急性肾功能衰竭的肾脏替代治疗现状与进展急性肾功能衰竭得流行病学急性肾功能衰竭得流行病学PrognosisofARF1975-1995WilfredDrumlNephron1996:73:8-15急性肾功能衰竭得流行病学肾脏替代治疗技术(RRT)肾脏替代治疗技术(RRT)CRRTVersusIHDCRRTVersusIHDCRRTVersusIHDCRRTVersusIHD大家学习辛苦了，还是要坚持CRRTVersusIHDCRRTVersusIHDCRRTVersusIHDCRRTversusEDDCRRTversusEDDCRRTversusEDDCRRTversusEDDPDversusCRRTPDversusCRRTPDversusCRRTBioartificialKidneyBioartificialKidney透析器特性透析器特性透析器特性透析器特性透析器特性透析器特性透析器特性DosingStrategiesDosingStrategiesDosingStrategiesDosingStrategiesDosingStrategiesDosingStrategiesDosingStrategiesDosingStrategiesDAILYHEMODIALYSIS160Patients80patientsassigned80patientsassignedtodailyhemodialysistoalternate-dayhemodialysis74patientsincluded72patientsincludedinanalysisinanalysisSchiffl,NEnglJMed,346:5305-310CharacteristicsofthepatientsatenrollmentAlternate-DayDailycharacteristichemodialysishemodialysisAge6159Sexmale4040female3234IntensivecaresettingMedical4442Surgical2832CauseofARFHypotension42(58%)37(50%)Sepsis23(32%)30(40%)Nephrotoxins7(10%)7(9%)BUN(mg/dl)9188SerumCr(mg/dl)4、94、6Oliguria31(43%)36(49%)APACHEIII8587Outeaccordingtotreatmentgroupalternate-daydailyPhemodialysishemodialysis(N=80)(N=80)mortalityno(%)37(46)22(28)0、01resolutionofARFday1690、001Schiffl,NEnglJMed,346:5305-310低血压得发生率每日透析5%,常规透析25%(P<0、001)少尿得发生率每日透析21%,常规透析73%Sepsis得发生率每日透析22%,常规透析46%(P=0、005)呼吸衰竭得发生率每日透析35%,常规透析69%(P<0、001)神志改变得发生率每日透析38%,常规透析69%(P=0、008)胃肠道出血得发生率每日透析15%,常规透析36%(P=0、007)DosingStrategiesDosingStrategiesEffectsofdifferentdosesincontinuousveno-venoudhaemofiltrationonoutesofacutrenalfailure:aprospectiverandomisedtrial研究设计分组病人特征K-M生存曲线并发败血症者需要更高得剂量治疗参数及并发症IRRTvsCRRT:thedifference讨论与结论ARF治疗时推荐得剂量Summary