急性肾损伤患者肾脏替代治疗时机的研究进展  

Research advance of the timing of renal replacement therapy among people with acute kidney injury

作　　者：郭东晨[1] 李昂[2] 段美丽[1] 

机构地区：[1]首都医科大学附属北京友谊医院重症医学科,100050 [2]首都医科大学附属北京地坛医院,100015

出　　处：《中华危重病急救医学》2016年第3期285-288,共4页Chinese Critical Care Medicine

基　　金：北京市科委首都特色临床应用研究项目（Z121107001012124）

摘　　要：急性肾损伤（AKI）是重症患者严重的常见合并症之一，是导致患者死亡的独立危险因素。近年来，肾脏替代治疗（RRT）已成为AKI患者常规治疗方法之一，但何时为开始进行RRT的最佳时机国内外尚无一致结论。通过回顾危重症医学及肾脏病学领域学者进行的多项临床研究，总结分析除以往公认的高钾血症、严重代谢性酸中毒、容量过负荷等经典RRT始动因素外的最佳开始治疗时机相关指标，探讨血清肌酐（SCr）、血尿素氮（BUN）、尿量、入重症加强治疗病房（ICU）时间点，以及AKI分期等标准的可行性指标作为RRT最佳始动时机，以期找到特定指标对患者预后意义最大的截点值，为AKI患者进行RRT的最佳时机判断提供指导。Acute kidney injury （AKI） is one of the most common serious complications in critically ill patients, and it is an independent risk factor for death. In recent years, renal replacement therapy （RRT） has become one of the routine treatments for AKI patients, however there is no accepted consensus on the optimal timing of RRT over the world. This paper reviewed the clinical studies carried out by researchers in the field of critical care and nephrology, thereby summarized and analyzed the related parameters of the optimal time to carry out, with the exception of previously acknowledged classic RRT indications such as hyperkalemia, severe metabolic acidosis, volume overload and so on. The feasible parameters such as serum creatinine （SCr）, blood urea nitrogen （BUN）, urine volume, the time admitted in the intensive care unit （ICU） and several standards distinguished AKI stages are discussed in order to find out the cutoff points of those parameters which were best for the patients＆#39; outcome, and to provide guidance of decision making for the optimal timing of RRT for AKI patients.

关 键 词：肾损伤 急性 肾脏替代治疗 治疗时机 

分 类 号：R692[医药卫生—泌尿科学]