1. 休克的早期识别、早期诊断是关键; 2. 液体复苏通常首选晶体液:平衡液与生理盐水,以平衡液相对更佳; 3. 当需要大量晶体液时,可酌情使用 4% 白蛋白; 4. 胶体液因无明显优势,不良反应风险可能较大,应严格掌握适应症与禁忌症。 5. 如果一定要有个口诀用来助记,大致应该是:「晶体为主、胶体少用,糖水不用,个体化复苏」。 ▎推荐阅读: 【干货】临床补液总结,简明扼要! ▼点击「阅读原文」查看文章首发:呼吸时间 作者:夏秋 排版:飞腾 题图:站酷海洛投稿:drugs@dxy.cn参考文献1.Myburgh JA, Mythen MG. Resuscitation fluids. N Engl J Med. 2013;369(13):1243-1251. doi:10.1056/NEJMra12086272.Antequera Martín AM, Barea Mendoza JA,Muriel A, et al. Buffered solutions versus 0.9% saline for resuscitation in critically illadults and children. Cochrane DatabaseSyst Rev. 2019;7:CD012247.3.European Medicines Agency. Hydroxyethyl- starch solutions (HES) should no longer be used in patients with sepsis or burn injuries or in critically ill patients. EMA http://www.ema.europa.eu/docs/en_GB/document_library/Referrals_document/Solutions_for_infusion_containing_hydroxyethyl_starch/European_Commission_final_decision/WC500162361.pdf(2014).4.US Food and Drug Administration. Vouluven (6% Hydroxyethyl starch 130/0.4 in 0.9% sodium chloride injection), for administration by intravenous infusion. FDA https://www.fda.gov/downloads/biologicsbloodvaccines/bloodbloodproducts/approvedproducts/newdrugapplicationsndas/ucm083138.pdf(2007).5. 国家药品监督管理局. 国家食品药品监督管理总局提醒关注含羟乙基淀粉类药品安全风险.https://www.nmpa.gov.cn/yaopin/ypjgdt/20140226102001216.html(2014).6.Finfer S, Bellomo R, Boyce N, et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004;350(22):2247-2256. doi:10.1056/NEJMoa0402327.Peng TJ, Andersen LW, Saindon BZ, et al. The administration of dextrose during in-hospital cardiac arrest is associated with increased mortality and neurologic morbidity. Crit Care. 2015;19(1):160. Published 2015 Apr 10. doi:10.1186/s13054-015-0867-z8.Hahn RG, Edsberg L, Sjöstrand F. Volume kinetic analysis of fluid shifts accompanying intravenous infusions of glucose solution. Cell Biochem Biophys. 2003;39(3):211-222. doi:10.1385/CBB:39:3:2119.Perel P, Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2012;(6):CD000567. Published 2012 Jun 13. doi:10.1002/14651858.CD000567.pub510. 中国医师协会急诊医师分会. 急性循环衰竭中国急诊临床实践专家共识 [J]. 中华急诊医学杂志, 2016(25):146-152.11. 中国医师协会急诊医师分会. 中国脓毒症/脓毒性休克急诊治疗指南 (2018)[J]. 临床急诊杂志, 2018, 19(09):6-27.12.Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017;45(3):486-552. doi:10.1097/CCM.000000000000225513.Alhazzani W, Møller MH, Arabi YM, et al. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Crit Care Med. 2020;48(6):e440-e469. doi:10.1097/CCM.000000000000436314.Self WH, Semler MW, Wanderer JP, et al. Balanced Crystalloids versus Saline in Noncritically Ill Adults.N Engl J Med. 2018;378(9):819-828. doi:10.1056/NEJMoa171158615.Semler MW, Self WH, Wanderer JP, et al. Balanced Crystalloids versus Saline in Critically Ill Adults. N Engl J Med. 2018;378(9):829-839. doi:10.1056/NEJMoa1711584