• 自貢市第一人民醫(yī)院重癥醫(yī)學(xué)科（四川自貢，643000）;

【摘要】　目的　 探討膿毒性休克早期液體復(fù)蘇的臨床反應(yīng)性。　方法　 對2008年2月—2010年2月38例采用早期目標(biāo)定向治療方案治療的膿毒性休克患者按是否存活進行分組，就中心靜脈壓、心率、平均動脈壓、輸液量、尿量、血乳酸等指標(biāo)進行評價。　結(jié)果　 38例采用早期目標(biāo)定向治療方案治療6 h均達標(biāo)，存活21例（55.26%），死亡17例（44.74%），兩組患者輸液總量及輸液種類差異無統(tǒng)計學(xué)意義（P gt;0.05），存活組6、24 h尿量及血乳酸清除率明顯優(yōu)于死亡組（P lt;0.05）。　結(jié)論　 血乳酸清除率及尿量可作為膿毒性休克液體復(fù)蘇有效的臨床監(jiān)測指標(biāo)。
【Abstract】　Objective　 To study the clinical response to early fluid resuscitation therapy in septic shock patients.　Methods　 Thirty-eight septic shock patients received early goal-directed therapy (EGDT) in the ICU of our hospital from February 2008 to February 2010. The patients were divided into survival group (n=21) and dead group (n=17). Indexes like central venous pressure (CVP), heart rate (HR), mean arterial pressure (MAP), fluid input, urine output, and blood lactate were evaluated.　Results　 Six hours after the EGDT, the results for the patients were all up to standard. There were 21 cases of survival (55.26%) and 17 cases of death (44.74%). The total fluid input and liquid types were similar in the two groups (P gt;0.05). The urine output and lactate clearance at hour 6 and 24 for the survival group were better than that for the dead group (P lt;0.05).　Conclusion　 The lactate clearance and urine output can be regarded as an surveillance indicator of fluid resuscitation for patients with septic shock.

引用本文： 楊明全,曹建偉,陳燕梅. 膿毒性休克早期液體復(fù)蘇的臨床反應(yīng)性評價. 華西醫(yī)學(xué), 2011, 26(6): 863-866. doi: 復(fù)制

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2. 　American Colege of Chest Physiciana/Society of Critical Care Medicine Consensus Confeernce.Definitionsforse psisa ndorgan failure and guidelines for the use of innovative therapies in sepsis [J].Crit Care Med, 1992, 20(6): 864-874.
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4. 　Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock[J]. N Engl J Med, 2001, 345(19): 1368 -1377.
5. 　Lee SW, Hong YS, Park DW, et al. Lactic acidosis not hyperlactatemia as a predictor of inhospital mortality in septic emergency patients[J]. Emergency Medicine J, 2008, 25(10): 659-665.
6. 　徐向東, 吳健鋒, 管向東, 等. 早期乳酸清除率評估外科嚴(yán)重膿毒癥預(yù)后的臨床價值研究[J]. 中國實用外科雜志, 2007, 27(12): 969-970.
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9. 　Dellinger RP. Cardiovascular management of septic shock[J]. Crit Care Med, 2003, 31(3): 946-955.
10. 　Finfer S, Bellomo R, Boyce N, et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit[J]. N Engl J Med, 2004, 350(22): 2247-2256.
11. 　Alsous F, Khamices M, DeGirolamo A, et al. Negative fluid balance predicts surgival in patients with septic shock:a retrospective pilot study[J]. Chest, 2000, 117(6): 1749-1754.
12. 　張麗, 席修明, 姜利. 膿毒性休克患者的負(fù)液體平衡與預(yù)后的關(guān)系[J]. 首都醫(yī)科大學(xué)學(xué)報, 2007, 28(5): 562-565.
13. 　Flierl MA, Rittirsch D, Hube-Lang MS, et al. Molecular events in the cardiomyopathy of sepsis[J]. Mol Med, 2008, 14(5-6): 327-336.
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  2. 2. 　American Colege of Chest Physiciana/Society of Critical Care Medicine Consensus Confeernce.Definitionsforse psisa ndorgan failure and guidelines for the use of innovative therapies in sepsis [J].Crit Care Med, 1992, 20(6): 864-874.
  3. 3. 　Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008[J]. Crit Care Med, 2008, 36(1): 296-327.
  4. 4. 　Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock[J]. N Engl J Med, 2001, 345(19): 1368 -1377.
  5. 5. 　Lee SW, Hong YS, Park DW, et al. Lactic acidosis not hyperlactatemia as a predictor of inhospital mortality in septic emergency patients[J]. Emergency Medicine J, 2008, 25(10): 659-665.
  6. 6. 　徐向東, 吳健鋒, 管向東, 等. 早期乳酸清除率評估外科嚴(yán)重膿毒癥預(yù)后的臨床價值研究[J]. 中國實用外科雜志, 2007, 27(12): 969-970.
  7. 7. 　Nguyen HB, Rivers EP, Knoblicb BP, et al. Earlylactate clearanceis associated with improved outcome in severe sepsis and septic shock[J]. Crit Care Med, 2004, 32(8): 1785-1786.
  8. 8. 　Sablotzki A, Muhling J, Czeslick E. Sepsis and multiple organ failure-update of current therapeutic concepts[J]. Anasthesiol Intensivmed Notfallmed Sehmerzthe, 2005, 40(9): 511-520.
  9. 9. 　Dellinger RP. Cardiovascular management of septic shock[J]. Crit Care Med, 2003, 31(3): 946-955.
  10. 10. 　Finfer S, Bellomo R, Boyce N, et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit[J]. N Engl J Med, 2004, 350(22): 2247-2256.
  11. 11. 　Alsous F, Khamices M, DeGirolamo A, et al. Negative fluid balance predicts surgival in patients with septic shock:a retrospective pilot study[J]. Chest, 2000, 117(6): 1749-1754.
  12. 12. 　張麗, 席修明, 姜利. 膿毒性休克患者的負(fù)液體平衡與預(yù)后的關(guān)系[J]. 首都醫(yī)科大學(xué)學(xué)報, 2007, 28(5): 562-565.
  13. 13. 　Flierl MA, Rittirsch D, Hube-Lang MS, et al. Molecular events in the cardiomyopathy of sepsis[J]. Mol Med, 2008, 14(5-6): 327-336.