急性功能衰竭患者的替代疗法:系统性审查
Neesh Pannu1, Scott Klarenbach, Natasha Wiebe
1Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
JAMA
|February 21, 2008
概括
急性功能衰竭透析显示,连续置换疗法 (CRRT) 和间歇性血液透析的结果类似. 更高的CVVHF剂量可能会降低死亡率,但对于最佳的急性功能衰竭管理,需要更多的研究.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 关键护理医学 关键护理医学
- 脏替代疗法治疗 脏替代疗法
背景情况:
- 需要透析的急性功能衰竭 (ARF) 与高死亡率和发病率有关.
- 透析支持对于管理ARF患者至关重要.
研究的目的:
- 综合对ARF提供透析的证据.
- 提供管理建议.
- 为了确定ARF治疗的研究缺口.
主要方法:
- 在2007年10月之前进行系统的文献搜索 (MEDLINE,EMBASE,EBM评论).
- 包括成人ARF患者的RCT和前性队列研究.
- 使用Jadad评分和Downs和黑名单进行质量评估.
主要成果:
- 比较CRRT和间歇性血液透析,发现死亡率或需要慢性透析没有显著差异.
- 建议二碳酸盐透析剂和酸盐抗凝剂用于CRRT.
- 指示较高的CVVHF剂量 (35毫升/千克/小时) 可能会降低死亡率.
- 在间歇性血液透析中建议不要使用非替代的纤维素膜.
结论:
- 间歇性血液透析和CRRT在ARF中提供了可比的临床结果.
- 推的CVVHF剂量为35毫升/千克/小时.
- 强调需要更多高质量的RCT来指导ARF管理.
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