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在出血性休克中进行液体管理
Andreas Markl-Le-Lev E1, Ingrid Haller, Mirjam Bachler
1Department of Anesthesiology and Intensive Care Medicine, Trauma Intensive Care Unit, Medical University of Innsbruck, Innsbruck, Austria.
Current opinion in anaesthesiology
|March 12, 2025
概括
目前用于出血性休克的液体复苏策略正在转向限制性方法. 虽然结晶体是最初的支柱,但对于严重的病例,考虑使用白蛋白和凝等合体,避免基乙烯粉.
科学领域:
- 关键护理医学 关键护理医学
- 创伤管理 创伤管理
- 复苏科学复苏科学 复苏科学
背景情况:
- 在出血性休克中流体管理仍然是一个复杂和不断发展的领域.
- 临床指南和基于证据的实践不断更新.
- 了解生理方面的关键是选择合适的体积替代解决方案.
研究的目的:
- 审查当前关于在出血性休克中进行液体复苏的证据.
- 突出选择体积替代解决方案的生理考虑因素.
- 讨论流体管理策略的不断变化的格局.
主要方法:
- 对当前证据和国际准则的文献综述.
- 在出血性休克中对生理原理的分析.
- 评估不同的液体复苏溶液.
主要成果:
- 国际指导方针倾向于限制性液体复苏策略,而不是自由的方法.
- 积极的液体治疗带有潜在的风险.
- "创伤的致命三位一体" (低输血,酸性,凝血病) 是出血性休克病理生理学的核心.
- 结晶体在恢复血管内体积方面存在局限性.
- 像基乙基粉这样的合物引起了关于功能和凝血的担忧.
- 专的益处是有争议的,在创伤性脑损伤中可能增加死亡率.
- 新鲜冷血不建议进行体积复苏,但可能有助于大量输血.
结论:
- 流体复苏管理趋势趋向于更具限制性的策略.
- 结晶体是初始复苏的基础,尽管在严重衰竭中效率较低.
- 基于凝的溶液和专是当水晶化物不足时的选择.
- 由于安全问题,基乙烯粉不再推使用.
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