连续性血液净化技术在脓毒症中的应用进展

发布时间：2018-12-11 19:36

【摘要】：脓毒症发病率及病死率高,其早期、积极、有效地治疗目前还是危重症治疗上的一大难题。而连续性血液净化治疗近几年在脓毒症合并急性肾衰竭、全身炎症反应综合征、多器官功能障碍、急性呼吸窘迫综合征和急性坏死性胰腺炎等危重症抢救中表现出了极为重要的作用。比较常用的连续性血液净化技术如:血液透析、血液滤过、血液吸附(灌流)、血浆置换等。目前脓毒症的连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)最重要的进展是几种方式联合应用,如血液滤过+透析,滤过+血浆交换以及血液滤过+吸附[联合滤过和吸附(coupled filtration and adsorption,CPFA)、分子吸附再循环系统(molecular adsorbent recirculating system,MARS)]等。CRRT与单一的、短时的血液透析相比,血流动力学稳定,清除物质多,有效纠正内环境、电解质及酸碱平衡的紊乱,更加符合人体生理,应用范围已超出了肾脏替代治疗的局限性,演变成了各种危重病患者的重要支持疗法,对抢救危急重症患者和延长其生存时间起到了积极有效的作用。
[Abstract]:The incidence and mortality of sepsis is high, its early, active and effective treatment is still a major problem in critical care. And continuous blood purification therapy in recent years in sepsis with acute renal failure, systemic inflammatory response syndrome, multiple organ dysfunction, Acute respiratory distress syndrome (ARDS) and acute necrotizing pancreatitis (ANP) have played an important role in severe rescue. More commonly used continuous blood purification techniques such as hemodialysis, hemofiltration, blood adsorption (perfusion), plasma exchange. At present, the most important progress in continuous renal replacement therapy (continuous renal replacement therapy,CRRT) for sepsis is the combination of several methods, such as hemofiltration and dialysis, Filtration plasma exchange and hemofiltration adsorption [combined filtration and adsorption of (coupled filtration and adsorption,CPFA], molecular adsorptive recirculation system (molecular adsorbent recirculating system,MARS), etc. Compared with single, short-term hemodialysis, CRRT is stable in hemodynamics. Removing more substances, effectively correcting the disturbance of internal environment, electrolyte and acid-base balance, which is more in line with human physiology, has gone beyond the limitations of renal replacement therapy, and has evolved into an important support therapy for all critically ill patients. It plays a positive and effective role in rescuing critical and severe patients and prolonging their survival time.
【作者单位】：天津市第四中心医院ICU;
【分类号】：R459.7

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