- 期刊
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Continuous Venovenous Hemofiltration (CVVH) and Continuous Venovenous Hemodialysis (CVVHD) Treatment Alternating with Hemodialysis in Critically ill Patients
重症病人利用血液透析機執行CVVH／CVVHD交替之治療
摘要
連續性生腎臟取代性治療（CRRT）可成功的治療急性腎臟衰竭的病人合併心肺衰竭及水份滯留，除可穩定的移除水份並且可藉透析原理清除尿毒。傳統的 CVVH（continuous venovenous hemofiltration）或CVVHD （continuous venovenous hemodialysis）需大量的補充液和複雜的輸液泵浦（pump）以控制水份的超過濾和電解質平衡，往往水份的超過濾不夠準確尿毒的清除亦不足，且操作複雜又需耗費相當多的照護人力。因此我們使用血液透析機執行精確的脫水及配合間歇性的血液透析來取代傳統的CVVH或CVVHD。回顧2002年5位急性腎衰竭的病人合併心衰竭及肺水腫及血液動力學不穩定的狀況下，用血液透析機交替執行CVVH和CVVHD，可穩定移除過多的水份及尿毒，因無使用肝素可減少病人出血的危險性。可提高重症病人的存活率並簡化CVVH和CVVHD操作複雜性與照護人力耗費。
並列摘要
Continuous renal replacement therapy (CRRT) can successfully treat patients with acute renal failure combined with cardiopulmonlary failure and water retention. CRRT not only removes excess water but can also effectively clear uremia toxins by means of dialysis. Conventional CVVH (continuous venovenous hemofiltration) or CVVHD (continuous venovenous hemodialysis) required large volumes of replacement fluid and a complex infusion pump to control the ultrafiltration of water and electrolyte balance. The ultrafiltration rate is often imprecise and the clearance of uremia is inadequate. The operating procedure is complicated, and intensive medical manpower is needed. Therefore, we used a hemodialysis machine to control for precise ultrafiltration, to provide intermittent hemodialysis, and to replace conventional CVVH and CVVHD. In 2002, we used a hemodialysis machine to conduct CVVH and CVVHD alternately in five patients with acute renal failure and cardiopulmonary failure. Excess water and urea toxins were removed in a stable fashion, and heparin was not used. This increased the survival rate of the severely affected patients, simplified the complicated operation procedure, and reduced the intense manpower required for CVVH and CVVHD.