课件：胶体与晶体液.pptVIP

淀粉类 分子量范围70 ~ 450 kDa决定特性 长到非常长的作用时间 可能会改善微循环和内皮细胞功能 对凝血功能有轻到中度的影响 过敏样反应风险最小 淀粉类 体内 分子量决定于 体外 分子量和取代级 体内 分子量决定副作用 体内 分子量低 良好的容量效应 最少的并发症 总结 右旋糖酐类 中时扩容效应显著抑制凝血功能右旋糖酐40对肾功能影响用量限制15ml/kg/24hr 明胶类 短时扩容效应对凝血功能影响最小没有用量限制 淀粉类 短到长时扩容效应对凝血功能有最小到中度的影响用量限制 33ml/kg/24hr (6%) or 20ml (10%) THANK YOU SUCCESS * * 可编辑 * * The colloids solutions, on the other hand all produce at least for volume for volume expansion of the intravascular volume and consequently they allow rapid resuscitation with a well maintained oncotic pressure. It is undoubtedly true that the use of colloids solutions is associated with less tissue oedema than is the use of crystalloids, but it is less clear that this translates into less organ oedema, particularly in the brain, the kidney and lungs. The colloids all interfere with coagulation to a greater or lesser degree and have a variable concentration of electrolytes in the suspending solution, although most of our suspended in 0.9% saline. The half life of the colloids is variable, depending largely on the molecular weight of the colloid and all of them exhibit some degree of adverse anaphylactoid reaction. All of colloids solutions are significantly more expensive than the crystalloids. * * The assumption that the crystalloid solutions are harmless is also not justified. The standard saline solution of 0.9% is hyperoncotic and significantly acidotic. It contains a highly unphysiological chloride load that has been associated with a metabolic acidosis and may possibly lead to renal dysfunction and an increased bleeding tendency. * 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 disadva