关注危重病人液体平衡(定稿).ppt

关注危重病人液体平衡 徐颖鹤 目录 EGDT提高抢救成功率 液体超负荷增加危重病人死亡率 CVP监测能准确指导液体复苏吗？ 白蛋白用于液体复苏新观点 Early Goal-Directed Therapy (EGDT): involves adjustments of cardiac preload, afterload, and contractility to balance O2 delivery with O2 demand Study purpose: to evaluate the efficacy of early goal-directed therapy in patients presenting to an emergency department with severe sepsis or septic shock (prior to ICU admission) Study design: prospective, randomized controlled, partially blinded, single center trial Early Goal-Directed Therapy Early Goal-Directed Therapy Results:28 Day Mortality 结论 1、CVP与血容量之间相关性很低 2、CVP或者△CVP没有能力判定补液对血流动力学的影响 3、CVP不应该用于医生决策液体治疗 Fluid Resuscitation in Septic shockA Positive Fluid Balance and Elevated Central Venous Pressure Are Associated With Increased Mortality 回归性分析 The Vasopressin in Septic Shock Trial (VASST) study 778为感染性休克患者 研究目的是确定CVP、液体平衡与死亡率关系 Fluid Resuscitation in Septic shockA Positive Fluid Balance and Elevated Central Venous Pressure Are Associated With Increased Mortality 回归性分析 The Vasopressin in Septic Shock Trial (VASST) study 778为感染性休克患者 研究目的是确定CVP、液体平衡与死亡率关系 Fluid accumulation survival and recovery of kidney function in critically ill patients with acute kidney injury. 目的: If fluid accumulation is associated with mortality and non-recovery of kidney function in critically ill adults with acute kidney injury. 方法: Fluid overload was defined as more than a 10% increase in body weight relative to baseline, measured in 618 patients enrolled in a prospective multicenter observational study. 618 critically ill patients were examined the effect of fluid overload a highly significant correlation was observed between mortality and the proportion of days in which fluid overload was present (P0.0001). 结论： In patients with acute kidney injury, fluid overload was independently associated with mortality. The importance of fluid management inacute lung injury secondary to septic shock Chest 2009; 136: 102–109 Wiedemann,---two fluid-managemen