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液体复苏依然被推荐为脓毒性休克的一线复苏治疗。但目前该疗法被接受的原因,部分是由于其应用历史较长,且其在其他类型休克复苏中的应用为人熟知;部分则在于对脓毒性休克病理生理学改变的不全面、不正确的认识。近来,静脉液体复苏的安全性受到质疑,部分观察性研究和前瞻性研究均提示更少量的液体复苏有可能改善预后。对支持继续将液体复苏作为脓毒性休克复苏措施的证据目前依然存有争议,没有前瞻性研究证据显示液体复苏作为单一治疗措施会带来益处。该文对液体复苏作为脓毒性休克治疗措施的病理生理学基本原理进行了回顾,并基于目前临床证据讨论几个重要问题。
Liquid resuscitation is still recommended as a first-line resuscitation treatment of septic shock. However, the reason why this therapy is currently accepted is due in part to its long history of use and its use in other types of shock resuscitation, and partly to the incomplete and incorrect understanding of the pathophysiological changes in septic shock. Recently, the safety of intravenous fluid resuscitation has been questioned. Some observational studies and prospective studies suggest that a smaller amount of liquid resuscitation may improve the prognosis. Evidence of continuing support for resuscitation as a septic shock is still controversial and there is no prospective evidence that liquid resuscitation offers benefits as a single treatment. This paper reviews the basic principles of the pathophysiology of fluid resuscitation as a treatment for septic shock and discusses several important issues based on current clinical evidence.