Department of Critical Care Medicine, University of Pittsburgh, 1215.4 Kaufmann Medical Building, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA.
Department of Critical Care Medicine, University of Pittsburgh, 1215.4 Kaufmann Medical Building, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA.
Crit Care Clin. 2018 Apr;34(2):267-277. doi: 10.1016/j.ccc.2017.12.010. Epub 2018 Feb 1.
Fluids during resuscitation from shock increase mean systemic pressure and venous return. The pressure gradient for venous return must increase. Mean systemic pressure is the amount of vascular space in unstressed and stressed volume, mostly unstressed. Shock states can decrease mean systemic pressure by increasing unstressed volume, decreasing total blood volume, or decreasing the pressure gradient for venous return. Crystalloids across bodily spaces restore normal volume, whereas colloids remain in the intravascular space. Electrolyte content of fluids matters and excess chloride impairs renal blood flow. Albumin seems to be more effective at restoring blood volume in severe sepsis, but not in other conditions.
在休克复苏期间，液体可增加平均体循环压和静脉回流。静脉回流的压力梯度必须增加。平均体循环压是未受压力和受压力容积的血管空间量，主要是未受压力容积。休克状态可通过增加未受压力容积、降低总血容量或降低静脉回流压力梯度来降低平均体循环压。晶体液可跨身体空间分布恢复正常容量，而胶体液则留在血管内空间。液体的电解质含量很重要，过多的氯离子会损害肾血流量。白蛋白似乎在严重脓毒症中更有效地恢复血容量，但在其他情况下则不然。
