Imm A, Carlson R W
Department of Critical Care Medicine, Wayne State University, Detroit, Michigan.
Crit Care Clin. 1993 Apr;9(2):313-33.
Over the past century, the treatment of various forms of circulatory shock has included fluid resuscitation with either crystalloidal or colloidal solutions. Despite decades of investigation, there still is considerable controversy over the beneficial and adverse effects of each fluid type. Most authors agree that the initial resuscitation of any form of shock should be performed with crystalloid solutions. Trauma resuscitation uses crystalloid therapy almost exclusively. Much controversy exists when the shock state involves increased microvascular permeability, such as seen in sepsis, anaphylaxis, and burns. Concerns involve increased permeability pulmonary edema and whether colloid or crystalloid therapy may contribute to its formation. Regardless of fluid type used for resuscitative efforts, it is essential to ensure adequate invasive and noninvasive monitoring to guide therapy. Endpoints to resuscitation should include stabilization of vital signs, adequate urine output, adequate cardiac output, and evidence of supply-independent oxygen consumption. Side effects of aggressive fluid loading are frequent and include intravascular volume overload, pulmonary edema, increased myocardial water content, brain swelling, gastrointestinal ischemia, and massive systemic edema. These complications can best be minimized by careful fluid titration, using physiologic and hemodynamic endpoints.
在过去的一个世纪里，各种形式循环性休克的治疗方法包括使用晶体溶液或胶体溶液进行液体复苏。尽管经过了数十年的研究，但对于每种液体类型的利弊仍存在相当大的争议。大多数作者认为，任何形式休克的初始复苏都应使用晶体溶液。创伤复苏几乎完全采用晶体疗法。当休克状态涉及微血管通透性增加时，如在脓毒症、过敏反应和烧伤中所见，就会存在很多争议。问题包括通透性增加导致的肺水肿以及胶体或晶体疗法是否可能促成其形成。无论用于复苏的液体类型如何，确保进行充分的有创和无创监测以指导治疗至关重要。复苏的终点应包括生命体征稳定、足够的尿量、足够的心输出量以及供应非依赖性氧消耗的证据。积极液体负荷的副作用很常见，包括血管内容量过载、肺水肿、心肌含水量增加、脑肿胀、胃肠道缺血和大量全身性水肿。通过使用生理和血流动力学终点进行仔细的液体滴定，可以将这些并发症降至最低。
