脓毒症围手术期患者的输液管理。

IF 3.5 3区 医学 Q1 CRITICAL CARE MEDICINE Current Opinion in Critical Care Pub Date : 2024-12-01 Epub Date: 2024-09-03 DOI:10.1097/MCC.0000000000001201
Prashant Nasa, Robert Wise, Manu L N G Malbrain
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引用次数: 0

摘要

目的:这篇综述深入探讨了近期涉及脓毒症围手术期患者的临床研究,并强调了在了解液体管理方面存在的差距。目的是加深对安全液体复苏的理解,以优化围手术期的预后并减少并发症:最新研究结果表明,围手术期患者水份不足或过量都会对手术和临床效果产生不利影响。在手术、全身麻醉和败血症期间,静脉输液的动力学会因内皮糖萼(EG)受损而发生显著变化,从而增加血管通透性和间质水肿。在临床麻醉中,神经麻醉和七氟醚对 EG 的影响较小。高血容量、输液速度和输液量也与 EG 脱落有关。尽管防腐策略有所改进,但围术期败血症并不少见。液体复苏是败血症治疗的基石。然而,过度热衷于液体复苏会增加败血症和脓毒性休克患者的死亡率。在仔细评估血管内容量状态、动态血流动力学变量和液体耐受性的基础上进行个性化液体复苏似乎是一种安全的方法。在脓毒症和脓毒性休克患者中,平衡溶液(BS)比 0.9% 生理盐水更受青睐,因为在使用专用平衡溶液和/或需要大量液体进行液体复苏时,平衡溶液可能会降低死亡率。使用动态血流动力学变量的围手术期目标导向液体疗法(GDFT)在减少术后并发症方面仍是一个值得关注的领域,可考虑用于脓毒症治疗(补充数字内容)。摘要:优化围手术期液体管理对于改善脓毒症患者的手术效果和减少术后并发症至关重要。在脓毒症围手术期患者的液体复苏中,使用 BS 的个性化和 GDFT 是首选方法。未来的研究应评估临床麻醉与 EG 之间的相互作用、其对液体复苏的影响以及 GDFT 对脓毒症围手术期患者的影响。
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Fluid management in the septic peri-operative patient.

Purpose of review: This review provides insight into recent clinical studies involving septic peri-operative patients and highlights gaps in understanding fluid management. The aim is to enhance the understanding of safe fluid resuscitation to optimize peri-operative outcomes and reduce complications.

Recent findings: Recent research shows adverse surgical and clinical outcomes with both under- and over-hydration of peri-operative patients. The kinetic of intravenous fluids varies significantly during surgery, general anaesthesia, and sepsis with damage to endothelial glycocalyx (EG), which increases vascular permeability and interstitial oedema. Among clinical anaesthesia, neuraxial anaesthesia and sevoflurane have less effect on EG. Hypervolemia and the speed and volume of fluid infusion are also linked to EG shedding. Despite improvement in the antisepsis strategies, peri-operative sepsis is not uncommon. Fluid resuscitation is the cornerstone of sepsis management. However, overzealous fluid resuscitation is associated with increased mortality in patients with sepsis and septic shock. Personalized fluid resuscitation based on a careful assessment of intravascular volume status, dynamic haemodynamic variables and fluid tolerance appears to be a safe approach. Balanced solutions (BS) are preferred over 0.9% saline in patients with sepsis and septic shock due to a potential reduction in mortality, when exclusive BS are used and/or large volume of fluids are required for fluid resuscitation. Peri-operative goal-directed fluid therapy (GDFT) using dynamic haemodynamic variables remains an area of interest in reducing postoperative complications and can be considered for sepsis management (Supplementary Digital Content).

Summary: Optimization of peri-operative fluid management is crucial for improving surgical outcomes and reducing postoperative complications in patients with sepsis. Individualized and GDFT using BS is the preferred approach for fluid resuscitation in septic peri-operative patients. Future research should evaluate the interaction between clinical anaesthesia and EG, its implications on fluid resuscitation, and the impact of GDFT in septic peri-operative patients.

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来源期刊
Current Opinion in Critical Care
Current Opinion in Critical Care 医学-危重病医学
CiteScore
5.90
自引率
3.00%
发文量
172
审稿时长
6-12 weeks
期刊介绍: ​​​​​​​​​Current Opinion in Critical Care delivers a broad-based perspective on the most recent and most exciting developments in critical care from across the world. Published bimonthly and featuring thirteen key topics – including the respiratory system, neuroscience, trauma and infectious diseases – the journal’s renowned team of guest editors ensure a balanced, expert assessment of the recently published literature in each respective field with insightful editorials and on-the-mark invited reviews.
期刊最新文献
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