Continuous Renal Replacement Therapy CRRT Continuous Blood Purification

连续性肾脏替代治疗 Continuous Renal Replacement Therapy (CRRT) 连续性血液净化 Continuous Blood Purification (CBP)

CRRT 溶质清除机制 n 弥散: n 对流: n 吸附: n Diffusion n Convection

血液滤过器（Hemofilter）

Anatomy of a Hemofilter blood in Cross Section hollow fiber membrane dialysate out Outside the Fiber (effluent) Inside the Fiber (blood) dialysate in blood out

CRRT技术命名 CAVH: Continuous arteriovenous hemofiltration CVVH: Continuous venous hemofiltration CAVHD: Continuous arteriovenous hemodialysis CVVHD: Continuous venous hemodialysis CAVHDF: Continuous arteriovenous hemodiafiltration CVVHDF: Continuous venous hemodiafiltration SCUF: Slow continuous ultralfiltration HVHF: High vlolume hemofiltration CHFD: Continuous high flux dialysis CPFA: Continuous plasma filtration absorption 第一届国际CRRT学术会议, 1995

Effect of different doses of CVVH on survival Group 3 = 45 ml/h. kg Group 2 = 35 ml/h. kg Group 1 = 20 ml/h. kg n Ronco et al. Lancet 2000

Cytokine changes IL 1 -HVHF IL 1 -Control TNF-HVHF TNF-Control % of variation 100 80 * 60 40 * 20 * * * Time Cole et al. Int Care Med 2001

连续性动-静脉(静脉-静脉)血液透析 ( Continuous arteriovenous/ venous hemodialysis, CAVHD/CVVHD ) q 弥散为主 q 应用低流量血滤器 q 逆向输入透析液 q CVVHD已取代CAVHD

CRRT对炎性介质的清除 Author n. Kellum et al. 1998 n. Hoffmanne et al, 1995 n. Andreasson et al, 1993 n. Riegel et al, 1995 n. Journois et al, 1996 n. Gasche et al, 1996 nvan Bommel et al, 1995 n. Bellomo et al, 1993 n. Tonnessen et al, 1993 n. Millar et al, 1993 n. Bellomo et al, 1995 n. Heidemann et al, 1994 n. Staubach et al, 1989 Membrane Adsorption of Convection of AN 69 TNFa, IL 6, IL-10 PA C 3 a, C 5 a, IL-8 C 3 a, C 5 a, IL-6 C 3 a, TNF, IL-1, 6, 8, 10 PA PS and PAN PAN PS and PAN PS PA factor D TNF minimal for TNF, IL-1, not IL-6, IL-8 Tx. B 2 and 6 -keto-PGF

CVVH对重症胰腺炎APACHE II评分的影响 Blood Purif 2001; 19: 329– 346

Reasons for CRRT Mehta et al. : Am J Nephrol 1999

接受与未接受CRRT治疗生存率比较 CRRT% no-CRRT% Significance APACHE II n < 19 83 (5 of 6) 71. 4 (5 of 7) n. s. n 19 -29 48 (40 of 80) 28. 8 (15 of 52) p<0. 025 n >29 21 (13 of 62) 20 (5 0 f 25) n. s. Failing organs n < 3 80 (32 of 40) 50 (6 of 12) p<0. 05 n 3 or 4 30. 5 (22 of 72) 26. 5 (13 of 49) n. s. n 4 or 5 20. 3 (12 of 59) 22. 7 (10 of 44) n. s. n >5 18. 2 (2 of 11) 25 (3 of 11) n. s. APACHE II：急性生理、年龄、既往健康状况评分 (Bellomo R. et al. Nephron 1995)

Fresenius ADM 08

Gambro Hospal Prisma

B. Braun Diapact