FluidsandBloodTransfusionpracticeinSurgery外科手术中的液体和输血实践.pptxVIP

会计学1FluidsandBloodTransfusionpracticeinSurgery外科手术中的液体和输血实践 Aims of Infusion therapyTo replace third space lossesTo restore plasma volumeTo restore/enhance oxygen transportTo replace/restore plasma composition-electrolytes, oncotic pressureTo augment haemostasis第1页/共28页 Plasma Volume therapyColloidsNatural: AlbuminArtificial: gelatinDextranStarchBlood+/componentsWhole bloodPacked red cellsFFPPlasma Proteins(bioplasma)第2页/共28页 Choice of Volume therapyWhichever one chooses:1.Choose the fluid for the correct purpose.2.Know the composition of the fluid chosen.3.Be aware of the risks and benefits of the particular fluid chosen第3页/共28页 Properties ofthe “ideal plasma substituteDistributed in intravascular compartiment onlyReadily availableLong shelf half-lifeInexpensiveNo special storage or infusion requirementsNo special limitations on volume that can be infusedNo interference with blood grouping or cross-matchingAcceptable to all patients no religious objections to its use.Iso-oncotic with plasmaIsotonicLow viscosityContamination easily detectedHalf-life should be 6-12 hoursShould be metabolised or excreted, not stored in body第4页/共28页 What is the Ideal Colloid?第5页/共28页 Historical Evolution of Artificial Colloids第6页/共28页 Volume expanding efficacy of Colloids第7页/共28页 第8页/共28页 GelatinsAdvantagesSmall MW=rapid excretionPreservative freeOnly 1% metabolizedNo storage in RESMinimal effect on coagulationDisadvantagesBovine source(collagen)=disease transmissionRapid clearance= continuous infusion, more volumeAnaphylactoid reactions第9页/共28页 DextransAdvantagesDecreased: blood viscosity, platelet adhesiveness, RBC aggregationClinical uses: plastic surgery, carotid end arterectomyprophylaxis of thrombembolectic phenomenonDisadvantagesBriefer volume expansionHighest incidence of anaphylactic reactionsInterferes with blood grouping , clotting, antiplateletWorsen renal failureHyperviscosity syndrome in renal tubules第10页/共28页 Hydroxyethyl Starches (HES)Introduced in 1960s to overcome