脓毒性休克液体复苏策略的共识与争议

Consensus and Controversy on Fluid Resuscitation Strategies of Septic Shock

脓毒性休克是脓毒症的一个亚型,也是重症监护病房患者死亡的主要原因。临床早期识别和干预脓毒症对于改善患者预后至关重要。脓毒性休克的病理生理机制较复杂,涉及外周血管张力下降、低血容量以及心肌抑制等。早期充分的晶体液复苏对于恢复循环容量至关重要,同时还应根据患者血流动力学状态、容量反应性、出入量情况、生化指标等进行阶段性液体复苏,并遵循“抢救、优化、稳定、消退”的液体复苏方案。目前关于复苏终点尚无统一标准,动态评估患者血流动力学变化有助于复苏终点的判断。

Septic shock is a subtype of sepsis,which is also the main cause of death of ICU patients.In clinical practice,early identification and intervention of sepsis is very important to improve the prognosis.it′s the pathophysiological mechanism of septic shock is very complex,involving peripheral vascular hypotension,hypovolemia and myocardial depression.Early adequate crystalloid fluid resuscitation is essential for the recovery of circulation capacity.After that,the fluid resuscitation should be carried out according to the hemodynamic state,volume responsiveness,intake and output,biochemical indexes,etc.,and the fluid resuscitation plan of"salvage,optimization,stability and de-escalation"(SOSD)should be followed.At present,there is no unified standard on the end point of resuscitation,and dynamic evaluation of hemodynamic changes is helpful to judge the end point of resuscitation.