PEDIATR NEPHROL：SLEDD-f可有效治疗危症急性肾损伤患儿

　　治疗前后肺部影像对比

　　对于危症急性肾损伤患儿，采用连续肾脏替代疗法（CRRT）和间歇性血液透析（IHD）治疗有着多种临床益处，同时也有不足之处。来自台湾的研究者通过调查研究在PICU给予危症患儿SLEDD-f（包括CRRT和IHD的混合治疗方式结合）治疗AKI发现，持续性低效率血液透析滤过（SLEDD-f）治疗有着良好的血流动力学耐受并且同时可以修正液体过载，pH，电解质平衡。研究发表于《小儿肾脏病杂志》。

　　研究者在2010年2月至2011年6月间对14名危症患者采用费森尤斯5008型治疗系统进行SLEDD-f治疗，设置血流量5 ml/kg/min，透析流量260 ml/min，血液滤过35 ml/kg/h，每天8-10小时。 严密监测患者的血压、血气分析、电解质、血红蛋白（Hb）和血细胞比容（Hct）。

　　回顾研究总共60次透析治疗结果发现，46次（76.6%）使用肝素治疗后没有出血并发症。高于135mmHg的高血压恢复到了正常，低于90mmHg的低血压没有血压下降。代谢性酸中毒和高钾血症也趋于正常化。Hb和Hct升高的比率显示血液稀释得到了改善。3名患者（5.0%）由于透析性低血压发作和1名患者（1.7%）由于循环凝血提前终止了治疗。28天生存率为71.4%

Treatment of critically ill children with kidney injury by sustained low-efficiency daily diafiltration

Background

Continuous renal replacement therapy (CRRT) and intermittent hemodialysis (IHD) offer diverse benefits and drawbacks for critically ill children with acute kidney injury (AKI). Sustained low-efficiency daily diafiltration (SLEDD-f) involves a conceptual and technical hybrid of CRRT and IHD. We report our SLEDD-f application to critically ill children in the pediatric intensive care unit (PICU).

Methods

SLEDD-f was delivered by the new Fresenius 5008 therapy system with blood flow 5 ml/kg/min, dialysate flow 260 ml/min, hemofiltration 35 ml/kg/h for 8–10 h daily. Changes in blood pressure, blood gas, electrolyte, hemoglobulin (Hb), and hematocrit (Hct) were closely monitored.

Results

From February 2010 to June 2011, 14 critical patients with a total of 60 SLEDD-f sessions were studied retrospectively. Heparin was used in 46 sessions (76.6%) with no bleeding complications. Hypertension above 135 mmHg returned to normal, hypotension below 90 mmHg showed no drop. Metabolic acidosis and hyperkalemia normalized. Elevated Hb, Hct, and their ratio revealed improving hemodilution. Three episodes of intradialytic hypotension (5.0%) and one of circuit clotting (1.7%) led to premature termination. The 28-day survival rate was 71.4%.

Conclusions

This pilot investigation demonstrates that SLEDD-f provides good hemodynamic tolerance and correction of fluid overload, pH, and electrolyte imbalance for critically ill children with AKI.