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中华重症医学电子杂志 ›› 2025, Vol. 11 ›› Issue (02) : 157 -162. doi: 10.3877/cma.j.issn.2096-1537.2025.02.011

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休克的血流动力学治疗:从生理机制到临床思维
刘圣均1, 程卫1, 王璐1, 隆云1,()   
  1. 1. 100730 北京,中国医学科学院北京协和医院重症医学科
  • 收稿日期:2025-01-31 出版日期:2025-05-28
  • 通信作者: 隆云
  • 基金资助:
    中央高水平医院临床科研专项(2022-PUMCH-B-115,2022-PUMCH-D-005)

Hemodynamic treatment of shock:from physiological mechanism to clinical thinking

Shengjun Liu1, Wei Cheng1, Lu Wang1, Yun Long1,()   

  1. 1. Department of Critical Care Medicine,Peking Union Medical College Hospital,CAMS & PUMC,Beijing 100730,China
  • Received:2025-01-31 Published:2025-05-28
  • Corresponding author: Yun Long
引用本文:

刘圣均, 程卫, 王璐, 隆云. 休克的血流动力学治疗:从生理机制到临床思维[J/OL]. 中华重症医学电子杂志, 2025, 11(02): 157-162.

Shengjun Liu, Wei Cheng, Lu Wang, Yun Long. Hemodynamic treatment of shock:from physiological mechanism to clinical thinking[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2025, 11(02): 157-162.

血流动力学评估与治疗是降低休克病死率的重要手段。目标导向治疗(GDT)在休克复苏早期为重症医师提供了切实可行的治疗目标和内容,但在液体优化维持阶段,由于个体反应性不同,导致治疗目标难以统一。复苏液体过量导致的肺水肿,血管活性药物引发心律失常、组织灌注不良等并发症延长了治疗时间并增加了治疗费用。随着血流动力学理论和技术的不断更新,使个性化复苏液体选择、个体化复苏反应性判定、精准化复苏效果的预测和评估成为可能。本文重点关注近年休克血流动力学治疗的新理念、新进展,并为临床治疗提供一定参考。

Hemodynamic assessment and treatment are essential tools for reducing mortality in patients with shock.Goal-directed therapy (GDT) has provided critical care physicians with practical therapeutic targets and content during the early stages of shock resuscitation.However,during the phase of fluid optimization and maintenance,individual variability in patient responses makes it challenging to establish a unified treatment goal.Complications such as pulmonary edema caused by fluid overload,and arrhythmias and impaired tissue perfusion triggered by vasopressors,can prolong the duration of treatment and increase medical costs.With the continuous advancement of hemodynamic theory and technology,it has become possible to achieve individualized selection of resuscitation fluids,determination of individualized resuscitation responsiveness,and precise prediction and evaluation of resuscitation outcomes.This review focuses on the new concepts and advances in the treatment of shock hemodynamics in recent years,providing some reference for clinical treatment.

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