休克还要认识ppt课件.ppt

* * * * * * * * * * * * * * * * * * * The choice of fluids for resuscitation should, therefore, centre on fluids that resemble extracellular and intravascular fluid as closely as possible. The initial objective should be the restoration of the extracellular fluid space accompanied by rapid expansion of the intravascular volume. Given that some degree of capillary leak is almost certain in all forms of trauma, it is important that that volume expansion should be sustained until haemodynamic stability is ensured. It is also important to avoid glucose containing solutions, as the physiological response will ensure that the blood sugar rises regardless of glucose administration. * 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 resuscitatio