液体复苏是急危重症救治最基本、最重要的环节之一,但在液体复苏后多数患者存在不同程度容量超负荷.有证据表明,液体超负荷对危重患者无益,反而增加死亡率.多中心研究证实危重患者进展至多器官功能衰竭时,液体超负荷是影响预后的独立危险因素.有学者认为只要利尿剂有效,可在短期内大剂量使用；但也有研究发现利尿剂不能预防和治疗急性肾损伤,不能使危重患者获益.持续液体超负荷且对利尿剂无反应时,应早期予以连续性血液净化治疗.%Aggressive resuscitation therapy is the most basic and most important medical treatment in patients with critically ill. Fluid overload may occur in critically ill as a result of aggressive resuscitation therapies. In such circumstances,persistent fluid overload must be avoided since it does not benefit the patient while it may increase the mortality. When organ failure develops in critically ill patients, fluid overload has been shown to be associated with worse outcomes in multiple disparate studies. It has been shown that diuretics should be only short term as long as it is effective, while other multiple randomized controlled trials have not shown benefit in the use of diuretics, either to prevent AKI or to treat established AKI. If fluid overload and the patient does not respond to diuretics, early initiation of continuous renal replacement therapies may be preferable.
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