脓毒症液体治疗进展与争议

The advance and controversy in fluid therapy for sepsis

脓毒症及脓毒症休克已经成为现代医学导致危重患者死亡的最主要原因之一,近年来人们已经越发意识到它在重症患者治疗中的重要性。为了进一步规范脓毒症的治疗,2004年拯救脓毒症指南〔1〕颁布,这一指南的出现大大降低了脓毒症患者的病死率,然而由于脓毒症发病机制极为复杂,因此即使是已经应用于临床的多项指南推荐意见亦在不断被质疑，尤其是贯穿脓毒症治疗全过程的液体治疗，随着大量新证据的出现，目前脓毒症休克患者的液体复苏出现较多争议。本文旨在通过回顾既往文献并结合最新进展，对脓毒症患者早期目标导向性复苏、晶胶体的选择等争议做一综述，为临床实践提供依据。

Sepsis is a systemic response to infection,which may progress to severe sepsis and septic shock.Severe sepsis and septic shock are major healthcare problems,affecting millions of people around the world each year.The Surviving Sepsis Campaign guidelines are intended to provide guidance for clinicians to treat patient with severe sepsis or septic shock.In fact,in recent years,numerous therapeutic strategies that aimed at reducing mortality in these patients have been investigated.However,most of them have not led to significant reductions in mortality,and are contentious.