休克的补液辩论：晶体液首选.ppt

* 晶体液 VS 胶体液 Crystalloids VS Colloids 1，液体种类的选择 2，复苏策略（量） 3，复苏程度endpoints （度） 液体复苏包括三个主题 Design: Systematic review of randomised controlled trials comparing administration of albumin or plasma protein fraction with no administration or with administration of crystalloid solution in critically ill patients with hypovolaemia, burns, or hypoalbuminaemia. Subjects: 30 randomised controlled trials including1419 randomised patients. Sesults： Pooled difference in the risk of death with albumin was 6% (95% confidence interval 3% to 9%) with a fixed effects model. These data suggest that for every 17 critically ill patients treated with albumin there is one additional death. Conclusions: There is no evidence that albumin administration reduces mortality in critically ill patients with hypovolaemia, burns, or hypoalbuminaemia and a strong suggestion that it may increase mortality. Conclusion: Albumin increase the risk of mortality by 6% Design: Systematic review of randomised controlled trials of resuscitation with colloids compared with crystalloids for volume replacement of critically ill patients. Subjects: 37 randomised controlled trials Type of injury: Trauma, Burns, Surgery, Septic and hypovolaemic shock, ARDS, Vascular leak syndrome Design: Systematic review of randomised controlled trials of resuscitation with colloids compared with crystalloids for volume replacement of critically ill patients; analysis stratified according to patient type and quality of allocation concealment. Subjects: 37 randomised controlled trials were eligible, of which 26 unconfounded trials compared colloids with crystalloids (n = 1622). (The 10 trials that compared colloid in hypertonic crystalloid with isotonic crystalloid (n = 1422) and one trial that compared colloid in isotonic crystalloid with hypertonic crystalloid (n = 38) are described in the longer version on our website ). 1998-2004 Comments in BMJ SAFE研究: 4% Albumin vs Normal Saline （Saline versus Albumin Flu