脓毒症液体治疗争论与进展

Argument and progress of fluid therapy for sepsis

重症脓毒症是指合并脏器功能障碍的细菌感染。造成循环功能和细胞代谢功能障碍的感染则为脓毒性休克。脓毒症早期紧急治疗的重要性如同脑卒中和心肌梗死的治疗。早期诊断脓毒症并及时开展合理的治疗可显著降低病死率。脓毒症的液体治疗包括初始复苏和后续的液体治疗,并可分为抢救、改善、稳定和去复苏4个阶段。复苏的初期阶段也被称为黄金6h。在第1个3h阶段,主要选用晶体液进行复苏,可按30mL/kg体重,大约2000 mL晶体液给予。"1h集束治疗"强调,液体复苏的量不一定要在1h内完成,但必须在1h内启动。后续的液体治疗要在连续监测症状体征的同时结合血液动力学监测决定后续补液速度与补液量。只有在感染源得到控制后才能达到有效的去复苏。

Sepsis is the organ dysfunction caused by infection.Septic shock is a subset of sepsis with circulatory and cellular/metabolic dysfunction.Early immediate diagnosis and treatment of sepsis is as important as the early intervention of acute myocardial infarction and stroke,which can significantly reduce mortality.The fluid therapy for sepsis includes early resuscitation and subsequent fluid therapy and can be divided into four phases involving the resuscitation phase,the optimization phase,the stabilization phase and the de-resuscitation phase.The first 6 hours of the early resuscitation of sepsis are called"golden 6 hours".At the first3 hours period,approximately 2 milliliter crystal fluid calculated from 30 mL/kg should be given.The resuscitation should be launched within the first 1 hour,although it does not need to be finished within the first 1 hour.Subsequent fluid therapy should be guided by sequential assessment of clinical symptoms and signs combined with monitoring of hemodynamic examinations.De-resuscitation could be realized only after appropriate source control.