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Continuous renal replacement therapy is associated with reduced serum ammonia levels and mortality in acute liver failure.
连续性肾脏替代治疗与急性肝衰竭血清氨水平降低和死亡率相关。

摘要

Hyperammonemia has been associated with intracranial hypertension and mortality in patients with acute liver failure (ALF). We evaluated the effect of renal replacement therapy (RRT) on serum ammonia level and outcomes in ALF. This was a multicenter cohort study of consecutive ALF patients from the United States ALF Study Group registry between January 1998 and December 2016. First, we studied the association of ammonia with hepatic encephalopathy (HE) and 21-day transplant-free survival (TFS; n = 1,186). Second, we studied the effect of RRT on ammonia for the first 3 days post study admission (n = 340) and on 21-day TFS (n = 1,186). Higher admission (n = 1,186) median ammonia level was associated with grade 3-4 HE (116 vs. 83 μmol/L) and mortality at day 21 attributed to neurological (181 vs. 90 μmol/L) and all causes (114 vs. 83 μmol/L; P < 0.001 for all). Among 340 patients with serial ammonia levels, 61 (18%) were on continuous RRT (CRRT), 59 (17%) were on intermittent RRT (IRRT), and 220 (65%) received no RRT for the first 2 days. From days 1 to 3, median ammonia decreased by 38%, 23%, and 19% with CRRT, IRRT, and no RRT, respectively. Comparing to no RRT use, whereas ammonia reduction with CRRT was significant (P = 0.007), with IRRT it was not (P = 0.75). After adjusting for year of enrollment, age, etiology, and disease severity, whereas CRRT (odds ratio [OR], 0.47 [95% confidence interval {CI}, 0.26-0.82]) was associated with reduction in 21-day transplant-free all-cause mortality, IRRT (OR, 1.68 [95% CI, 1.04-2.72]) was associated with an increase. Conclusion: In a large cohort of ALF patients, hyperammonemia was associated with high-grade HE and worse 21-day TFS. CRRT was associated with a reduction in serum ammonia level and improvement of 21-day TFS. (Hepatology 2018;67:711-720).

译文

高血氨血症与急性肝衰竭 (ALF) 患者的颅内高压和死亡率有关。我们评估了肾脏替代治疗 (RRT) 对 ALF 血清氨水平和结局的影响。这是一项多中心队列研究,研究对象是 1998年1月至 2016年12月间来自美国 ALF 研究组注册的连续 ALF 患者。首先,我们研究了氨与肝性脑病 (HE) 和 21 天无移植存活率 (TFS; n = 1,186) 的关系。第二,我们研究了 RRT 对研究入院后前 3 天 (n = 340) 和 21 天 TFS (n = 1,186) 氨的影响。较高的入院 (n = 1,186) 中氨水平与 3-4 级 HE (116 vs. 83 μ mol/L) 和 181 天的死亡率归因于神经学 (vs. 90 μ mol/L) 和所有原因 (114 vs. 83 μ mol/L; 所有 P <0.001)。在 340 例连续氨水平患者中,61 例 (18%) 接受了连续 RRT (CRRT),59 例 (17%) 接受了间歇性 RRT (IRRT),220 例 (65%) 头两天没有收到 RRT。从第 1 天到第 3 天,CRRT 、 IRRT 和无 RRT 的平均氨分别下降了 38% 、 23% 和 19%。与不使用 RRT 相比,CRRT 对氨的还原作用显著 (P = 0.007),而 IRRT 则不显著 (P = 0.75)。在调整注册年份、年龄、病因和疾病严重程度后,而 CRRT (比值比 [OR],0.47 [95% 置信区间 {CI},0.26-0.82]) 与 21 天无移植全因死亡率的降低相关,IRRT (OR,1.68 [95% CI,1.04-2.72]) 与增加相关。结论: 在大型 ALF 患者队列中,高氨血症与高级别 HE 和更差的 21 天 TFS 相关。CRRT 与血清氨水平降低和 21 天 TFS 改善相关。(肝病学 2018; 67: 711-720)。

Continuous renal replacement therapy

儿科 肾脏 治疗方法
概述  :  

连续性肾脏替代治疗(CRRT)通常用于为有急性肾损伤(AKI)的重症患者提供肾脏支持,特别是血流动力学不稳定的患者。可以使用各种不同溶质清除方式的技术,包括采用连续静脉血液滤过(CVVH)—主要用对流进行溶质清除;连续静脉血液透析(CVVHD)—主要用弥散进行溶质清除及连续静脉血液透析滤过(CVVHDF)—结合透析和血液滤过。在本文中,我们将CRRT与其他肾脏支持方式进行比较,并回顾肾脏替代治疗的指征,以及CRRT管理中的剂量和技术方面的问题。RRT适应症容量过负荷、酸碱异常、严重电解质紊

continuous 英 /kənˈtɪnjuəs/  美 /kənˈtɪnjuəs/

释    义   adj. 连续的,持续的;继续的;连绵不断的

例    句   This article reviews internal and abroad progresses in treating acute renal failure includingcontinuous renal replacement therapy, medication, cytokine and nutritional therapy. 近年来,国内外在连续肾脏替代疗法、 药物治疗、 细胞因子及营养治疗急性肾衰竭上有了新的进展。  

 

renal 英 /ˈriːnl/  美 /ˈriːnl/

释    义   adj. [解剖] 肾脏的,[解剖] 肾的

例    句   Being treated with continuous renal replacement treatment (CRRT)-hemodialysis(HD)and complextherapy-renal function of 31 cases recovered from oliguria period.经过连续性肾脏替代治疗(CRRT)、血液透析(HD)及综合治疗,31例渡过少尿期,肾功能得以恢复。

 

replacement 英 /rɪˈpleɪsmənt/  美 /rɪˈpleɪsmənt/

释    义   n. 更换;复位;代替者;补充兵员

例    句   There was no significant difference in the duration of RRT between continuous renal replacementtherapy (CRRT) patients and hemodialysis patients. RRT的平均治疗天数在连续性肾脏替代治疗组和间歇血液透析组之间的差异没有统计学意义。

 

therapy 英 /ˈθerəpi/  美 /ˈθerəpi/

释    义   n. 治疗,疗法

例    句   Objective To study the proper training and test methods for nurses of hemodialysis center about thecontinuous renal replacement therapy. 目的探讨对血液净化中心护士连续性肾脏替代治疗培训与考核的管理方法。

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