Continuous Renal Replacement Therapy in Neonates
Continuous Renal Replacement Therapy in Neonates
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新生儿持续肾脏替代治疗
DOI：
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发表时间：
2013
期刊：
影响因子：
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通讯作者：
B. Lee
中科院分区：
文献类型：
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作者：
B. Lee
连续性肾脏替代治疗（CRRT）是一种基于血液滤过的透析方式，用于治疗患有急性肾功能衰竭、多器官功能障碍和先天性代谢缺陷的高危新生儿。尽管危重患者中使用了不同类型的CRRT（血液透析、血液滤过或两者），但对于CRRT的最佳类型或目标超滤剂量尚无共识。在继发于先天性代谢缺陷的高氨血症新生儿中，CRRT在降低血浆氨浓度方面比腹膜透析更有效，尽管没有研究明确证明其在降低死亡率或长期神经发育发病率方面的获益。在新生儿护理中，CRRT作为主要肾脏替代治疗的作用受到血管通路困难、出血并发症和缺乏透析专用血液滤过装置的限制。目前，韩国的新生儿CRRT仅在少数大型中心可用，主要位于首尔。在全国范围内支持建立患者转诊系统，并确保拥有在新生儿CRRT方面经验丰富的人员，这可能有助于提高韩国新生儿护理的质量。
Continuous renal replacement therapy (CRRT) is one of the hemofiltration-based dialysis modalities used in the management of the high risk neonates with acute renal failure, multi-organ dysfunction and inborn errors of metabolism. While there are different types of CRRT (hemodialysis, hemofiltration or both) used in critically ill patients, there is no consensus on the best type or target ultrafiltration dose of CRRT. In the neonates with hyperammonemia secondary to inborn errors of metabolism, CRRT is more efficient in lowering the plasma ammonia concentration than peritoneal dialysis, although no studies have clearly demonstrated the benefits in decreasing the mortality or the long-term neurodevelopmental morbidities. In neonatal care, the role of CRRT as a primary renal replacement therapy is limited by the difficulties in vascular access, bleeding complications and the lack of neonatespecific hemofiltration devices. Currently, neonatal CRRT in Korea is available only in a few large centers, mostly located in Seoul. The nationwide support for the establishment of the patient referral system and the securing of the personnel who are highly experienced in neonatal CRRT may contribute to improving the quality of neonatal care in Korea.