休克補(bǔ)液辯論：晶體液首選課件

1、晶體液 VS 膠體液Crystalloids VS Colloids1，液體種類的選擇2，復(fù)蘇策略（量）3，復(fù)蘇程度endpoints （度） 液體復(fù)蘇包括三個主題晶體液膠體液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

2、 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%Desi

3、gn: Systematic review of randomised controlled trials of resuscitation with colloids compared with crystalloids for volume replacement of critically ill patients.Subjects: 37 randomised controlled trialsType of injury: Trauma, Burns, Surgery, Septic and hypovolaemic shock, ARDS, Vascular leak syndro

4、meDesign: 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

5、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

6、 in the longer version on our website ).SAFE研究: 4% Albumin vs Normal Saline（Saline versus Albumin Fluid Evaluation）雙盲隨機(jī)對照，28天死亡率評估澳大利亞新西蘭16個ICU，共6997個病人不同病人群體亞組分析VISEP Study (HES vs Ringers lactate) Efficacy of Volume Substitution and Insulin Therapy in Severe SepsisVISEP Study (HES vs Ringers lacta

7、te) 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/day, then preferentially Ringers or other non-colloi

8、d fluidsRL group：Ringers lactateVISEP Study (HES vs Ringers lactate) VISEP Study (HES vs Ringers lactate) P=0.007 between HES dosesP=0.345 between Ringers lactate dosesVISEP Study (HES vs Ringers lactate) 60402000 - 24 h24 - 48 hHemohes ml / kg / BW / 24h22 ml/kg/BW28,274最初 24 hours內(nèi)38,2100研究期間至少有一天

9、%nn=262VISEP Study (HES vs Ringers lactate) 57.6%30.9%0%25%50%75%22.8%33.0%0%25%50%75%28-day 死亡率90-day 死亡率死亡率 (%)n=162n=100HES 22 ml/kg BW/day *n=162n=99p=0.071P0.001* on at least one study dayVISEP Study (HES vs Ringers lactate) VISEP Study (HES vs Ringers lactate) 33.6%30.9%0%25%50%75%24.2%22.8%0%

10、25%50%75%28-day 死亡率90-day 死亡率死亡率 (%)n=256n=162HESRingers lactaten=256n=162p=0.747p=0.562VISEP 研究 (HES vs. 乳酸林格氏液) - 死亡率 HES 22 ml/kg/BW vs 乳酸林格氏液 -VISEP 研究 (HES vs. 乳酸林格氏液） - 發(fā)病率： 乳酸林格氏液 vs. HES 22 ml/kg BW/天 - 晶體液組織水腫晶體液組織水腫In our study, patients who were resuscitated with albumin received less flu

11、id than those who were resuscitated with saline. During the first four days，the ratio of albumin administered to saline administered was approximately 1:1.4. However, there was no significant difference in mean arterial pressure between the groups, and the differences in central venous pressure and heart rate were small. Thus, we believe that the patients in the two groups were resuscitated to similar and acceptable end points.1.32 for the entire stud