急性肾功能衰竭(ARF)是一组多种病因引起的临床综合征。根据病人ARF的病因、病程、病理类型和各种药物的不同药理学特点选择具体的治疗方案。近年来随着对ARF病程各阶段的病理生理过程研究的进步,有越来越多的治疗方法(包括药物治疗和非药物治疗)被应用于动物模型和人体实验。本文主要介绍近年来药物治疗方面的一些新进展。在低血容量的患者,血管加压剂,比如去甲肾上腺素、多巴酚丁胺、血管加压素等,被认为是目前最有效的扩容或纠正低血容量的药物。前列腺素能够扩张肾血管并能利尿利钠因此也正用于临床实验。多巴胺因其能在低浓度时扩张肾血管、利尿利钠等作用曾经被广泛应用于ARF患者,但近年的一些研究发现它的一些副作用和并发症使它在ARF的治疗方面仍有争议。已有研究证明钙通道拮抗剂能减少肾移植后急性肾小管坏死(ATN)的发生。有学者认为袢利尿剂的利尿作用可能延误ARF的及时诊治所以应慎用。目前甘露醇被预防性地用于被认为有高风险患ATN的病人,但无有力证据表明它可预防或减少ATN的发生且由于它潜在的副作用限制了它的应用。许多生长因子已试用于缺血性和中毒性肾损伤的修复过程,但临床上用生长因子治疗ARF还没有满意的疗效。有研究表明心钠素能选择性地抗ARF。针对ARF中的炎症反应和细胞因子的作用,一些药物治疗已逐步开始应用于ARF的治疗中。 Acute renal failure (ARF) is a group of clinical syndromes caused by a variety of causes. According to the patient ARF etiology, duration, pathological types and various pharmacological characteristics of different pharmacological options for specific treatment options. In recent years, with the progress of the pathophysiological process in all stages of the course of ARF, more and more treatments (including drug treatment and non-drug treatment) have been applied to animal models and human experiments. This article describes some recent advances in drug treatment. In patients with hypovolemia, vasopressors, such as norepinephrine, dobutamine, vasopressin and the like, are considered as the most effective drugs to increase or correct hypovolemia. Prostaglandin is able to dilate renal blood vessels and to diuretic sodium is also being used in clinical trials. Because of its ability to dilate renal vessels at low concentrations, dopamine has been widely used in patients with ARF. However, some studies in recent years found that some of its side effects and complications make it still controversial in the treatment of ARF. Studies have shown that calcium channel antagonists can reduce the incidence of acute tubular necrosis (ATN) after renal transplantation. Some scholars believe that 袢 diuretic diuretic may delay the timely diagnosis and treatment of ARF so should be used with caution. Mannitol is currently used prophylactically in patients who are thought to have a high risk of developing ATN, but there is no conclusive evidence that it prevents or reduces the incidence of ATN and limits its use due to its potential side effects. Many growth factors have been tested for the repair of ischemic and toxic kidney injury, but clinically use of growth factors for ARF has not been satisfactory. Studies have shown that atrial natriuretic peptide can selectively anti-ARF. In response to the inflammatory response and the role of cytokines in ARF, some medical treatments have gradually begun to be used in the treatment of ARF.