休克补液辩论：晶体液首选PPT.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. 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 Fluid Evaluation） 双盲随机对照，28天死亡率评估 澳大利亚新西兰16个ICU，共6997个病人 N Engl J Med 2004;350(22):2247-2256 (n=3497) (n=3500) 28天病死率 不同病人群体亚组分析 Albumin NS RR ( 95% CI ) p 创伤 (N=1186) 13.6 10.0 1.36 (0.99-1.86) 0.06 伴颅脑伤 24.5 15.1 1.62 (1.12-2.34) 0.01 (N=492) 不伴颅脑伤 6.2 6.2 1.00 (0.56-1.79) 1.00 (N=694) Trauma 亚组分析 VISEP Study (HES vs Ringer’s lactate) Efficacy of Volume Substitution and Insulin Therapy in Severe Sepsis VISEP Study (HES vs Ringer’s lactate) Subjects： Patients were deemed to be eligible if the onset of the syndrome was less than 24 hours before admission to the ICU or less than 12 hours after admission if the condition developed in the ICU. HES group： HES until a limit of 20 mL/kg/da