围术期的液体管理ppt课件.ppt

* Crystalloid solutions will expand primarily the extracellular fluid volume. It is commonly stated that crystalloids “disappear” from the circulation in a relatively short space of time. This is not entirely correct. In reality, and the crystalloids redistributed between the intravascular and extracellular compartments in proportion to the normal distribution of fluid between these two spaces: that is approximately 1: 4. Consequently, in order to achieve full volume expansion after blood loss, three to four times in the volume lost must be replaced with crystalloids alone to replenish the intravascular losses. Furthermore, the Starling’s forces will ensure that, in the initial resuscitation phase, crystalloids will be deceptively effective, but once the capillary perfusion is re-established, the crystalloid will rapidly move out of the vascular space. The use of crystalloids will result in a reduction plasma oncotic pressure. * Isotonic colloids will not escape from the normal vascular tree and consequently will produce a plasma volume expansion equal to the volume of fluid administered. However, these colloids will not expand the extracellular fluid space, and it is necessary to accompany the colloids with some degree of crystalloid solution replacement to ensure adequate resuscitation of this important compartment. The use of isotonic colloids will also retain the normal plasma oncotic pressure. * * * * 小儿液体的生理需要量：新生儿 低体重新生儿第一周的液体需要量(ml/(kg*d) 年龄（d） 751-1000g 1001-1250g 1251-1500g 1501-2000g 1 85 75 70 60 2-3 105 95 80 75 4-7 130 120 105 95 小儿电解质的需要量 Na+ 2.5mmol/100kcal K+ 2.5mmol/100kcal Cl+ 5 mmol/100kcal 葡萄糖 25g/100kcal 维持液：( /L) 葡萄糖(g) 50 Na+(mmol) 25 K+(mmol) 25 Cl+(mmol) 50 水电解质平衡紊乱 脱水 原因：高热、禁食水、呕吐、肠瘘、腹膜炎、腹泻 程度：轻(5%).中(10%).重(15%) 分类： 高渗性脱水 Na+150mmol/L 低渗性脱水Na+120mmol/L 治疗：2：1溶液 30; 50; 100 ml/kg 水电解质平衡紊乱 水肿 指细胞外水量增加。低钠性水肿也称作水中毒。 原因：水摄入过多、清水灌肠等 症状：浮肿、惊厥、呕吐、