患者，男，45岁。进行性少尿4天。既往体健。查体：BP160/90mmHg,心率120次/分，双下肢水肿。血BUN18.9mmol/L,Scr655.6umoI/L。动脉血气分析：pH7.31,Pa0265mmHg,PaC0233mmHg,BE-8.5mraol/L。急需采取的最主要治疗措施是

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