液体治疗降阶梯策略在腹腔脓毒性休克中的应用进展

The application progress of fluid de-escalation therapy in abdominal infection-induced septic shock

脓毒性休克经早期充分的液体复苏后,过多的液体积聚在体内,可导致患者器官功能障碍和住院时间、机械通气时间、肾脏替代治疗时间延长,与患者不良预后相关。液体治疗降阶梯策略是脓毒性休克晚期阶段重要的液体管理措施,指通过限制液体输入、使用利尿剂和肾脏替代治疗等方法去除体内多余的液体,实现液体负平衡,以期改善患者的临床结局和降低病死率。本文围绕液体治疗降阶梯策略的提出、实施时机和终点、实施手段、与腹腔感染源控制的关系及其对器官功能和临床结局的影响等方面,就液体治疗降阶梯策略在腹腔脓毒性休克的研究现状及应用进展进行综述,旨在为腹腔脓毒性休克晚期阶段的治疗提供指导,并探索新的治疗方向。

After adequate fluid resuscitation in the early stage of septic shock,excessive accumulation of fluid in the body leads to organ dysfunction,which prolongs hospitalization,mechanical ventilation time,and renal replacement therapy time,and is associated with poor prognosis.The fluid de-escalation therapy is an important fluid management strategy performed in the late stage of septic shock.It aims to clear excess fluid by restricting fluid infusion,using diuretics and renal replacement therapy to achieve a negative fluid balance.The fluid de-escalation therapy contributes to improve clinical outcome of septic shock patients and reduce the mortality.This review mainly discusses the current researches and application progress of the fluid de-escalation therapy of abdominal infection-induced septic shock through clarifying its origin,time and endpoint,method of the therapy,the relationship with the control of the source of abdominal infection and its impact on organ function and clinical outcome.Our study intends to provide guidance for the treatment of abdominal infection-induced septic shock in the late stage,and explore the novel research directions.