课件病理生理学脱水.pptxVIP

A2-605室QQ 群: ４１８３６７０７１邮箱: wuwei1970222@Blog: zhuwuwei1970吴卫 病理生理学教研室Disorders of water and sodium体液的分布BW：70-kilogram 42 liter （60% BW）Plasma 3.0L（5%）ISF 11.0L （15%）ICF 28.0L （40%）transcellular fluid 透细胞液(third space)150mEq/LECFCl-HCO3-Na+Ca++Mg++0K+PO43-proteinand organic anionsICF150mEq/LanionscationsmOsm/LPlasmaISFICFNa+130+3.5-5.04.0140Ca++1.3(1.0-1.4)1.20Mg+0.80.720Cl-103-1121084HCO3-2428.310HPO4-, H2PO4-2211Protein1.20.24Creatine 0.20.29…………Total Osmolar activity 280-310281.0281.0 正常人每日水的摄入与排出Intake fluids ingested from metabolism Total intakeOutput insensible–skin,lungs Sweat feces urine Total outputQuantity (ml/day)2250 350260090010010015002600 正常人每日钠的摄入与排出Intake natrium ingested Total intakeOutput Sweat and feces urine Total outputQuantity (g/day) 10.5 10.5 0.510.010.5影响肾脏水、钠重吸收的主要激素ADH：渗透压（水）Ald.：容量（钠）ANP（心房利钠因子）其它:循环血量?;AT-II,应激,药物…Plasma osmolarity 血浆渗透压?BP / ECBV (effective circulatory blood volume 有效循环血容量）↓ 渗透压感受器口渴中枢尿量↓尿比重?BP / ECBV (effective circulatory blood volume 有效循环血容量）↓ Na+/K+AT II 尿钠↓ECBVeffective circulatory blood volume 有效循环血容量 =BV blood volmeblood volume (BV)cardiac output心输出量heart pumpECBVperipheral resistance外周阻力vessel capacityECBV=BV BV ?cardiac output?心输出量heart pumpECBVabsolutely绝对?peripheral resistance外周阻力vessel capacityECBV=BV BV cardiac output?心输出量heart pump?ECBVrelatively相对?peripheral resistance外周阻力vessel capacityECBV=BV BV cardiac output心输出量heart pumpECBVrelatively?peripheral resistance?外周阻力vessel capacity? Blood [Na+] 130-150mmol/LTotal plama osmolarity 血浆渗透压 280-310mmol/LUrine output 尿量 1000～2000ml/日Urine SG 尿比重 1.015～1.030Urine osmolarity 尿渗透压600～1000 mmol/LUrine Na+ 20-40mmol/LAld.? BP (ECBV)? 血浆渗透压↑ADH ? 水钠代谢紊乱体液容量?: 脱水Dehydration 低渗性 等渗性 高渗性体液容量?: 水中毒（自学） 水肿Edema 盐中毒低渗性脱水hypotonic dehydration失钠失水, 血清钠 130mmol/L,血浆渗透压280mmol/L继发性脱水： 肾： 肾外: 消化道，皮肤外周循环衰竭出现早，明显失水体征(细胞外液? ?) 尿量一般不少，尿相对密度? 尿钠减少提捏实验高渗性脱水hypertonic dehydration失水失钠,血清钠 150mmol/L,血浆渗透压310mmol/L水摄入过少，水丢失过多(单纯失水, 低渗液丢失)口渴明显 CN