文献类型：期刊文献

中文题名：脓毒性休克去复苏的研究进展

英文题名：Advances in the study of de-resuscitation in septic shock

作者：姚伟晴[1,2];高玉娟[3];寇春焕[3];刘莉[3];肖鸿[1];刘东[2]

第一作者：姚伟晴

机构：[1]西北民族大学医学部,兰州730030;[2]解放军联勤保障部队第九四〇医院重症医学科/高原医学科,兰州730050;[3]甘肃中医药大学第一临床医学院,兰州730000

第一机构：西北民族大学医学部,兰州730030

年份：2025

卷号：37

期号：11

起止页码：1062

中文期刊名：中华危重病急救医学

外文期刊名：Chinese Critical Care Medicine

收录：;北大核心:【北大核心2023】；

基金：甘肃省自然科学基金项目(21JR11RA002);卫勤部拔尖培育项目(2021yxky003)。

语种：中文

中文关键词：脓毒性休克;液体积聚综合征;去复苏;液体管理;器官保护

外文关键词：Septic shock;Fluid accumulation syndrome;De-resuscitation;Fluid management;Organ protection

摘要：脓毒性休克的早期救治依赖充分的液体复苏以恢复组织灌注。然而,过量或持续的液体输注可能导致液体积聚综合征(FAS),显著增加患者器官功能障碍和死亡风险。因此,主动预防和管理FAS对改善患者预后至关重要。随着液体复苏策略在脓毒性休克治疗中的不断优化,去复苏作为预防或纠正FAS的关键阶段,为改善患者预后提供了重要契机。新近研究表明,在脓毒性休克复苏后期,主动去复苏联合血流动力学监测、血管活性药物调整等综合干预手段,有助于减少液体正平衡,降低器官功能障碍发生风险,缩短重症监护病房(ICU)住院时间,改善患者预后。目前,去复苏的时机选择、容量评估方法、个体化治疗方案的制定以及相关并发症的防控已成为研究重点,而寻找可靠的生物标志物指导去复苏策略将成为未来热点研究方向。本文对FAS的病理生理学与临床诊断以及脓毒性休克去复苏的临床策略、争议与挑战进行综述,并探讨去复苏策略的未来研究方向,以期为优化脓毒性休克患者的液体管理提供理论依据和实践指导。
The initial management of septic shock necessitates adequate fluid resuscitation to restore tissue perfusion.However,excessive or sustained fluid administration may precipitate fluid accumulation syndrome(FAS),significantly exacerbating the risk of organ dysfunction and mortality.Consequently,proactive prevention and management of FAS are paramount for optimizing patient outcomes.With the continuous optimization of fluid resuscitation strategies in the treatment of septic shock,de-resuscitation,as a key stage for preventing or correcting FAS,provides an important opportunity to improve patient prognosis.Recent studies have shown that during the later phase of septic shock resuscitation,active de-resuscitation combined with hemodynamic monitoring,adjustment of vasoactive drugs and other comprehensive intervention measures can help reduce fluid positive balance,lower the risk of organ dysfunction,shorten the length of intensive care unit(ICU)stay,and improve patient prognosis.Currently,the timing of de-resuscitation,volume assessment methods,the development of individualized treatment protocols,and the prevention and control of related complications have become the focus of research,while the search for reliable biomarkers to guide de-resuscitation strategies will become a future hot direction.In this article,we review the pathophysiology and clinical diagnosis of FAS,as well as the clinical strategies,controversies and challenges of de-resuscitation in septic shock,and explore the future research directions of de-resuscitation strategies,with the aim of providing theoretical basis and practical guidance for optimizing fluid management in patients with septic shock.