[논문]급성 신손상을 가진 소아의 지속적 신대체 요법

박세진; 신재일

doi:10.3339/jkspn.2011.15.2.107

급성 신손상을 가진 소아의 지속적 신대체 요법
Overview of Pediatric Continuous Renal Replacement Therapy in Acute Kidney Injury 원문보기

대한소아신장학회지 = Journal of the Korean society of pediatric nephrology, v.15 no.2, 2011년, pp.107 - 115

박세진 (아주대학교 의과대학 소아과학교실) , 신재일 (연세대학교 의과대학 소아과학교실)

초록
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소아에서 급성 신손상의 흔한 원인들로는 신허혈, 신독성 약물들, 그리고 패혈증 등이 있으며, 신대체요법 시작시의 저혈압, 신대체 요법 동안 승압제의 사용, 그리고 신대체 요법 시작시의 수액 과부하 정도가 환자의 생존(소아 중환자실 퇴원)에 영향을 미치는 요인들로 알려져 있다. 지속적 신대체 요법의 빠른 시작은 급성 신손상을 가진 환자들에게서 사망률과 예후에 나쁜 영향을 미치는 수액 과부하를 감소시키는 것으로 보고되었다. 이에 저자들은 소아 환자에게서 지속적 신대체 요법의 실제 처방과 급성 신손상, 수액 과부하, 그리고 지속적 신대체 요법간의 연관성 및 치료결과를 살펴보고자 한다. 결론적으로, 급성 신손상을 가진 소아의 치료에 있어서 과도한 수액 과부하가 발생하기 전에 빠른 지속적 신대체 요법의 시작이 필요하다고 제시하는 바이다.

Abstract ▼ AI-Helper

Acute kidney injury (AKI) is associated with mortality and may lead to increased medical expense. A modified criteria (pediatric RIFLE [pRIFLE]: Risk, Injury, Failure, Loss, and End-stage renal disease) has been proposed to standardize the definition of AKI. The common causes of AKI are renal ischemia, nephrotoxic medications, and sepsis. A majority of critically ill children develop AKI by the pRIFLE criteria and need to receive intensive care early in the course of AKI. Factors influencing patient survival (pediatric intensive care unit discharge) are known to be low blood pressure at the onset of renal replacement therapy (RRT), the use of vasoactive pressors during RRT, and the degrees of fluid overload at the initiation of RRT. Early intervention of continuous RRT (CRRT) has been introduced to reduce mortality and fluid overload that affects poor prognosis in patients with AKI. Here, we briefly review the practical prescription of pediatric CRRT and literatures on the outcomes of patients with AKI receiving CRRT and associations among AKI, fluid overload, and CRRT. In conclusion, we suggest that an increased emphasis should be placed on the early initiation of CRRT and fluid overload in the management of pediatric AKI.

주제어

AI 본문요약
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문제 정의

CRRT allows gentle and gradual removal of solutes and fluid, thereby decreasing the episodes of hypotension and electrolyte disturbance [11]. In this review, we will focus on the use and outcome of CRRT in the treatment of AKI.
이에 저자들은 소아 환자에게서 지속적 신대체 요법의 실제 처방과 급성 신손상, 수액 과부하, 그리고 지속적 신대체 요법간의 연관성 및 치료결과를 살펴보고자 한다.

제안 방법

0, the activated partial thromboplastin time (aPTT) >60 seconds, and an episode of active bleeding. Laboratory tests such as sodium, potassium, blood urea nitrogen, creatinine, phosphate, ionized calcium, aPTT, and INR should be monitored every 12 hours for a day and then every 24 hours.

성능/효과

01) [23]. Among these, the study concluded that the use of vasoactive pressor was a surrogate marker for the severity of illness and had the greatest prediction of survival. In a study by Lim et al.
The median percent FO (%FO), calculated by [(fluid in)–(fluid out)/(ICU admission weight)]×100, was significantly lower in survivors than in non-survivors (P=0.02) and was also lower in survivors with multiple organ dysfunction syndrome (MODS) than in nonsurvivors with MODS (P=0.01) [26].

후속연구

결론적으로, 급성 신손상을 가진 소아의 치료에 있어서 과도한 수액 과부하가 발생하기 전에 빠른 지속적 신대체 요법의 시작이 필요하다고 제시하는 바이다.

참고문헌 (37)

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