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中华重症医学电子杂志 ›› 2026, Vol. 12 ›› Issue (01) : 15 -20. doi: 10.3877/cma.j.issn.2096-1537.2026.01.003

专题笔谈

慢病脓毒症的液体复苏:器官储备功能导向的个体化策略
席寅, 高妍纯, 王炜林, 徐永昊()   
  1. 510120 广州,广州医科大学附属第一医院重症医学科
  • 收稿日期:2025-09-26 出版日期:2026-02-28
  • 通信作者: 徐永昊
  • 基金资助:
    国家科技重大专项(2023ZD0506500,2023ZD0506503); 广州市科技局基础研究计划项目(市校〔院〕企联合资助“登峰医院”专题)(2023A03J0337)

Individualized fluid resuscitation in sepsis with chronic comorbidities: an organ reserve capacity-guided approach

Yin Xi, Yanchun Gao, Weilin Wang, Yonghao Xu()   

  1. Department of Critical Care Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
  • Received:2025-09-26 Published:2026-02-28
  • Corresponding author: Yonghao Xu
引用本文:

席寅, 高妍纯, 王炜林, 徐永昊. 慢病脓毒症的液体复苏:器官储备功能导向的个体化策略[J/OL]. 中华重症医学电子杂志, 2026, 12(01): 15-20.

Yin Xi, Yanchun Gao, Weilin Wang, Yonghao Xu. Individualized fluid resuscitation in sepsis with chronic comorbidities: an organ reserve capacity-guided approach[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2026, 12(01): 15-20.

脓毒症是一类高度异质性的疾病,其发病率与病死率居高不下。合并慢性疾病(简称慢病)的患者因器官储备功能下降而预后更差。液体复苏作为治疗脓毒症的集束化方案中的重要组成部分,在部分患者中显示较好的疗效,但对于慢性心力衰竭、慢性肺疾病或慢性肾脏病(CKD)等患者,标准化的复苏策略往往存在局限,甚至可能加重器官损伤。器官储备功能反映了机体在应激状态下的代偿能力,是制定个体化液体复苏方案的重要参考。心力衰竭患者需基于容量反应性精准评估液体复苏;慢性肺疾病患者需兼顾呼吸支持与肺保护,避免容量过负荷与通气相关损伤;CKD患者则应重视肾脏替代治疗的早期启动及液体管理的平衡。基于器官储备功能的个体化液体复苏,有望改善慢病合并脓毒症患者的预后。因此,本研究聚焦合并慢病的脓毒症患者,系统探讨器官储备功能在液体复苏决策中的临床价值,旨在为不同慢病人群制定更为精准、安全的个体化复苏策略提供依据。

Sepsis is a highly heterogeneous syndrome with persistently high incidence and mortality. Patients with underlying chronic diseases have worse outcomes due to reduced organ reserve capacity. Fluid resuscitation, a key component of sepsis bundle therapy, has shown efficacy in certain populations; however, standardized resuscitation strategies are often limited in patients with chronic heart failure, chronic lung disease, or chronic kidney disease, and may even exacerbate organ injury. Organ reserve capacity, reflecting the body's compensatory ability under stress, is an important reference for individualized resuscitation strategies. For patients with heart failure, fluid resuscitation should be guided by precise assessment of fluid responsiveness; for those with chronic lung disease, treatment should balance respiratory support and lung protection to avoid fluid overload and ventilator-related injury; for patients with chronic kidney disease, early initiation of renal replacement therapy and careful fluid management are essential. Individualized resuscitation based on organ reserve capacity has the potential to improve outcomes in septic patients with chronic comorbidities. Therefore, this study aims to investigate the clinical value of organ reserve capacity in fluid resuscitation decision-making among patients with sepsis and underlying chronic diseases, in order to inform the development of more precise and safer individualized resuscitation strategies across different chronic disease populations.

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