失血性休克下輸液復甦療法的應用與護理

Fluid Resuscitation Therapy Application and Nursing Following Hemorrhagic Shock

失血性休克為創傷患者常見的死亡原因。過去公認積極及大量的輸液復甦治療乃為失血性休克患者的必要措施，也是目前臨床急重症護理人員最常執行的護理措施。過去已有許多研究針對輸液復甦進行討論，證實不合理的輸液復甦將導致器官傷害，甚至進展到不可逆的多重器官衰竭與死亡。因此，本文前半段主要是討論身體面臨外傷或休克情境時，所誘發一系列複雜的初級及次級自體免疫反應，而造成後續多重器官衰竭的雙擊理論。後半段再深入探討大量輸液復甦所造成的細胞、發炎反應及各系統的不良影響。自1997年起，高級創傷救命術已制定一套輸液復甦的策略可供依循，然而至目前為止，輸液的速度及量的多寡、輸液的黃金時段、晶質及膠質液的種類等仍然有許多的爭議點，導致臨床無一定的處置準則。因此，本文期望以此議題，引發臨床急重症護理人員思考失血後積極大量輸液復甦療法，對患者各細胞與生理功能的影響，預防不合適的醫護處置所造成後續器官二次傷害的後果。

Hemorrhagic shock is the most important cause of early death following major trauma. Aggressive fluid resuscitation therapy is an important treatment approach for hemorrhagic shock, and nurses in critical care units must be adept at the skills to administer such. However, past studies have shown that failure in multiple organs has been induced by aggressive fluid resuscitation therapy. This article first discusses the two hit theory following trauma or shock, then discusses how aggressive crystalloid-based resuscitation strategies are associated with cell, multiple organs and immunological and inflammatory mediator dysfunction. While the Advanced Trauma Life Support (ATLS) training program has provided fluid resuscitation therapy guidelines since 1997, resuscitation volume, rate and time as well as crystalloid and colloid ratios remain uncertain. Therefore, we hope this article can provide evidence-based knowledge related to fluid resuscitation therapy in order to avoid secondary organ damage in critical care.