aDivision of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina bDepartment of Anesthesiology, Duke University Medical Center, Durham VAMC, Durham, North Carolina, USA.
Curr Opin Crit Care. 2013 Dec;19(6):537-43. doi: 10.1097/MCC.0000000000000028.
Septic shock is one of the most common and life-threatening conditions afflicting critically ill patients. Intravenous volume resuscitation is considered an initial and very important step in management. The most suitable fluid for volume expansion during septic shock remains unclear. In this review, we focus on the benefits and adverse effects of the most commonly used intravenous fluids in critically ill septic patients.
The debate about the benefits of colloids over crystalloids has been ongoing for the last few decades. With recent literature showing apparent harm from the use of hydroxyethyl starches (HESs), and given the growing concerns of adverse renal and acid-base abnormalities associated with 0.9% saline compared with balanced crystalloid solutions, it may be time to change the nature of the 'fluid debate'.
Crystalloids should still be considered as the first-choice drug for volume resuscitation in patients with septic shock. Colloids such as albumin can be considered in some clinical settings. HES should be avoided. Balanced crystalloids might have an important role to play in the management of septic shock.
感染性休克是困扰重症患者的最常见且最具生命威胁性的病症之一。静脉补液复苏被认为是治疗的初始且非常重要的步骤。在感染性休克期间用于容量扩充的最适宜液体仍不明确。在本综述中，我们重点关注在重症感染性休克患者中最常使用的静脉输液的益处和不良反应。
在过去几十年中，胶体相对于晶体的优势的争论一直在持续。最近的文献表明羟乙基淀粉（HES）的使用明显有害，并且与平衡晶体溶液相比，0.9%生理盐水相关的不良肾功能和酸碱平衡异常的担忧日益增加，可能是时候改变“液体争论”的性质了。
晶体液仍应被视为感染性休克患者容量复苏的首选药物。在某些临床情况下，可以考虑使用胶体，如白蛋白。应避免使用 HES。平衡晶体可能在感染性休克的治疗中发挥重要作用。
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