2018国际重症医学回顾与展望  

Review and forecast of critical care medicine in 2018

作　　者：黄伟[1] 秦永新[1] Huang Wei;Qin Yongxin(Department of Critical Care Medicine,the First Affiliated Hospital of Dalian Medical University,Dalian 116011, Liaoning,China)

机构地区：[1]大连医科大学附属第一医院重症医学科,辽宁大连116011

出　　处：《中华危重病急救医学》2019年第1期16-22,共7页Chinese Critical Care Medicine

基　　金：辽宁省自然科学基金(20170540264);辽宁省教育厅科学研究项目(L2016015).

摘　　要：2018年,国际脓毒症与感染性休克治疗指南推出了1h集束化策略,并在急性呼吸窘迫综合征(ARDS)的食道压监测、平衡盐液体复苏、抗菌药物新品种、血管紧张素Ⅱ治疗严重血管扩张性休克、院外心搏骤停(OHCA)患者的高级气道管理、感染性休克的细胞免疫治疗等方面取得了进展;但在ARDS的体外膜肺氧合(ECMO)治疗、有创-无创序贯撤机、感染性休克的特利加压素治疗、有创通气患者的吸入治疗、氟哌啶醇预防谵妄、专业团队对重症患者治疗决策影响以及泮托拉唑预防应激性溃疡等方面未取得阳性的试验结果。更为重要的是,在国际指南制定、推行集束化策略的卫生政策、羟乙基淀粉(HES)的市场地位和激素疗效等重要问题上,反对者的证据与声音正在逐渐增强,呈现出更为分化与争议的局面。In 2018, a bunch of considerable positive progresses have been presented, including a revised "hour-1 bundle" introduced by international guideline for management of sepsis and septic shock, trans-pulmonary pressure monitoring via esophageal manometry in acute respiratory distress syndrome (ARDS) models, successful trials for new antibiotics, angiotensin Ⅱ in patients with vasodilatory shock and renal replacement therapy, advanced airway management in out-of-hospital cardiac arrest (OHCA) patients as well cellular immunotherapy for septic shock. But some of investigational trials did not yield expected results. For example, extracorporeal membrane oxygenation (ECMO) therapy for ARDS patients, the strategy of sequencing weaning with early extubation to noninvasive ventilation, prevention of delirium with haloperidol, surrogate decision supported by interprofessional intensive care unit (ICU) team and prophylaxis for gastrointestinal stress ulceration with pantoprazole in ICU. And more importantly, it has been obvious that the voices and evidences gathered by the opponents against guidelines development, compulsory polices of implementing bundled strategy, market position of hydroxyethyl-starch solutions (HES) and the usage of steroid in septic shock have been largely strengthen, highlighting a more divided and controversial situation.

关 键 词：脓毒症 感染性休克 集束化 指南 争议 

分 类 号：R459.7[医药卫生—急诊医学]