Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China.
Chin Med J (Engl). 2022 Jan 4;135(2):137-144. doi: 10.1097/CM9.0000000000001869.
Fluid resuscitation is an essential intervention in critically ill patients, and its ultimate goal is to restore tissue perfusion. Critical illnesses are often accompanied by glycocalyx degradation caused by inflammatory reactions, hypoperfusion, shock, and so forth, leading to disturbed microcirculatory perfusion and organ dysfunction. Therefore, maintaining or even restoring the glycocalyx integrity may be of high priority in the therapeutic strategy. Like drugs, however, different resuscitation fluids may have beneficial or harmful effects on the integrity of the glycocalyx. The purpose of this article is to review the effects of different resuscitation fluids on the glycocalyx. Many animal studies have shown that normal saline might be associated with glycocalyx degradation, but clinical studies have not confirmed this finding. Hydroxyethyl starch (HES), rather than other synthetic colloids, may restore the glycocalyx. However, the use of HES also leads to serious adverse events such as acute kidney injury and bleeding tendencies. Some studies have suggested that albumin may restore the glycocalyx, whereas others have suggested that balanced crystalloids might aggravate glycocalyx degradation. Notably, most studies did not correct the effects of the infusion rate or fluid volume; therefore, the results of using balanced crystalloids remain unclear. Moreover, mainly animal studies have suggested that plasma may protect and restore glycocalyx integrity, and this still requires confirmation by high-quality clinical studies.
液体复苏是危重症患者的基本干预措施，其最终目标是恢复组织灌注。危重病常伴有炎症反应、灌注不足、休克等引起的糖萼降解，导致微循环灌注紊乱和器官功能障碍。因此，维持甚至恢复糖萼的完整性可能是治疗策略中的重中之重。然而，与药物一样，不同的复苏液可能对糖萼的完整性产生有益或有害的影响。本文旨在综述不同复苏液对糖萼的影响。许多动物研究表明，生理盐水可能与糖萼降解有关，但临床研究并未证实这一发现。羟乙基淀粉（HES）而非其他合成胶体可能会恢复糖萼。然而，HES 的使用也会导致严重的不良事件，如急性肾损伤和出血倾向。一些研究表明白蛋白可能会恢复糖萼，而另一些研究表明平衡晶体液可能会加重糖萼降解。值得注意的是，大多数研究并未校正输液速度或液体量的影响；因此，使用平衡晶体液的结果仍不清楚。此外，主要是动物研究表明血浆可能保护和恢复糖萼的完整性，这仍需要高质量的临床研究来证实。
