休克补液辩论晶体液首选ppt课件

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1、晶体液VS胶体液CrystalloidsVSColloids1，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晶体液胶体液Design:Systematicreviewofrandomisedcontrolledtrialscomparingadministrationofalbuminorplasmaproteinfractionwithnoadministrationorwithadministrationofcrystalloidsolutionincriticallyi

2、llpatientswithhypovolaemia,burns,orhypoalbuminaemia.Subjects:30randomisedcontrolledtrialsincluding1419randomisedpatients.Sesults：Pooleddifferenceintheriskofdeathwithalbuminwas6%(95%confidenceinterval3%to9%)withafixedeffectsmodel.Thesedatasuggestthatforevery17cri

3、ticallyillpatientstreatedwithalbuminthereisoneadditionaldeath.Conclusions:Thereisnoevidencethatalbuminadministrationreducesmortalityincriticallyillpatientswithhypovolaemia,burns,orhypoalbuminaemiaandastrongsuggestionthatitmayincreasemortality.Conclusion:Albumini

4、ncreasetheriskofmortalityby6%Design:Systematicreviewofrandomisedcontrolledtrialsofresuscitationwithcolloidscomparedwithcrystalloidsforvolumereplacementofcriticallyillpatients.Subjects:37randomisedcontrolledtrialsTypeofinjury:Trauma,Burns,Surgery,Septicandhypovol

5、aemicshock,ARDS,Vascularleaksyndrome1998-2004CommentsinBMJSAFE研究:4%AlbuminvsNormalSaline（SalineversusAlbuminFluidEvaluation）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NEnglJMed2004;350(22):2247-2256(n=3497)(n=3500)28天病死率不同病人群体亚组分析AlbuminNSRR(95%CI)p创伤(N=1186)13.610.01

6、.36(0.99-1.86)0.06伴颅脑伤24.515.11.62(1.12-2.34)0.01(N=492)不伴颅脑伤6.26.21.00(0.56-1.79)1.00(N=694)Trauma亚组分析VISEPStudy(HESvsRinger’slactate)EfficacyofVolumeSubstitutionandInsulinTherapyinSevereSepsisVISEPStudy(HESvsRinger’slactate)Subjects：Patientsweredeemedtobeeligi

7、bleiftheonsetofthesyndromewaslessthan24hoursbeforeadmissiontotheICUorlessthan12hoursafteradmissioniftheconditiondevelopedintheICU.HESgroup：HESuntilalimitof20mL/kg/day,thenpreferentiallyRinger’sorothernon-colloidfluidsRLgroup：Ringer’slactateVISEPStudy(HESvsRinger

8、’slactate)VISEPStudy(HESvsRinger’slactate)VISEPStudy(HESvsRinger’slactate)P=0.007betweenHESdosesP=0.345betweenRinger‘slactatedosesVISEPStudy(HESvsRinger’slactate)VISE