感染中毒性休克的液体复苏和血管活性药物应用的时机、评价标准与规范

Fluid resuscitation and application of vasoactive drugs in septic shock:timing,evaluation criteria,and specifications

感染中毒性休克(SS)是感染中毒症(sepsis)的最严重并发症,一直是危重症领域救治难点和研究热点。SS属于分布性休克,液体复苏和血管活性药物应用相辅相成,已经成为临床救治SS的两个常规措施。然而,怎样基于SS动态的病理生理过程,在复苏、优化、稳定和撤除的管理环节中精准地监测大循环、微循环及细胞代谢指标,从而指导两个措施的统筹兼顾、个体化和动态化应用,仍没有明确答案。笔者将结合近年的国际管理指南和文献,在液体治疗和血管活性药物的应用方面提出相关建议。

Septic shock(SS),the most severe complication of sepsis,has always been a major challenge and research focus in the field of critical care treatment.SS is categorized as a distributive shock,where fluid resuscitation and the use of vasoactive drugs are the two standard measures for the clinical management of SS.However,it remains unclear how to accurately monitor macro-circulation,micro-circulation,and cellular metabolism indicators during the process of resuscitation,optimization,stabilization,and evacuation based on the dynamic pathophysiological processes of SS.This monitoring is essential to guide the comprehensive,individualized,and dynamic application of these two measures.Based on recent international management guidelines and literature review,the authors will propose relevant recommendations regarding the use of fluid therapy and vasoactive drugs.