危重患者的液体管理讲解.ppt

Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock We randomly assigned patients who arrived at an urban emergency department with severe sepsis or septic shock to receive either six hours of early goal-directed therapy or standard therapy (as a control) before admission to the intensive care unit Rivers E, et al. N Engl J Med 2001; 345:1368–1377 标准治疗：CVP≥8 ~12 mm Hg、MAP≥ 65 mm Hg EGDT: 6 h达标，ScvO2≥ 70% 结果：EGDT需大量补液(4,981±2,984 mL vs 3,499±2,438 mL;P0.001),需要更多的多巴酚丁胺和RBC 标准治疗使乳酸酸中毒持续时间长、器官功能障碍多，院内病死率高(46.5% vs 30.5%). Rivers E, et al. N Engl J Med 2001; 345:136