ICU中液体的管理问题C.ppt

对血容量不足的病人而言，多输一袋液体， 就可能避免做CRRT 主张限制输液者（干派）的观点 肠道手术病人总数172例，加入随机、双盲对照研究 围术期液体治疗分成限制输液和常规输液组 限制输液组各种并发症发生率降低 心、肺并发症 7% vs 24% 组织愈合并发症 16% vs 31% 死亡率 0 vs 4.7% 结论：择期结直肠手术围术期限制输液有利 Brandstrup B, Pott F, et al: Effects of Intravenous Fluid Restriction on Postoperative Complications: Comparison of Two Perioperative Fluid Regimens. Annals of Surgery 2003,238:641 在适当的阶段滴定式的管理液体是我们的朋友，而超过生理需要的液体输入则成为敌人。保守的液体管理和开放式的液体管理同样重要，只是在不同的时期实施而已。在液体管理中，保守和开放都是对的，只是时机的不同。 Fluid-Management Strategies in Acute Lung Injury — Liberal, Conservative, or Both? Emanuel P. Rivers 2006；354:2598-2600 液体管理 近年来，ICU中目标导向液体管理有益于患者 液体治疗的量，液体的种类，液体输注的速度， 对其进行恰当调控越来越受到临床的重视 小 结 液体管理是重症病人救治的基础 液体管理：系统化、动态化、个体化 可以肯定的是：早期液体复苏能改善病人预后 容量动态评估，及时调整液体治疗方案 谢 谢 In summary, the crystalloid colloid debate can be simplified to one that addresses the nature of the fluid loss sustained. Virtually all fluid loss incorporates some degree of extracellular fluid depletion, and consequently, it is appropriate to commence most fluid replacement regimens with crystalloid solutions. However, in ongoing losses where plasma volume has been lost, it seems logical to use colloids for this replacement, particularly where the fluid loss is large requiring more than 3 l of resuscitation fluids. Blood should only be given to replace lost red cell mass. * 照读 ICU 危重病人的液体管理策略变化很快，在脓毒症早期提倡充足的液体复苏，但是在晚期提倡保守的液体管理，尤其是当肺脏受损伤时，如果液体不加以控制，所有的策略都可能是危险的。 Tests detecting volume unresponsiveness at any moment of fluid resuscitation or detecting volume unresponsiveness at any moment of fluid restriction would help to better assess the benefit/risk ratio of continuing such strategies. Measuring the short-term hemodynamic changes during passive leg raising can be reliably used for that purpose in both situations, even when patients are breathing spontaneously. Crit Care. 2009;13(4):175. Epub 2009 Aug 10. ALI患者而无组织灌注不良时,应采用保守的液体治疗策略，可缩短机械通气和住ICU时间。（1 C）