外科病人体液失调lxb.pptxVIP

外 科 病 人 体 液 失 调Body Fluid Imbalance of Surgical Patients ; extracellular fluid ( Na+) (20%) intracellular fluid (K+) (35-40%);;平 均 值 与 正 常 值 范 围  Average and Normal Range ; 每 日 水 出 入 量(一)  Daily water intake and excretion;(ml/day);体 液 平 衡 及 渗 透 压 的 调 节Regulation of Body Fluid Balance and Osmotic Pressure;渴 感 (thirst) ;Hypothalamus－Posterior pituitary－ ADH ;RAAS; 体 液 代 谢 失 调 Imbalance of Body Fluid metabolism ;水 和 钠 的 代 谢 紊 乱 Disturbances of water and sodium balance;概念(conception) ;消化液(digestive juices) intestinal fistula肠瘘, severe vomiting剧烈呕吐 等渗液积聚在第三间隙 (iso-osmotic fluid accumulated in the 3rd space) infection (abdominal cavity or retroperitoneal) 腹腔内或腹膜后感染 肠梗阻肠腔积液，burn; 2-3% weight losses, fatigue, poor skin-turgor 4-6% weight losses, clammy limbs, oliguria 尿少, pulse is weak and fast, BP decrease 6% weight losses, serious shock, fantod 烦燥, phrenitis 谵妄, coma昏迷 ; hemoconcentration 血液浓缩 RBC, hemoglobin and HCT increase Serum [Na＋] and [Cl－] normal Specific gravity of urine 尿比重 increase accompanied with (or not) acidosis/alkalosis;Active treatment to primary disease 迅速扩容 常用 ，每丧失体重1%补600ml+ 生理量（4.5g NaCl and 2000ml） Intimately monitor heart function HR, CVP, PAWP 纠正缺水后应预防低血钾，但须尿量＞40ml/h才补钾; Balanced Salt Mixtures 乳酸钠林格氏液，复方生理盐溶液(Ringer’s), 1.25% 碳酸氢钠溶液 单用Normal saline ，可引起 血压稳定者，可先补 60kg成人，BP下降则快速补充 ;概念(conception) ;massively continuous losses of digestive juices repetitive vomit，long-period gastrointestinal decompression，chronic intestinal obstruction skin losses