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摘要


於急重症患者,急性腎損傷為一常見的共病症,評估腎臟損傷等級分級,仍以AKIN (acute kidney injury network) criteria和RIFLE (risk, injury, failure, loss, and end stage) criteria為評估的標準。臨床評估上,基於器官功能性的復原狀況,評估尿量變化似乎優於檢驗數值(BUN、Creatinine)的變化。急性腎衰竭的損傷程度進而需緊急透析介入的時機跟角色,近十餘年來,正反論證不斷。就目前的分析統合結果,若為75歲以上的老人,多重器官衰竭並有急性腎臟疾病,早期CRRT介入可能有其角色,儘管目前於這方面研究似乎無法很明確的統計出其差異性。但是,就減輕酸血症、尿毒症、體液量過多和全身性發炎等--所造成直接或間接地腎臟損傷,暫時保護腎臟的功能,讓腎臟得以休息減少持續性的傷害,增加腎功能復原的機會。

參考文獻


KDIGO Clinical practice guideline for acute kidney injury, Kidney Int 2012;2:1-138. < http://www.kidney-international.org >
Vinsonneau C, Camus C, Combes A, et al. Continuous venovenous haemodiafiltration versus intermittent haemodialysis for acute renal failure in patients with multiple-organ dysfunction syndrome: a multicentre randomised trial. Lancet 2006;368:379-85.
Vanholder R, Van Biesen W, Hoste E, et al. Pro/con debate: continuous versus intermittent dialysis for acute kidney injury: a never-ending story yet approaching the finish? Crit Care 2011;15:204. doi: 10.1186/cc9345.
Park JY, An JN, Jhee JH, et al. Early initiation of continuous renal replacement therapy improves survival of elderly patients with acute kidney injury: a multicenter prospective cohort study. Crit Care 2016;20:260. doi: 10.1186/s13054-016-1437-8.
Comparison of two strategies for initiating renal replacement therapy in the intensive care unit: study protocol for a randomized controlled trial (AKIKI). Gaudry S, Hajage D, Schortgen F. et al. Trials. 2015;16:170. doi: 10.1186/s13063-015-0718-x.

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