利用贝朗Diapact CRRT实现双重血浆置换新功能的研究

本文介绍了以贝朗Diapact CRRT原有治疗模式为基础．结合该机只用一个称重系统保持液体平衡的设计特点，实现双重血浆置换新功能的原理、方法和临床应用。     

连续性肾替代治疗的护理体会

连续性肾替代治疗（CRRT）于1977年首次用于治疗对利尿无反应的液体超负荷的肾衰竭患者,至今这一治疗方法已经历了十分显著的技术和概念更新.它是目前急性肾衰竭尤其是并发多器官功能障碍综合征患者最安全、最有效的治疗手段.我院于2004年8月至2005年4月对20例患者成功地进行了CRRT,取得了良好的临床效果,现总结如下.     

CRRT加血管收缩药治疗三环类抗精神病药中毒的护理

目的迅速清除体内毒物,保持血流动力学稳定,降低病死率。方法采用连续肾脏替代治疗(CRRT)加α-受体兴奋剂持续静脉泵入治疗重度三环类药物中毒。结果16例中毒在CRRT治疗期间血压平稳,CRRT1～2次后,病人很快清醒,血管收缩药持续静脉泵入对CRRT期间血流动力稳定起到至关重要的作用,同时便于观察,减轻护理工作量。结论CRRT配合α-受体兴奋剂持续静脉泵入治疗是非常有效的治疗措施。     

221例患者急诊血液净化及病因分析

目的了解患者急诊血液净化的病因、方式及疗效。方法分析该院2003年1月￣2005年1月行急诊血液净化的221例患者(CRF除外)的病因、方式及疗效。结果221例患者,其中男136例;平均年龄(42.86±21.15)岁,女85例;平均年龄(37.63±18.08)岁。所有患者的病因,占首位的是中毒87例(39.4%),其他依次为外科性疾病74例(33.5%)、内科性疾病46例(20.8%)和流行性出血热(epidemichemorrhagicfever,EHF)14例(6.3%)。短期血液净化后,98例治愈,104例好转,19例死亡,但死亡者的生存时间明显延长。71例MODS患者CRRT后水电解质和酸碱紊乱得到改善,抽血检测BUN、Scr、血K+(均P<0.01﹚、Na+(均P<0.05)下降,血PH、HCO3-(均P<0.01)、Cl-(P<0.05)升高。结论急诊血液净化的病因在原有中毒和ARF的基础上,新增了非肾脏疾病和MODS,提示血液净化的方式已从单纯的HD或HP扩大到多种方式联合治疗。该组成功的经验是,对不同的病例采取不同的血液净化方式,HD+HP或CRRT能缩短急性重症中毒患者的病程。对伴血小板减少或有出血的患者采用无肝素、低分子肝素或治疗后使用鱼精蛋白对抗等方法;对严重的外科性疾病如急性重症胰腺炎、大面积烧伤、严重复合性创伤、外科手术后、严重感染等患者,采用CRRT可有效地清除代谢产物,稳定内环境,提高患者的生存率。     

流程改进在缩短患者CRRT等候时间中的应用

目的：通过对流程进行改进减少患者连续肾脏替代疗法（CRRT)等候时间,保证医疗护理质量安全。方法：按照数据收集、近端原因分析、介入措施等步骤实施。结果：患者CRRT平均等候时间较改善前减少了22.6min,价值效率由改善前的28.57%提高到了改善后的36.37%,流程效率由27.66%提高到了41.40%。结论：改进流程后,价值效率和流程效率得到了提高,且活动周期短,快速解决问题。     

连续性血液净化治疗对危重患者药物清除率影响的研究进展

本文通过查阅文献,了解药物本身药理学及连续性血液净化治疗（ CBP）的滤过膜材料、面积、孔径大小,透析液／超滤液流速,过滤器使用时间,血液滤过模式及滤过原理等对药物清除率的影响,总结连续性血液滤过治疗对各类药物清除率的研究进展。为临床医师调整治疗方案,更好地进行个体化治疗提供参考,同时为药物清除率的进一步研究开拓思路。     

A pilot randomised controlled comparison of continuous veno–venous haemofiltration and extended daily dialysis with filtration: effect on small solutes and acid–base balance

Background and aims Continuous veno–venous haemofiltration (CVVH) is an established treatment for acute renal failure (ARF). Recently, extended intermittent dialytic techniques have been proposed for the treatment of ARF. The aim of this study was to compare these two approaches. Setting Intensive care unit of tertiary hospital. Subjects Sixteen critically ill patients with ARF. Design Randomised controlled trial. Intervention We randomised sixteen patients to three consecutive days of treatment with either CVVH (8) or extended daily dialysis with filtration (EDDf) (8) and compared small-solute, electrolyte and acid–base control. Results There was no significant difference between the two therapies for urea or creatinine levels over 3 days. Of 80 electrolyte measurements taken before treatment, 19 were abnormal. All values were corrected as a result of treatment, except for one patient in the CVVH group who developed hypophosphataemia (0.54 mmol/l) at 72 h. After 3 days of treatment, there was a mild but persistent metabolic acidosis in the EDDf group compared to the CVVH group (median bicarbonate: 20 mmol/l vs. 29 mmol/l: p = 0.039; median base deficit: –4 mEq/l vs. –2.1 mEq/l, p = 0.033). Conclusions CVVH and EDDf as prescribed achieved similar control of urea, creatinine and electrolytes. Acidosis was better controlled with CVVH. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Pharmacokinetics of piperacillin and tazobactam in plasma and subcutaneous interstitial fluid in critically ill patients receiving continuous venovenous haemodiafiltration

This prospective pharmacokinetic study aimed to describe plasma and interstitial fluid (ISF) pharmacokinetics of piperacillin and tazobactam in critically ill patients on continuous venovenous haemodiafiltration (CVVHDF). Piperacillin/tazobactam (4 g/0.5 g) was administered every 8 h and CVVHDF was performed as a 3–3.5 L/h exchange using a polyacrylonitrile filter with a surface area of 1.05 m². Serial blood (pre- and post-filter), filtrate/dialysate, urine and ISF concentrations were measured. Subcutaneous tissue ISF concentrations were determined using microdialysis. A total of 407 samples were collected. Median peak plasma concentrations were 210.5 (interquartile range = 161.5–229.0) and 29.4 (27.9–32.0) mg/L and median trough plasma concentrations were 64.3 (49.0–68.9) and 12.3 (7.7–13.7) mg/L for piperacillin and tazobactam, respectively. The plasma elimination half-life was 6.4 (4.6–8.7) and 7.3 (4.6–11.8) h, volume of distribution 0.42 (0.29–0.49) and 0.32 (0.24–0.36) L/kg, total clearance 5.1 (4.2–6.2) and 3.8 (3.3–4.2) L/h and CVVHDF clearance 2.5 (2.3–3.1) and 2.5 (2.3–3.2) L/h for piperacillin and tazobactam, respectively. The tissue penetration ratio or ratio of area under the concentration–time curve of the unbound drug in ISF to plasma (unbound AUC_ISF/AUC_plasma) was ca. 1 for both piperacillin and tazobactam. This is the first report of concurrent plasma and ISF concentrations of piperacillin and tazobactam during CVVHDF. For the CVVHDF settings used in this study, a dose of 4.5 g piperacillin/tazobactam administered evry 8 h resulted in piperacillin concentrations in plasma and ISF >32 mg/L throughout most of the dosing interval.