反映机体组织灌流缺氧情况和乳酸酸中毒的程度。有临床

    试验表明 ,复苏 24h内乳酸水平达到正常值者全部存活;

    24～48h内达到正常者 78%存活;超过 48h者仅 14%存活。

    血乳酸正常值为 1～2mmol /L,乳酸可作为机体低灌注的一

    面镜子 ,其水平升高提示氧债的增加。甚至有人认为 ,动脉

    乳酸正常化是目前为止最好的确定复苏终点的指标之

    一[ 19 ]

    ,优于以氧供、 氧耗和 CI作为复苏终点。

    3 . 4 碱缺失 (BD) 是一个敏感的反映组织低灌流程度和

    时间的指标 ,能迅速反映全身组织酸中毒的情况 ,与伤情严

    重度和预后密切相关。在失血性休克模型中发现 ,BD与氧

    债的变化及并发症发生率密切相关。由于是间接反映血乳

    酸水平 ,故在发生复杂酸碱紊乱时 ,BD不能准确反映氧债。

    3 . 5 胃黏膜 pH ( pHi) 反映内脏或局部组织的灌流状

    态 ,休克期间肠黏膜最先受到影响 ,且在复苏后最后恢复正

    常 ,故 pHi能灵敏地帮助判断复苏的终点。pHi的不足在

    于胃和血内 HCO3

    -

    浓度未必相等 ,其只能间接反映 BL升

    高和相伴的酸中毒 ,而且需用特殊的设备。

    参 考 文 献

    [ 1 ] BickellWH,WallMJ, Pepe PE, et al . I mmediate versus delayed

    fluid resuscitati on for hypotensive patients with penetrating t ors o

    injuries[ J ]. N Engl J Med, 1994, 331 (17) : 1105 - 1109.

    [ 2 ] KnoferlMW,AngeleMK,Ayala A, et al . Do different rates of fluid

    resuscitation adversely or beneficially influence immune res ponses

    after trauma hemorrhage? [ J ]. J Trauma, 1999, 46 (1) : 23 .

    [ 3 ] Varela JE, Cohn S M, Diaz I , et al . Sp lanchnic perfusion during

    delayed, hypotensive, or aggressive fluid resuscitation from uncon2

    trolled hemorrhage[ J ]. Shock, 2003, 20 (5) : 476 - 480.

    [ 4 ] Carrillo P, Takasu A, Safar P, et al . Prolonged severe hemorrhagic

    shock and resuscitation in rats does not cause subtle brain dam2

    age[ J ]. J Trauma, 1998, 45 (2) : 239 - 248.

    [ 5 ] 中华医学会重症医学分会.成人严重感染与感染性休克血流

    动力学监测与支持指南 ( 2006 ) [ J ]. 中国实用外科杂志,2007, 27 (1) : 7 - 13.

    [ 6 ] Rhee P, Koustova E,Alam HB. Searching for the op timal resuscita2

    tion method: Recommendati ons for the initial fluid resuscitati on of

    combat casualities[ J ]. J Trauma, 2003, 54 (5, suppl) : S52 - S62 .

    [ 7 ] Tremblay LN, Riz oli S B,Brenneman FD. Advances in fluid resus2

    citati on of hemorrhagic shock[ J ]. Can J Surg, 2001, 44 ( 3) : 172

    - 179.

    [ 8 ] Rhee P, Koustova E,Alam HB. Searching for the op timal resuscita2

    tion method: Recommendations for the initial fluid resuscition of

    combat casualities[ J ]. J Trauma, 2003, 54 (5, Supp l) : S52 - S62 .

    [ 9 ] Chiara O, Pel osi P,Brazzi L, et al . Resuscitati on from hemorrhag2

    ic shock: experimental model comparing nor mal saline, dextran,and hypertonic saline s olutions[ J ]. Crit CareMed, 2003, 31 (7) :

    1915 - 1922.

    [ 10 ] Assalia A,Bitteman H, Hirsh T M, et al . Influence of hypertonic

    saline on bacterial transl ocation in controlled hemorrhagic shock

    [ J ]. Shock, 2001, 15 (4) : 307 - 311.

    [ 11 ] Vincent JL,WilkesMM,Navickis RJ . Safety of human albumin2

    serious adverse events reported worldwide in 1998 - 2000 [ J ].

    Br J Anaesth, 2003, 91 (5) : 625 - 630.

    [ 12 ] Cochrane Injuries Gr oup Albumin Reviews Human albumin ad2

    ministration in critically ill patients : systematic review of ran2

    domized contr olled trials[ J ]. BrMed J, 1998, 317 ( 7153) : 235

    - 240.

    [ 13 ] Finfer S, Bell omo R, Boyce N, et al . A comparis on of albumin

    and saline for fluid resuscitati on in the intensive care unit[ J ]. N

    Engl J Med, 2004, 350 (22) : 2247 - 2256.

    [ 14 ] Soejima A, Matsuzawa N. Quantitative as well as qualitative

    changes of serum albumin in patientswithmalnutrition[ J ]. Ni p2

    pon Rinsho, 2005, 63 (1) : 91 - 95.

    [ 15 ] Yukl RL,BarOr, HarrisL, et al . Low albumin level in the emer2

    gency depart ment : a potential independent p redictor of delayed ......