关注(guānzhù)危重病人液体平衡徐颖鹤第一页，共六十一页。目录(mùlù)•EGDT提高抢救成功率•液体超负荷增加危重病人死亡率•CVP监测(jiāncè)能准确指导液体复苏吗？•白蛋白用于液体复苏新观点第二页，共六十一页。EarlyGoal-DirectedTherapy(EGDT):involvesadjustmentsofcardiacpreload,afterload,andcontractilitytobalanceO2deliverywithO2demandChest1992;101:1644..第三页，共六十一页。EarlyGoal-DirectedTherapyintheTreatmentofSevereSepsisandSepticShockRiversE,NguyenB,HavstadS,etal.Earlygoal-directedtherapyinthetreatmentofseveresepsisandsepticshock.NEJM2001;345:1368.Studypurpose:toevaluatetheefficacyofearlygoal-directedtherapyinpatientspresentingtoanemergencydepartmentwithseveresepsisorsepticshock(priortoICUadmission)Studydesign:prospective,randomizedcontrolled,partiallyblinded,singlecentertrial第四页，共六十一页。PatientrandomizedN=263EarlygoaldirectedtherapyN=130StandardtherapyN=133CVP>8-12mmHgMAP>65mmHgUrineOutput>0.5ml/kg/hrCVP>8-12mmHgMAP>65mmHgUrineOutput>0.5ml/kg/hrScvO2>70%SaO2>93%Hct>30%AntibioticsgivenatdiscretionoftreatingcliniciansAssoonaspossibleMean6.2hrsICUMDsblindedtostudytreatmentNEJM2001;345:1368-77.Atleast6hoursofEGDTMean8hrsTransfertoICU第五页，共六十一页。CVP:centralvenouspressureMAP:meanarterialpressureScvO2:centralvenousoxygensaturationEarlyGoal-DirectedTherapyNEJM2001;345:1368-77.第六页，共六十一页。第七页，共六十一页。第八页，共六十一页。49.2%33.3%0102030405060StandardTherapyN=133EGDTN=130P=0.01**KeydifferencewasinsuddenCVcollapse,notMODSEarlyGoal-DirectedTherapyResults:28DayMortalitySuddenCVCollapseMODS21%vs10%p=0.0222%vs16%P=0.27NEJM2001;345:1368-77.Mortality第九页，共六十一页。质疑(zhìyí)点质疑(zhìyí)点质疑(zhìyí)点第十页，共六十一页。CVP监测能准确指导液体(yètǐ)复苏吗？第十一页，共六十一页。Objective:Asystematicreviewoftheliteraturetodeterminethefollowing:(1)therelationshipbetweenCVPandbloodvolume,(2)theabilityofCVPtopredictfluidresponsiveness,(3)theabilityofthechangeinCVP(CVP)topredictfluidresponsiveness.第十二页，共六十一页。Thepooledcorrelatio...
