緊急透析於重症醫療的角色

10.6666/ClinMed.2017.80.1.075

趙桓農；張家築；邱炳芳

hemodialysis ； 緊急透析 ； AKIN ； 急性腎損傷 ； CRRT ； 連續性腎替代治療

臨床醫學月刊

80卷1期（2017 / 07 / 28）

399 - 402

繁體中文

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。

1. (2012).KDIGO Clinical practice guideline for acute kidney injury.Kidney Int,2,1-138.
2. Bagshaw, SM,Lamontagne, F,Joannidis, M(2016).When to start renal replacement therapy in critically ill patients with acute kidney injury: comment on AKIKI and ELAIN.Crit Care,20,245.
3. De Corte, W,Dhondt, A,Vanholder, R(2016).Long-term outcome in ICU patients with acute kidney injury treated with renal replacement therapy: a prospective cohort study.Crit Care,20,256.
4. Gaudry, S,Hajage, D,Schortgen, F(2015).Comparison of two strategies for initiating renal replacement therapy in the intensive care unit: study protocol for a randomized controlled trial (AKIKI).Trials,16,170.
5. Gaudry, S,Hajage, D,Schortgen, F,Martin-Lefevre, L(2016).Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit.N Engl J Med,375,122-133.
6. Park, JY,An, JN,Jhee, JH(2016).Early initiation of continuous renal replacement therapy improves survival of elderly patients with acute kidney injury: a multicenter prospective cohort study.Crit Care,20,260.
7. Vanholder, R,Van Biesen, W,Hoste, E(2011).Pro/con debate: continuous versus intermittent dialysis for acute kidney injury: a never-ending story yet approaching the finish?.Crit Care,15,204.
8. Vinsonneau, C,Camus, C,Combes, A(2006).Continuous venovenous haemodiafiltration versus intermittent haemodialysis for acute renal failure in patients with multiple-organ dysfunction syndrome: a multicentre randomised trial.Lancet,368,379-385.
9. Zarbock, A,Kellum, JA,Schmidt, C(2016).Effect of Early vs Delayed Initiation of Renal Replacement Therapy on Mortality in Critically Ill Patients With Acute Kidney Injury: The ELAIN Randomized Clinical Trial.JAMA,315,2190-2199.

1. 賴靜怡,蔡佩臻,楊雅婷,王湞雅(2020)。提升加護病房護理人員執行連續性靜脈血液過濾術照護能力。志為護理-慈濟護理雜誌，19(3)，75-88。
2. 盧美言,邱真如,朱慶文(2023)。一位長期血液透析患者食用楊桃汁自殺之急診護理經驗。長庚護理，34卷增訂刊，1-9。