儿童急性呼吸窘迫综合征的液体复苏和平衡管理策略  

Fluid resuscitation and balance management strategies in pediatric acute respiratory distress syndrome

作　　者：党红星[1] 许峰[1] Dang Hongxing;Xu Feng(Department of PICU,Children's Hospital of Chongqing Medical University,National Clinical Research Center for Child Health and Disorders,Ministry of Education Key Laboratory of Child Development and Disorders,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院重症医学科,国家儿童健康与疾病临床医学研究中心,儿童发育疾病研究教育部重点实验室,重庆400014

出　　处：《中国小儿急救医学》2025年第1期1-7,共7页Chinese Pediatric Emergency Medicine

基　　金：重庆医科大学未来医学青年创新团队发展支持计划(2021-W0111);重庆市自然科学基金面上项目(CSTB2022NSCQ-MSX0983)。

摘　　要：液体管理是儿童急性呼吸窘迫综合征(PARDS)治疗中的关键环节,其主要目标是在维持血流动力学稳定和改善组织灌注的同时,避免液体过负荷引起肺水肿加重及其他并发症的发生。对于合并休克并需要液体复苏的患儿,液体管理应平衡早期复苏的必要性与后期去复苏的需求,制定个体化的精准评估和管理方案。本文结合临床实践与最新证据,探讨了PARDS的病理生理特点,液体复苏的策略,主要的监测指标,液体复苏的适应证与禁忌证,以及常见问题的处理和当前争议与未来方向。Fluid management is a key component in the treatment of pediatric acute respiratory distress syndrome(PARDS).Its primary goal is to maintain hemodynamic stability and improve tissue perfusion while avoiding complications such as worsening pulmonary edema and other adverse effects due to fluid overload.In children with shock who require fluid resuscitation,fluid management must balance the necessity of early resuscitation with the need for de-resuscitation in later stages,necessitating the development of an individualized and precise assessment and management strategy.This review integrates clinical practice with the latest evidence to explore the pathophysiological characteristics of PARDS,strategies for fluid resuscitation,key monitoring indicators,indications and contraindications for fluid resuscitation,as well as the management of common issues,current controversies,and future directions.

关 键 词：急性呼吸窘迫综合征 液体 液体平衡 儿科 重症监护 

分 类 号：R725.6[医药卫生—儿科]