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    2013年休克急救指南的血液動力學要素(Hemodynamic Pearls from the Surviving Sepsis Guideline)
    原作者: Haney Mallemat,肖鋒譯 文章來源: 中華急診醫學雜志編輯部 發布日期:2013-02-02

    Title: Hemodynamic Pearls from the Surviving Sepsis Guideline
    Author作者: Haney Mallemat

    The updated Surviving Sepsis Guidelines have been released and here are some recommendations as they pertain to hemodynamic management (grades of recommendations in parenthesis).
    Fluid therapy
    • An initial fluid bolus of at least 30 mL/kg is recommended; crystalloids should be the initial fluids (1B).
    • 建議最初的液體復蘇的量為每公斤體重30毫升,首先的液體應該是晶體液(1B)。
    • Consider albumin when “substantial” amounts of crystalloid have been given (2C).
    • 在輸入相當量的晶體液后,要考慮給白蛋白(2C)。
    • Use of hydroxyethyl starch is not recommended (1B)
    • 不建議使用羥乙基淀粉液

    Vasopressors (targeting MAP of at least 65 mmHg)
    • Norepinephrine (NE) is the vasopressor of choice (1B)
    • 首選去甲基腎上腺素(NE)(1B)
    • Epinephrine (EPI) if an additional agent is required; can be added to or substituted for NE (2B)
    • 如再需要血管加壓素,可加用腎上腺素(EPI)或取代NE(2B)
    • Vasopressin (0.03 units/minute) can be added to NE; it should not be titrated or used as a single agent (ungraded).
    • 腦垂體后葉素(0.03單位/分鐘)可于NE同用,不要靜脈滴注或單獨使用。
    • In selected patients (e.g., bradycardia or low-risk of tachyarrhythmia), dopamine may be considered (2C). Low-dose dopamine (for renal protection) should not be used (1A).
    • 在某些特定病人(如心動過緩或心動過速可能性不大)中,可考慮用多巴胺(2C)。不要用低劑量(腎保護劑量)的多巴胺(1A)。
    • Phenylephrine (PE) is not recommended, except if (1C):
    • 去氧腎上腺素(新福林,PE)不建議用,除非(1C):
    ? Serious NE associated arrhythmias
    ? NE導致的嚴重心律失常
    ? Cardiac output can be measured and is increased with low MAP (PE can reduce cardiac output)
    ? 可監測心輸出量,心輸出量高但血壓低(PE可以降低心輸出量)
    ? Other therapies cannot achieve the target MAP
    ? 其它任何方法無法維持理想MAP

    • Use if fluids and vasopressors cannot restore adequate perfusion
    • 如液體和血管加壓劑不能恢復正常循環時,可考慮用
    • Total daily dose of 200 mg (2C) administered by continuous infusion (2D)
    • 總劑量為200毫克(2C),靜脈持續滴注(2D)
    • ACTH stimulation test is not recommended (2B)
    • 沒有必要做ACTH刺激試驗(2B)
    • Tapering hydrocortisone when vasopressors have been discontinued (2D)
    • 在停止血管加壓素后,逐漸減激素的量

    Inotropic Therapy
    • Administer dobutamine if it is believed that cardiac filling pressures are elevated, cardiac output is low, or persistent signs of hypoperfusion despite other therapies (1C)
    • 在如下的情況下可考慮使用多巴酚丁胺:心臟充盈壓高,心輸出量低,或對其它治療效果無效的持續性低灌注癥狀


    Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock. Crit Care Med. 2013 Feb;41(2):580-637.