外科病人液体治疗争论与共识

Consistency and controversy of the fluid therapy for surgical patients

液体治疗目的包括复苏、维持液体及电解质平衡,纠正液体失衡和异常分布。生理盐水是最早使用的晶体液,但其并不完全符合生理,又陆续产生了林格液、乳酸林格液和醋酸林格液等。在重症脓毒症病人复苏时推荐使用白蛋白溶液。在失血性休克复苏中,全血仍是最好的选择。液体治疗须对病人进行全面评估,包括病史、体检情况、目前用药情况、临床监测和实验室检查,由此决定病人液体和电解质需要量。复苏后再评估可确保后续液体治疗正确合理。对持续接受静脉液体治疗的病人须定期监测液体需要量、实验室指标、出入量和体重。

The aims of fluid therapy include resuscitation,routine maintenance, replacement and redistribution. Initialassessment and monitoring should be performed before andafter fluid therapy. If patients are receiving IV fluids forresuscitation, reassess the patient is necessary frequently. Thechoice of fluid comprised of sodium chloride glucose solution,albumin, Ringer＇ s solution, hydroxyethyl starch. Recommendhuman albumin solution for fluid resuscitation only in patientswith severe sepsis. Damage control resuscitation should beconsidered when managing the severe trauma patients andwhole blood or reconstituted blood is superior to the packedred blood cells. Surgeons should assess the patient＇s likelyfluid and electrolyte needs from their history, clinicalexamination, current medications, clinical monitoring andlaboratory investigations before and during fluid therapy.