1、1ICU 中血液净化的应用指南血液净化(blood purification)技术指各种连续或间断清除体内过多水分、溶质方法的总称，该技术是在肾脏替代治疗技术的基础上逐步发展而来。血液净化方法有肾脏替代治疗、血液灌流、免疫吸附、内毒素吸附和血浆置换等。每一种血液净化方式都各有特点，且各适用于不同疾病或不同疾病状态。本指南仅对 ICU 中应用最多的肾脏替代治疗(renal replacement therapy, RRT)进行讨论并提出建议。血液净化概念和常见种类上世纪 70 年代末，RRT 主要用于治疗重症急性肾功能衰竭患者。随着技术不断发展，近 30 年， RRT 已用于全身过度炎症反应(如
2、严重创伤、重症急性胰腺炎等)、脓毒血症、中毒和多脏器功能衰竭等危重症的救治。另外，对重症患者并发的特殊情况，如严重电解质紊乱、过高热等， RRT 也能显示良好疗效。RRT 在重症患者救治中起着极其重要的作用，是 ICU 医师应予掌握的基本技术。基于此，国内 ICU 有关专家根据循证医学证据制定本指南。制定本指南的意义循证医学证据按照 Delphi 分级标准(见表 1)。循证医学证据时间跨度为 1999 年 1 月至 2009 年 3 月；数据主要来自Medline、Evidence-Based Medicine Reviews (EBMR)、Lippincott Williams 13(6):
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