medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2024-3-36-47medalphabet-3638Research ArticleСтатьиЗаместительно-почечная терапия у пациентов в критическом состоянииRenal replacement therapy in critical ill patientshttps://orcid.org/0000-0001-9848-3554АлександровскийА. А.AleksandrovskiyA. A.

Александровский Александр Алексеевич, врач-анестезиолог-реаниматолог отделения реанимации и интенсивной терапии для пациентов хирургического профиля, ГБУЗ «Городская клиническая больница имени В. М. Буянова Департамента здравоохранения города Москвы», соискатель отдела анестезиологии-реаниматологии ФГБУ «Национальный медицинский исследовательский центр хирургии имени А. В. Вишневского»

Москва

 

Aleksandrovsky Alexander A., anesthesiologist-resuscitator at Dept of Intensive Care for surgical patients, City Clinical Hospital named after. V. M. Buyanov Department of Health Care of the City of Moscow, candidate of Dept of Anesthesiology and Resuscitation, National Medical Research Center for Surgery named after A. V. Vishnevskiy

Moscow

eye1ess@mail.ruhttps://orcid.org/0000-0001-9651-4759СуряхинВ. С.SuryakhinV. S.

Суряхин Виктор Станиславович, к.м.н., рук. службы реанимации и интенсивной терапии, ГБУЗ «Городская клиническая больница имени В. М. Буянова Департамента здравоохранения города Москвы», в.н.с. организационно-методического отдела по анестезиологии и реаниматологии, ГБУ «Научно-исследовательский институт организации здравоохранения и медицинского менеджмента Департамента здравоохранения города Москвы»

Москва

Suryakhin Viktor S., PhD Med, head of the Resuscitation and Intensive Care Service, City Clinical Hospital named after. V. M. Buyanov Department of Health Care of the City of Moscow, leading researcher at Organizational and Methodological Dept for Aesthesiology and Resuscitation, Research Institute of Healthcare Organization and Medical Management of the Moscow Health Department

Moscow

surjakhin@mail.ruСаликовА. В.SalikovA. V.

Саликов Александр Викторович, к.м.н., гл. врач, ГБУЗ «Городская клиническая больница имени В. М. Буянова Департамента здравоохранения города Москвы», доцент кафедры общей хирургии

Москва

Salikov Alexander V., Ph.D., chief physician, City Clinical Hospital named after. V. M. Buyanov Department of Health Care of the City of Moscow, associate professor at Dept of General Surgery

Moscow

gkb12@zdrav.mos.ruhttps://orcid.org/0000-0001-8833-3886РаутбартС. А.RautbartS. A.

Раутбарт Сергей Александрович, к.м.н. врач-анестезиолог-реаниматолог отделения реанимации и интенсивной терапии для пациентов хирургического профиля ГБУЗ «Городская клиническая больница имени В. М. Буянова Департамента здравоохранения города Москвы», врач высшей категории, московский врач

Москва

Rautbart Sergey A., PhD Med, anesthesiologist-resuscitator at Dept of Intensive Care for surgical patients, City Clinical Hospital named after. V. M. Buyanov Department of Health Care of the City of Moscow, physician of the highest category, Moscow physician

Moscow

raut2s@mail.ruhttps://orcid.org/0009-0007-3370-3000МахмудовД. М.MakhmudovD. M.

Махмудов Даниял Муратбекович, врач-анестезиолог-реаниматолог отдела анестезиологии-реаниматологии

Москва

Makhmudov Daniyal M., anesthesiologist-resuscitator at Dept of Anesthesiology and Resuscitation

Moscow

daniyalmahmudov@mail.ruГейзеА. В.GeiseA. V.

Гейзе Антон Викторович, к.м.н., врач-анестезиолог-реаниматолог отдела анестезиологии-реаниматологии

Москва

Geise Anton V., Ph.D., anesthesiologist-resuscitator at Dept of Anesthesiology and Resuscitation

Moscow

Antongeyze@mail.ruФГБУ «Национальный медицинский исследовательский центр хирургии имени А. В. Вишневского»; ГБУЗ «Городская клиническая больница имени В. М. Буянова Департамента здравоохранения города Москвы»РоссияNational Medical Research Center for Surgery named after A. V. Vishnevskiy; City Clinical Hospital named after. V. M. Buyanov Department of Health Care of the City of MoscowRussian FederationГБУЗ «Городская клиническая больница имени В. М. Буянова Департамента здравоохранения города Москвы»; ГБУ «Научно-исследовательский институт организации здравоохранения и медицинского менеджмента Департамента здравоохранения города Москвы»РоссияCity Clinical Hospital named after. V. M. Buyanov Department of Health Care of the City of Moscow; Research Institute of Healthcare Organization and Medical Management of the Moscow Health DepartmentRussian FederationГБУЗ «Городская клиническая больница имени В. М. Буянова Департамента здравоохранения города Москвы»РоссияCity Clinical Hospital named after. V. M. Buyanov Department of Health Care of the City of MoscowRussian FederationФГБУ «Национальный медицинский исследовательский центр хирургии имени А. В. Вишневского»РоссияNational Medical Research Center for Surgery named after A. V. VishnevskiyRussian Federation20240605202403Кардиология. Неотложная медицина (1)3647Copyright © Александровский А.А., Суряхин В.С., Саликов А.В., Раутбарт С.А., Махмудов Д.М., Гейзе А.В., 20242024Александровский А.А., Суряхин В.С., Саликов А.В., Раутбарт С.А., Махмудов Д.М., Гейзе А.В.Aleksandrovskiy A.A., Suryakhin V.S., Salikov A.V., Rautbart S.A., Makhmudov D.M., Geise A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/3638

Острое повреждение почек (ОПП), особенно если оно вызвано или сопровождается сепсисом, связано с длительной госпитализацией, прогрессированием хронической болезни почек (ХБП), финансовой нагрузкой на систему здравоохранения и повышает уровень смертности при различных нозологиях. Продленная заместительная почечная терапия (ПЗПТ) является преобладающей формой заместительной почечной терапии (ЗПТ) в отделениях реанимации и интенсивной терапии (ОРИТ) за счет обеспечения гемодинамической стабильности у пациентов в критическом состоянии, более точному контролю жидкостного баланса, коррекции сдвигов кислотно-основного состояния, электролитных нарушений и стабильной коррекции гиперосмолярности, в том числе и у полиморбидных пациентов.

В этой статье рассматриваются различные аспекты назначения ПЗПТ пациентам в критическом состоянии с тяжелым ОПП на фоне высокой коморбидности, а также у пациентов с сепсисом и полиорганной недостаточностью. Проводится аналитическая оценка выбора ПЗПТ вместо прерывистого/интермиттирующего гемодиализа (П/ИГД) при определенных клинических условиях. Оценивается срок службы фильтра/диализатора, включая оценку фильтрационной фракции, использование вариантов антикоагуляции, включая регионарную цитратную антикоагуляцию (РЦА), назначенная и доставленная доза ПЗПТ, управление сосудистым доступом, общие критерии время начала и прекращения ПЗПТ и инициации заместительной почечной терапии при внепочечных показаниях, при ОПП и/или сепсисе.

Acute kidney injury (AKI), especially when caused or accompanied by sepsis, is associated with prolonged hospitalization, progression of chronic kidney disease (CKD), financial burden on the health care system, and increases mortality in various entities. Extended renal replacement therapy (CRRT) is the predominant form of renal replacement therapy (RRT) in intensive care units (ICU) by providing hemodynamic stability in critically ill patients, more precise control of fluid balance, correction of acid-base imbalances, electrolyte disorders and achieving a stable level of osmolarity correction, including in multimorbid patients. This article examines the various aspects of CRRT in critically ill patients with severe AKI with high comorbidity, as well as in patients with sepsis and multiple organ failure. An analytical evaluation of the choice of CRRT over intermittent/intermittent hemodialysis (IHD) in selected clinical settings is being conducted. Filter/dialyzer life is assessed, including assessment of filtration fraction, use of anticoagulation options including regional citrate anticoagulation (RCA), dose of CRRT prescribed and delivered, vascular access management, general criteria, timing of initiation and cessation of CRRT, and initiation of renal replacement therapy for nonrenal indications. with AKI and/or sepsis.

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The authors declare that there are no conflicts of interest present.