患者，男性，35岁，既往体健。近3天尿量减少，今出现呼吸困难、全身水肿。血压180/100mmHg，血肌酐320μmol/L，血pH7.25，PaO250mmHg，PaCO224mmHg，BE—12mmol/L，K+6.9mmol/L，Na+126mmol/L，胸CT示双肺渗出，双侧胸腔积液。急诊最适宜的治疗措施是

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