华西医学

华西医学

2017 台湾重症患者之连续性肾脏替代治疗处置操作手册

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急性肾损伤是重症患者常见之并发症,经常合并多重器官衰竭,一旦需要透析治疗,病死率相当高。连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)以缓慢而持续的治疗方式达到移除水分及毒素的目的,可同时兼顾血流动力学稳定、体液平衡及营养的补充,已经逐渐成为重症透析治疗的主流方式,甚至成为多器官衰竭时的辅助支持治疗。然而,CRRT 的操作技术繁琐,治疗时间冗长,极度耗费医疗资源与护理人力;重症患者的临床状况复杂且变化快速,重症医护团队对 CRRT 的处方考虑及操作需要娴熟精确,依据专业经验评估患者需求,因时因地制宜作最好的处置选择,才能提供患者安全且高质量的医疗。本手册以临床实务的观点着手,整合既有临床照护指南、最新的相关文献与专家经验,撷取最重要的具体建议,以表格及流程图呈现,达到精简易读的目标,提供医疗照护团队处理患者各种临床需要时,便利且原则性的指南。同时,协助重症医疗新进人员能快速熟悉 CRRT 相关技术的操作与故障排除,使医护人员能准确地掌握要领,提高临床技能,避免并发症,并传承临床经验。

Acute kidney injury is a common complication and is associated with multiple organ dysfunction syndrome among critically ill patients in intensive care unit. Once renal replacement therapy in required, the mortality rate was high. Using slow and uninterrupted clearance of retained fluid and toxins, continuous renal replacement therapy (CRRT) can avoid hemodynamic instability while provide acid-base, electrolytes, and volume homeostasis. For decades, CRRT has become the dominant form of renal replacement therapy as well as multiple organ support in critically ill patient with acute kidney injury. However, there remains wide practice variation in the CRRT care when clinicians take into account the needs of individual patients, available resources, and limitations unique to an institution or type of practice, despite evidences to guide practice. In addition, CRRT is a complex technology that is resource-intensive, costly, and requires specialized training by health providers.Taiwan Society of Critical Care Medicine organized a group of experts in critical care and nephrology to review the recommendations and provide their clinical practice and concerns to write this operational manual. The purpose of this manual is to provide step-by-step instructions on the practice of CRRT and troubleshooting. In addition, it is designed to help the newbies to carry out this complex treatment correctly and efficiently. We hope that this operational manual is of value to improve clinical skills, quality of care, and patient safety.

关键词: 急性肾损伤; 连续性肾脏替代治疗; 重症患者; 操作手册

Key words: Acute kidney injury; Continuous renal replacement therapy; Critically ill; Operational manual

引用本文: 庄乔琳, 洪芳明, 詹明澄, 古世基, 许翔浩. 2017 台湾重症患者之连续性肾脏替代治疗处置操作手册. 华西医学, 2018, 33(7): 816-823. doi: 10.7507/1002-0179.201807062 复制