晶体液与胶体液.pptVIP

**Foremostpurposes,thereisnorealdifferencebetweenRinger’slactateandsaline,althoughthechlorideloadfromsalinebabydisadvantageousinpatientswithametabolicacidosis.Thelactatemadetheproblematicinpatientsinwhomitcannotbemetabolised,includingthosewiththeliverfailureanddiabeticsonmetformin(二甲双胍).Itshouldberememberedthatthephysiologicalresponsetostressproducesareductionintheplasmasodium,astheADHmechanismresultsinanexcessiveretentionofwater.TheuseofexcessivequantitiesofRinger’slactatewillexacerbatethisproblem.**Thekeypointsoncrystalloids,therefore,arethatlargevolumesofrelativelyunphysiologicalsolutionsmayneedtobeadministeredandthethesemayleadtoimportantabnormalitiesinphysiologyintraumatisedpatients.ThereissomeevidencethattheuseofhypotonicsolutionssuchasRinger’slactatemayadverselyaffecttheoutcomeinpatientswithbraininjury.**Hypertonicsalinehasbeenadvocatedforresuscitationformanyyears.Theconceptisthatveryhighconcentrationsofsodiumchloridewillreexpandtheintravascularcompartmentveryrapidlyattheexpenseoftheextracellularspace.Forshort-term,buttheresuscitationhypertonicsalinehasbeenshowntobebeneficialinanumberofcircumstances,particularlywheretraumaisinvolvedcerebralinjury.Itis,however,effectiveforalimitedperiodonlyandthehyperchloraemiamayhavenegativelong-termconsequences.Combinewitheitherhydroxyethylstarchdextran,hypertonicsalinehasbeenshowntoreduceexcellentresuscitationwithimprovedcerebraloutcome.**Thereareessentiallyfourtypesofcolloidssolutions:thevariousplasmaproteinpreparationsderiveddirectlyfromplasma,thegelatins,thedextransandthehydroxyethylstarches.**Colloidsderivedfromplasmaproteinsincludefreshfrozenplasmaandcryoprecipitate,twoproductsthatshouldbeusedexclusivelyforthetreatmentof