晶体与胶体液-培训课件.pptVIP

* Although the solution is acidic in the bottle, once it is infused, the lactate is rapidly metabolised over about 15-20 minutes to carbon dioxide and water on this is consequently converted to bicarbonate, provided that the patient has adequate hepatic and renal function. * Foremost purposes, there is no real difference between Ringer’s lactate and saline, although the chloride load from saline baby disadvantageous in patients with a metabolic acidosis. The lactate made the problematic in patients in whom it cannot be metabolised, including those with the liver failure and diabetics on metformin(二甲双胍). It should be remembered that the physiological response to stress produces a reduction in the plasma sodium, as the ADH mechanism results in an excessive retention of water. The use of excessive quantities of Ringer’s lactate will exacerbate this problem. * The key points on crystalloids, therefore, are that large volumes of relatively unphysiological solutions may need to be administered and the these may lead to important abnormalities in physiology in traumatised patients. There is some evidence that the use of hypotonic solutions such as Ringer’s lactate may adversely affect the outcome in patients with brain injury. * Hypertonic saline has been advocated for resuscitation for many years. The concept is that very high concentrations of sodium chloride will reexpand the intravascular compartment very rapidly at the expense of the extracellular space. For short-term, but the resuscitation hypertonic saline has been shown to be beneficial in a number of circumstances, particularly where trauma is involved cerebral injury. It is, however, effective for a limited period only and the hyperchloraemia may have negative long-term consequences. Combine with either hydroxyethyl starch dextran, hypertonic saline has been shown to reduce excellent resuscitation with improved cerebral outcome. * There are essentially four types of colloids solutions: the various plasma