Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, USA.
Shock. 2010 Mar;33(3):229-41. doi: 10.1097/SHK.0b013e3181c30f0c.
Hemorrhage remains a major cause of preventable death following both civilian and military trauma. The goals of resuscitation in the face of hemorrhagic shock are restoring end-organ perfusion and maintaining tissue oxygenation while attempting definitive control of bleeding. However, if not performed properly, resuscitation can actually exacerbate cellular injury caused by hemorrhagic shock, and the type of fluid used for resuscitation plays an important role in this injury pattern. This article reviews the historical development and scientific underpinnings of modern resuscitation techniques. We summarized data from a number of studies to illustrate the differential effects of commonly used resuscitation fluids, including isotonic crystalloids, natural and artificial colloids, hypertonic and hyperoncotic solutions, and artificial oxygen carriers, on cellular injury and how these relate to clinical practice. The data reveal that a uniformly safe, effective, and practical resuscitation fluid when blood products are unavailable and direct hemorrhage control is delayed has been elusive. Yet, it is logical to prevent this cellular injury through wiser resuscitation strategies than attempting immunomodulation after the damage has already occurred. Thus, we describe how some novel resuscitation strategies aimed at preventing or ameliorating cellular injury may become clinically available in the future.
出血仍然是民用和军事创伤后可预防死亡的主要原因。面对出血性休克，复苏的目标是恢复终末器官灌注和维持组织氧合，同时尝试对出血进行明确控制。然而，如果复苏操作不当，实际上会加重出血性休克引起的细胞损伤，而用于复苏的液体类型在这种损伤模式中起着重要作用。本文回顾了现代复苏技术的历史发展和科学基础。我们总结了多项研究的数据，以说明常用复苏液（包括等渗晶体液、天然和人工胶体液、高渗和高渗溶液以及人工氧载体）对细胞损伤的差异影响，并探讨这些影响与临床实践的关系。数据表明，在血液制品不可用时且直接控制出血延迟的情况下，一种安全、有效且实用的通用复苏液仍然难以捉摸。然而，通过比在已经发生损伤后尝试免疫调节更明智的复苏策略来预防这种细胞损伤是合理的。因此，我们描述了一些旨在预防或减轻细胞损伤的新型复苏策略如何在未来可能在临床上得到应用。
