Objective To evaluate the effects and the clinical significances of liquid resuscitation on blood gas analysis， acid-base balance， electrolytes， acute physiology and chronic health evaluationsⅡ（APACHEⅡ） score of patients with septic shock， and then to analyze the relations between serum chlorine （Cl－） level and APACHEⅡscore and the volume of liquid resuscitation.
Methods According to the target of resuscitation （centre venous pressure 8-12mm Hg and mean arterial pressure≥65mm Hg）， 21 patients with septic shock received enough fluid for resuscitation during 24h . The results of blood gas analysis， acid-base balance， electrolytes， and APACHE Ⅱ score were compared between pre-resuscitation and 24h post-resuscitation by self-controlled prospective study. The relationships of the level of serum Cl－ and APACHEⅡ score with the volume of liquid used in resuscitation were analyzed .
Results The mean resus-citation duration was （18.09±4.57） h， and the volume of liquid during 24 h resuscitation was 5 320-11 028mL with mean volume of （7 775±1 735） mL in 21 patients with septic shock. Serum sodium （Na＋， mmol/L） and Cl－（mmol/L）levels of post-resuscitation were significant higher than those of pre-resuscitation （Na＋：138.71±5.67 versus 135.62±7.23， P=0.024；Cl－：109.10±4.90 versus 101.67±8.59， P=0.000）. Compared with the levels of pre-resuscitation， the blood pH value， hematocrit （Hct，%）， anion gap （AG， mmol/L）， lactic acid （mmol/L）， and APACHE Ⅱscore significantly decreased （pH：7.31±0.05 versus 7.37±0.06， P=0.000；Hct：28.48±2.56 versus 32.76±9.19， P=0.049；AG：8.33±3.45 versus 14.17±8.83， P=0.004；lactic acid：1.66±0.89 versus 2.96±1.23， P=0.001；APACHEⅡ：10.90±3.73 versus 17.24±4.06， P=0.000） after 24h resuscitation. The correlation analysis showed that the level of serum Cl- was positively correlated with the volume of liquid used in resuscitation （r=0.717，P＜0.01）. However， there was no correlation between APACHEⅡscore and the volume of liquid used in resuscitation （P＞0.05）.
Conclusions The target of liquid resuscitation in patients with septic shock should be cautiously determined， including control of the volume of crystal liquid for resuscitation， in order to avoid acid-base imbalance or hyperchloraemia. At the same time， the change in internal environment should be monitored. An optimistic fluid resuscitation to decrease APACHE Ⅱ score in patients with septic shock is unrelated to the volume of liquid resuscitation.
Citation：
LIU Shaohua,ZUO Xiangrong,QUE Jun,CAO Quan. Effects of Fluid Resuscitation on Homeostasis and Acute Physiology and Chronic Health EvaluationsⅡof Patients with Septic Shock. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(5): 508-511. doi:
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Copyright © the editorial department of CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY of West China Medical Publisher. All rights reserved
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- 1. Kellum JA. Fluid resuscitation and hyperchloremic acidosis in experimental sepsis：improved short-term survival and acid-base balance with Hextend compared with saline[J]. Crit Care Med， 2002， 30(2)：300-305.
- 2. 倪海滨， 李维勤， 柯路， 等. 液体复苏对重症急性胰腺炎患者内稳态影响的临床分析[J]. 中国危重病急救医学， 2010， 22(9)：522-524.
- 3. Hartog CS， Bauer M， Reinhart K. The efficacy and safety of colloidresuscitation in the critically ill[J]. Anesth Analg， 2011， 112(1)：156-164.
- 4. Dellinger RP， Levy MM， Rhodes A， et al. Surviving sepsis campaign：international guidelines for management of severe sepsis and septic shock， 2012[J]. Intensive Care Med， 2013， 39(2)：165-228.
- 5. 李峰， 孙华， 韩旭东. 不同液体对感染性休克早期液体复苏的影响研究[J]. 中国危重病急救医学， 2008， 20(8)：472-475.
- 6. Marik PE. Surviving sepsis：going beyond the guidelines[J]. Ann Intensive Care， 2011， 1(1)：17-22.
- 7. Boyd JH， Forbes J， Nakada TA， et al. Fluid resuscitation in septic shock：a positive fluid balance and elevated central venous pressure are associated with increased mortality[J]. Crit Care Med， 2011， 39(2)：259-265.
- 8. Maitland K， Kiguli S， Opoka RO， et al. Mortality after fluid bolusin African children with severe infection[J]. N Engl J Med， 2011， 364(26)：2483-2495.
- 9. 王爱田， 刘芳， 朱曦， 等. 优化的液体治疗策略对感染性休克患者预后影响的系统评价[J]. 中国危重病急救医学， 2012， 24(1)：13-17.
- 10. 陈齐红， 郑瑞强， 林华， 等. 不同液体管理策略对感染性休克患者病死率的影响[J]. 中国危重病急救医学， 2011， 23(3)：142-145.
- 11. O’Dell E， Tibby SM， Durward A， et al. Hyperchloremia is the dominant cause of metabolic acidosis in the postresuscitation phase of pediatric meningococcal sepsis[J]. Crit Care Med， 2007， 35(10)：2390-2394.
- 12. Todd SR， Malinoski D， Muller PJ， et al. Lactated ringer’s issuperior to normal saline in the resuscitation of uncontrolled hemorrhagic shock[J]. J Trauma， 2007， 62(3)：636-639.
- 13. Bellomo R， Morimatsu H， French C， et al. The effects of saline or albumin resuscitation on acid-base status and serum electrolytes[J]. Crit Care Med， 2006， 34(12)：2891-2897.
