水电酸碱紊乱诊治幻灯片.pptVIP

FLUID, ELECTROLYTE, AND ACID-BASE DISORDERS 外科水电紊乱与酸碱失衡 Case Report 78 ys, female 平时一般状态良好，自行料理家务，活动 近月来纳差，近5天进食后呕吐，乏力、懒言、嗜睡，入院前一天未排尿 入院Bp 96/58 mmHg, P 106 bpm, R 28 tpm 心肺查体无明显异常；腹部稍隆，未见胃肠型及逆蠕动波，胃区振水音未闻及；肝、胆、脾未触及，全腹未及肿物，无压痛、反跳痛区；膀胱区叩浊，移动性浊音阴性。留置导尿，膀胱潴留尿液3200 ml，导尿后尿量30 ml/hrs。 Case Report (cont) Blood RT Hb 152 g/L RBC 452×1012/L Hct 45.2% WBC 107×109/L N 71% Electrolytes Na 128 mEq/L K 2.8 mEq/L Ca 1.83 mEq/L Cl 87 mEq/L TCO2 32.8 mEq/L Liver Function Alb 28 g/L Glu 26 g/L Others normal Kidney Function BUN 7.1 mg/L Cr 218 mg/L Blood Sugar 4.6 mEq/L Urine RT Density 1.030 KET +++ Others normal Outline Introduction Physiology Pathophysiology Dehydration Disorders of Composition Acidosis and Alkalosis Body Fluids Total body water is contained in 2 compartments. Intracellular Extracellular Extracellular is divided into 2 spaces. Intravascular Interstitial The intravascular space contains the plasma volume. 25% of the extracellular fluid 8% of the total body water 5% of body weight These compartments are in dynamic equilibrium, and alterations in one ultimately leads to compensatory changes in the others. 体液的构成 体液的成份 Water Transcompartmental Movement The Third Space An additional ECF compartment, the transcellular compartment, consists of water that is poorly exchangeable under normal circumstances. This fluid is separated from other compartments by both endothelial and epithelial barriers. Included in this category are cerebrospinal fluid, synovial fluid, water in cartilage and bone, fluids of the eye, and the lubricating fluids of the serous membranes. Gastrointestinal juice also belongs to this category. Together, these fluids constitute approximately 4% of TBW. (1%----2%BW) ELECTROLYTE CONCENTRATION QUANTITY IN GASTROINTESTINAL SECRETIONS Maintenance of Fluid Homeostasis 机体通过肾来维持体液平衡，保持内环境稳定。 肾调节功能受神经和内分泌反应的影响。 肾调节功能的实现 先通过下丘脑－垂体后叶－抗利尿激素系统来恢复和维持体液的正常渗透压 后通过肾素－醛固酮系统来恢复和维持血容量 血容量锐减时，机体将以牺牲体液渗透压的维持为代价，优先保持和恢复血容量，使重要生命器官的灌流得到保证。 Maintenance of Acid-Base B