限制性液体复苏临床应用中几个应注意的问题

Attention on clinical application of hypotension resuscitation

针对日前正被大家认识和接受的限制性液体复苏的治疗方法，笔者重点强调以下几点：限制性液体复苏应侧重于以心胸部和腹部为主的有活动性出血的休克病人，但对于严重颅脑外伤病人应慎用；要注意不同致伤部位的差异和病人个体化差异，不要一概而论。尤其是对患有高血压的颅脑外伤病人，血压不要调得太低，以免发生脑供血不足；平均动脉压（MAP）以调节在80～90mmHg为宜。在监控指标上仍主张以血压、尿量、乳酸和硷基作为限制性液体复苏的评估和指导。限制性液体复苏的持续时间越短越好，对有活动性出血的休克病人，手术止血越早越好。

Limited resuscitation （ hypotension resuscitation ） has been accepted as a strategy to treat uncontrolled hemorrhagic shock. It is recommended mainly to the patients with uncontrolled bleeding in chest and abdomen. For the head trauma patients ,the strategy should be applied cautiously. The different kinds of injury should be considered carefully, and treatment should be individualiyed during hemorrhagic shock treatment. For head traumatic patients with hypertension, the mean arterial pressure（ MAP）should be maintained between 80-90mmHg. Blood pressure, urine volume, lactate level and base deficit are criteria to guide the strategy. For uncontrolled bleeding, shorter time of limited resuscitation and earlier operation are essential to better outcomes.