撰写与审定专家：
姚咏明(解放军总医院第四医学中心)
朱华栋(北京协和医院)
柴艳芬(天津医科大学总医院)
杜俊凯(西安交通大学第一附属医院)
张国秀(河南科技大学第一附属医院)
康海(山东烟台毓璜顶医院)
张泓(安徽医科大学附属第一医院)
杨立山(宁夏医科大学总医院)
毛恩强(上海交通大学医学院附属瑞金医院)
钱传云(昆明医科大学第一附属医院)
侯明(青海大学附属医院)
吴利东(南昌大学第二附属医院)
曹钰(四川大学华西医院)
闫柏刚(重庆市第三人民医院)
程少文(海南医学院第一附属医院)
李燕(山西医科大学附属第二医院)
詹红(中山大学附属第一医院)
陈杨(贵州中医药大学第一附属医院)
高恒波(河北医科大学第二医院)
王维展(衡水市哈励逊国际和平医院)
杨灿菊(云南大理州人民医院)
彭鹏(新疆医科大学附属第一医院)
尹文(空军军医大学第一附属医院)
朱长举(郑州大学第一附属医院)
康健(大连医科大学附属第一医院)
曲爱军(山东省聊城市人民医院)
冀兵(山西医科大学附属第一医院)
丁邦晗(广东省中医院)
魏捷(武汉大学人民医院)
李德忠(湖北省恩施土家族苗族自治州中心医院)
张劲松(江苏省人民医院)
李湘民(中南大学湘雅医院)
邓颖(哈尔滨医科大学附属第二医院)
邢吉红(吉林大学第一医院)
李培武(兰州大学第二医院)
陈凤英(内蒙古医科大学附属医院)
徐善祥(浙江大学医学院附属第二医院)
李仕来(广西医科大学第一附属医院)
赵刚(华中科技大学同济医学院附属协和医院)
闵军(福建省福州市第二医院)
王振杰(蚌埠医科大学附属第一医院)
王辉(牡丹江市第二人民医院)
李岩(吉林大学中日联谊医院)
樊麦英(湖南省人民医院)
熊辉(北京大学第一医院)
辜小丹(成都市第六人民医院)
黄亮(南昌大学第一附属医院)
林志鸿(福建医科大学附属第一医院)
刘海波(吉林大学第一医院)
郑云(安徽医科大学附属第一医院)
吕传柱(四川省人民医院)
全锦花(北京医院)
王旭涛(北京医院)
郑粉双(云南大学附属医院)
聂时南(东部战区总医院)
杜贤进(武汉大学人民医院)
刘霜(北京协和医院)
董士民(河北医科大学第三医院)
张新超(北京医院)
温伟(北京医院)
金红旭(北部战区总医院)
张东山(中南大学湘雅二医院)
秦历杰(河南省人民医院)
秦延军(河北医科大学第三医院)
甘秀妮(重庆医科大学第二医院)
卢中秋(温州医科大学附属第一医院)
刘明华(陆军军医大学第一附属医院)
Emergency experts consensus on volume management in critical illness in the elderly
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Key words:
- critical illness /
- volume management /
- elderly
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表 1 老年危重症液体反应性急诊常用评估方法
液体反应性试验 机制 需要的血流动力学监测技术 主要的优点 主要的缺点与不足 适用性推荐等级 PLR 通过体位变化实现自我容量负荷变化 脉冲轮廓分析(CO)、超声心动图(VTI)、脉搏血氧计(PI) 避免液体过负荷适用于机械通气和非通气患者，易于操作 需要实时血流动力学评估，在腹内压增高(IAH)情况下不可靠，颅压高者受限，容量绝对缺乏时，意义不大 强推荐 脉搏变异度 机械通气时心肺交互原理 动脉导管持续监测 不需要监测CO，易于操作 不可靠的情况：自主呼吸，心律失常、IAH、低潮气量和低肺顺应性 推荐 SVV 机械通气时心肺交互原理 食管超声心动图(TEE)、PiCCO技术、经动脉压力波形分析技术(FloTrac) 连续监测CO，灵敏度和特异度较高 不可靠的情况：自主呼吸，心律失常、IAH、低潮气量和低肺顺应性 推荐 EEO test 机械通气时心肺交互原理 脉冲轮廓分析(CO) 易于操作 实时连续监测CO，需要完全控制通气 推荐 下腔静脉呼吸变异度(IVCd) 自主呼吸时和机械通气时的心肺交互原理 超声 适用于机械通气和非通气患者，不需要监测CO 需要熟练操作，在IAH的情况下价值有限，可靠性不足 弱推荐 液体负荷试验 15~30 min内输注300~500 mL晶体液 脉冲轮廓分析(CO)、超声心动图(主动脉瓣血流速) 适用于机械通气和非通气患者，实施简单 液体负荷增加较快较多 强推荐 微量液体负荷试验 1 min内输注50~100 mL晶体液 脉冲轮廓分析(CO) 液体负荷增加风险小 cut off值为5%，需要精准的CO量 推荐 
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