Winters Michael E, Sherwin Robert, Vilke Gary M, Wardi Gabriel
University of Maryland School of Medicine, Baltimore, Maryland.
Wayne State University, Detroit, Michigan.
J Emerg Med. 2017 Dec;53(6):928-939. doi: 10.1016/j.jemermed.2017.08.093. Epub 2017 Oct 25.
Current guidelines for the management of patients with severe sepsis and septic shock recommend crystalloids as the initial fluid solution of choice in the resuscitation of these patients. In recent years, there have been numerous studies published on the type of fluid used in the resuscitation of patients with sepsis. The primary goal of this article is to determine the preferred intravenous fluid for the resuscitation of patients with severe sepsis and septic shock.
A MEDLINE literature review was completed to identify studies that investigated the type of resuscitation fluid in the management of patients with severe sepsis and septic shock. Articles included were those published in English between 2011 and 2016, enrolled human subjects, and limited to the following types: randomized controlled trial, prospective observational trial, retrospective cohort trial, and meta-analyses. All selected articles then underwent a structured review by the authors.
Nine thousand sixty-two articles were identified in the search. After use of predetermined criteria, 17 articles were selected for review. Eleven of these were original investigations and six were meta-analyses and systemic reviews.
Crystalloids are the preferred solution for the resuscitation of emergency department patients with severe sepsis and septic shock. Balanced crystalloids may improve patient-centered outcomes and should be considered as an alternative to normal saline, if available. There is strong evidence that suggests semi-synthetic colloids decrease survival and should be avoided. The role of albumin in the resuscitation of patients with severe sepsis and sepsis is uncertain.
目前针对严重脓毒症和脓毒性休克患者的管理指南推荐使用晶体液作为这些患者复苏时的初始补液选择。近年来，关于脓毒症患者复苏所用液体类型已发表了大量研究。本文的主要目的是确定严重脓毒症和脓毒性休克患者复苏时的首选静脉补液。
完成了一项MEDLINE文献综述，以识别研究严重脓毒症和脓毒性休克患者管理中复苏液体类型的研究。纳入的文章为2011年至2016年期间以英文发表、纳入人类受试者且限于以下类型的文章：随机对照试验、前瞻性观察性试验、回顾性队列试验和荟萃分析。然后作者对所有选定的文章进行了结构化审查。
搜索中识别出9062篇文章。使用预定标准后，选择了17篇文章进行审查。其中11篇为原始研究，6篇为荟萃分析和系统评价。
晶体液是急诊科严重脓毒症和脓毒性休克患者复苏的首选溶液。平衡晶体液可能改善以患者为中心的结局，如有条件，应考虑作为生理盐水的替代选择。有强有力的证据表明半合成胶体降低生存率，应避免使用。白蛋白在严重脓毒症和脓毒症患者复苏中的作用尚不确定。
