指标体系的建立及验证[J/OL]. 中华重症医学电子杂志, 2024, 10(04): 351-357.
[8] 向阳, 史黎炜, 肖月, 邱海波, 杨毅, 刘松桥, 邱英鹏, 张莹. 连续性肾脏替代治疗在我国五地区重症医学科的效率分析[J/OL]. 中华重症医学电子杂志, 2024, 10(04): 358-363.
[9] 赵佳钰, 邱英鹏, 刘松桥, 杨毅, 张凌, 于湘友, 秦秉玉, 邱海波, 史黎炜, 刘克军, 蒲莹莹, 陈子扬, 赵羽西, 刘永军, 肖月. 连续性肾脏替代治疗在我国五地区重症医学科的应用现况[J/OL]. 中华重症医学电子杂志, 2024, 10(04): 364-374.
[10] 陈曦, 吴宗盛, 郑明珠, 邱海波. 胸腺萎缩在脓毒症免疫紊乱中的研究进展[J/OL]. 中华重症医学电子杂志, 2024, 10(04): 379-383.
[11] 杨翔, 郭兰骐, 谢剑锋, 邱海波. 转录组学在脓毒症诊疗中的临床研究进展[J/OL]. 中华重症医学电子杂志, 2024, 10(04): 384-388.
[12] 司楠, 孙洪涛. 创伤性脑损伤后肾功能障碍危险因素的研究进展[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(05): 300-305.
[13] 沈炎, 张俊峰, 唐春芳. 预后营养指数结合血清降钙素原、胱抑素C及视黄醇结合蛋白对急性胰腺炎并发急性肾损伤的预测价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 536-540.
[14] 陈惠英, 邱敏珊, 邵汉权. 脓毒症诱发肠黏膜屏障功能损伤的风险因素模型构建与应用效果[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(05): 448-452.
[15] 颜世锐, 熊辉. 感染性心内膜炎合并急性肾损伤患者的危险因素探索及死亡风险预测[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 618-624.
阅读次数
全文


摘要