课件：麻醉补液的计算.ppt

* 2 The crystalloid colloid controversy has dominated fluid therapy for the last 50 years. The debate has fluctuated from one side to the other as knowledge of physiology has been extended and as different fluids have become available. * To understand that the basis of the controversy, it is important to appreciate the background physiology of fluid disposition in the body. The average human body contains approximately 60% of the total body weight as water. This water is partitioned into two major compartments, the extracellular and the intracellular fluid spaces. The extracellular fluid is further subdivided into two major compartments, interstitial and intravascular spaces, and a minor group of fluid spaces made up of special, isolated fluid spaces formed by special processes. * In the average, 70 kg man, the total extracellular fluid volume is approximately 14 l, of which the plasma component is only 2.8 l. The intracellular space is approximately 28 l, and includes a significant portion of the total blood volume, as approximately 2 l of a 5 l blood volume is made up of intracellular fluid. * The chemical composition of extracellular and intracellular fluid is quite different. Extracellular fluid is dominated by Na and Cl while the intracellular fluid is dominated by potassium and phosphate. The plasma volume is slightly different from the interstitial fluid compartment in that it contains a small quantity of protein that does not defuse freely into the interstitial fluid, and thus creates a small osmotic pressure difference between the plasma and the interstitial fluid. The osmotic pressure of the intracellular fluid is considerably higher than that of the interstitial fluid, and thus creates a higher pressure within the cell which creates tissue tension or turgor. * The osmotic pressure of plasma is expressed either as osmolarity (mosm/litre of solvent), in which the sum of all the measured osmotic particles is calculated, or as osmolality (mosm/Kg of s