pathophysiology of fluid imbalance病理生理学的液体失衡.pdfVIP

/content/4/S2/S3 Pathophysiology of fluid imbalance Uwe Kreimeier Ludwig-Maximilians-Universität München, Munich, Germany Received: 3 August 2000 Crit Care 2000, 4 (suppl 2):S3–S7 Published: 13 October 2000 © Current Science Ltd (Print ISSN 1364-8535; Online ISSN 1466-609X) Abstract Fluid imbalance can arise due to hypovolemia, normovolemia with maldistribution of fluid, and hypervolemia. Trauma is among the most frequent causes of hypovolemia, with its often profuse attendant blood loss. Another common cause is dehydration, which primarily entails loss of plasma rather than whole blood. The consequences of hypovolemia include reduction in circulating blood volume, lower venous return and, in profound cases, arterial hypotension. Myocardial failure may result from increased myocardial oxygen demand in conjunction with reduced tissue perfusion. Finally, anerobic metabolism due to reduced perfusion may produce acidosis and, together with myocardial dysfunction, precipitate multi-organ failure. The splanchnic organs are particularly susceptible to the deleterious effects of hypotension and hypovolemic shock, and these effects, depending upon their duration and severity, may be irreversible despite restoration of normovolemia by fluid administration. Patient monitoring in the intensive care unit typically relies upon central venous pressure devices, whereas the primary focus in the operating theater is blood volume deficit estimated from