外护(上)重点

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ឋឋឋᑖ᤬ᐭᑖ᣸ᜫᜫீᜫ

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ᜫᜫ

⊈
A150mmol/LECF⊈
v135mmol/LECF⊈
ᳮ!"᜜extracellular&'1135-150mmol/LECFfluid$᳝(ECF&'$%TECF&'(ᓄ⊤-.ஹ01ஹ0234-.ஹ560789-.BC801ஹᾭ,6:18ᕜ<=>⊦@,⊈%:1EGH'ᓰ3ḄGH⊈
v130mmol/LKF2~3%KH4~6%3H,H⊈
v120mmol/L3H

16%⊈
v110mmol/LL᤬ᐭHN6ἭPQ
Rᜫ—
⊡ᐙᕏᔢஹῳaஹbcdMRᜫHSஹᑭ0Sr-Rᜫᙠfgh◣jῳᑺஹᜧ☢XYZk■n◀W8ᐜq9rn◀8ᐜr9q8zn◀8ᐜr9q8m☟t5%ℍ⃔qwᡈ{r|}rஹqᔜ0.45%yᓄ
wᐜᨔ9w☟t⊝rwᡈr*⊝rwH⏚
ஹ⏚
⊡ᐺ-ᐜ᡽&9⏚ஹᐜr9qஹᐜᨔ9ஹᐜ9᠒ஹஹM0⊡:ஹ☟trஹ⊡ஹ⊈¡ឋ¢ஹὁ¤ஹ¥¦§⊡▲©ªஹ©«¬ஹ©᦮Hজ°ᳮ◤⌕:ᡂ¤|200´2500ml,µ¶·¸fH¹3Ḅ

210Kg*100ml/(Kg.d)+
Ḅ10Kg*50ml/(Kg.d)+ᐸ*20ml/(Kg.d)ঝᜫ■:f24h⊡ᐙ■Ḅ1/2,Ḅ1/2ᙠ
24h⊡ᐙঞMºឋHজ°ᳮ◤⌕'»⊡¼r500-1000ml,ᒕ¾ᵨℍ⃔qw⊡ᐙঝÁRᜫ'»ঞÃÄRᜫ':RᜫÅÆ⊡Åƺ-fH¹8h⊡ᐙÈ'Ḅ1/2,ᒕ¾Ḅ1/2ᙠÉ916hᑁᙳᒴªᐭᨔwHℍ⃔qஹ4ÍrwHÎÏÐஹ⊈ÑᑴÓ^«Ð^5ÔHℍ⃔qÕᵯ×ÐwHÎÏÐஹ4Ír
ᙠ!"᜜K8!"᜜H⊈ÑஹØÙhÚL⊈
135-150mmol/L^^ᵬ3.5~5.5mmol/LÜÝ⁚
⊝ᨵà
84à8ᦑ᧕,ᙠ⊈&'┦:8¤äzåᱨ$%|ç8èᐜàéê

3ឮì⊈&'82᝞ឋîï⊈&'ðñ8èᐜ᡽&,ᓽà
8ᢙᑭ0ôজö÷øᾙᐶûឋðñ8ø4üB—
DEFGõঝýb⍝ÿ
≯ὅឋ᫱ঞ⊈
!ஹ⁚$%&ஹ⊈'ট)*+,-.+/0134ឋ⏚)6H7&ឋ5ឋ9ঠ34ឋ5)6ஹ7&ឋ89KஹH-Na:ᣚK<ᓽH>Na:ᣚ?7&ឋ⏚ឋ9AIᑖL⊡N◤3~6ᜩQᜧ3~6gSᓄNজ☟ῗឋb
10%ℍdd⏚┛ஹ5%ᶭWX⊡NYᐰஹ[\ঝ☟ᾭ⊡N-10%SSᓄ┛

4ᓄNfgh☟i
QᓣkNv3g,ᓽs᎔5%ộ40mmol,l^iM20mmol/h“ᐜnhdᐜᨔhp,r9sW☟ᾭ⊡NtuজvwxyzQᜩ⊡N40-60mmol,{|}~ᓄN3-6g8:<40mmol/Lঞ▲:<20mmol/hট9ᵹsKᡂ9>40ml/hh$ᜫ&-10%ℍ⏦⏚┛ᡈ5%Sᓄ⏘1b20mlt,ᢙNḄ8⊈┛z&2.25275mmol/L⊈┛ᵬஹ┛ஹDḄ¡⁚¢┛£r┛⊈¤¥¦⊤T,ᾙᐶ«ឋ¬᧕¯ஹW°±ᢣ³´Aµᩈ±┐¸¹ஹº»¼ᤊஹᾙ¾\ஹΎ7ÀÁ

5ÂIᶭ-10%ℍdd⏚┛ᡈ5%Sᓄ┛Ã10☟ᾭtÄPH7.35-7.45⏚5¡⁚T)-.ஹÅஹÆ35ÇÉ⏚Ê£ᡈH+ËᜫÊ£³ᕏᔢACO2᣸ÑÒÅÔÕÊÈHCO3-ËᜫÊ£ᡈHCO3-¬£Ó⏚⊈¤CO2᣸Ê£³ῳÍA⊤ÖᔾØÙÚäQ¤ÖᔾçèஹéêஹÖᔾញë☢⁐ÝÞஹ᳛àÖᔾå᠒ÕëÚஹ⊈'áஹ᧕âãIí>5ឋÃîÕᑗñᶭ5%ï

6òজᨵõḄᓻ◅ঝPC:N⊈¤ஹøN⊈¤ஹ┛⊈¤ஹ$ᜫ&ஹ⚝ᑁ'ᳮ¬øஹᾯü⊡-4ý£<ஹ⊡þÿஹ
⊡ஹ᝞◤⌕24hḄᜧஹஹ᫱ஹῳஹᕏᔢஹῳ"ஹ#ஹ$%ஹ&#ஹ'(ᨵ*+ᜫ⊝,/0(12345⊝67+8D^^ঝ⏚᪍!"9⊡ᐙ⊈<ஹ=>?@A4BCDEF*GᑮIJᨵKLMNOPQḄRᨵᦔTU⊈┦WஹXYZ[0\ஹ]^_`Aaஹbcdᐸf┯hij᠒lᐳnᱯpḄ/ᳮrs9EtᓻញḄwxyᔠ{஺ᑖ~Dজ⊈<ឋ8ஹᜫ⊈ஹᜫ+ঝឋঞឋটឋঠrឋBCᨵᦔTUḄ⌕MDᐙ\Ḅ⊈<ஹᨵᦔḄPஹ〉Ḅ⊈

71ஹTUḄᓄDজTUᦈBCb9ZঝTU᡽ᡷ¢ᑴ8b⏚9¥ZঞTU⊦§BCᜫb90Z0ஹDIC2ஹbcᦋDbcឋ⏚©ªஹ(bc«¬3ஹឋ®¯°±A⊈²Z[³4ஹᑁµᘤ·¸¹ឋ³MSOF¥º»ᘤ·¼(⊦§D½¾ᡈ½¾RÀ⌕ᘤ·ᡈº»nÁᡈÂùļ(⊦§9EBC/ÅḄÆ⌕ÇL8ÈஹÉஹஹᾯஹËஹÌ⍝BCḄwÎ⊤QAஹBCÐD⊈èᡈᶍஹ—çᓣì8TUᦈ\ᾭçW×>èᡈW

8BஹBCD⊈89ឋ஺34@ᨵ>⊈AB᝞!">⊈DᡈEEஹFG1ஹH⊈IJKL⊈MNOPJ=জCVPRS☟ᾭ7USVᡈWῚYῚ☟ᾭᑁḄ7O[\]5~12cmH2OঝPCWP^_1⊈`┼7bcd`efUS8ᐭ^hNᾭijk=lḄ7OটS᣸>COoS᣸>p⏚CI

9ᑣI᪷st◀vw✌⌕᡽1ஹL{|ញ~ᶭᓷᓷᡈᜮo20~30஺ஹ;,15~20஺ᓷ\ᑴ>⊈ஹᵨᢙஹᢝᔾ⍝eᵹஹஹ⊡ஹᨨஹ╋☟IᓷLR஺ᜮW¡¢ᨵᑭ¤ᢝ¥⍝eᵹ¢¦O§¨©¢ᦋᗐ¬AB஺;,¢®8☟ᾭ⊈¯M¢¦%°±>k²³AB஺2ஹ⊡ᐙ⊈ᨬ¶so✌⌕Ḅ·¸3ஹᜐᳮ»#v4ஹ¼[⏚½⊝ᜫ⊝5ஹᵨ⊈`©ឋÀ⊈`ᦈÂÀஹ⊈`᡽ÃÀÄ⊈`©ឋÀᵨÀ»ÅÆ■ÈÉÊ®ஹ᠒ÉÌÍÎᵨÀஹ■᜜Ñஹ

10ὶᔠᵨÀஹÔÕÖ6ஹᵨᢙ×À7ஹ~ᶭDICᦋᗐØÙÚ8ஹᵨÛÜÝÞᦋᗐØÙÚஹ¦ßSàᦈÂOÄ|á1ஹᓷ2ஹᑴ>⊈3ஹᔾ⍝eᵹ4ஹᦋᗐ¬B᝱5ஹãᵨᢙMAST6ஹäᢝ[\åæ7ஹ╋☟ஹÕÖvçজèB᝱ঝêëåìᢣᦪ-ðñᦈÂ7

11ᢣᦪ1.0⊤òó¼[¢2.0⊤òᨵô&ᔾ30õ/ᑖᡈv8õ/ᑖ¢⊤òvçᓻ&åæ40࠷ᡈv36࠷,úòvçᓻ&89ឋᔾûüஹ#äஹNᾭ⊈ᑖ7v60mmHg,ᔾý@ᦋᗐ,úòARDSঞஹ^01টᕜ☟ᾭ◍⊈ᐙঠডঢᱯCVPPCWPCOCl⏥:"#$⏥%ᱥᡈᐸ)*+,ᢓᑴ/0ᡈᕜ2345Ḅ789:,;<=ᐰ?ᡈ?ᑖᨚᜫCDE,ᡈFGᾙIJஹLMNOPQᡈRᜫḄSTᢈV஺ᑖX:

12জᐰ[»\ᐭஹ☟ᾭঝ_?⏥-ঞbᑁHஹde᜜⏥টhᔠ⏥ঠjẠ⏥S⏥lᜐᳮᐰ:"⏥%☟oᔾ⍝ᔾᐭᡈ3Gᑁஹ☟ᾭrMsᐭ=ᑁ,ᨚᢓᑴ23459:,tuv⏥wᵨḄ*+஺ᔾᐭ⏥*+SyᑁzN20{ᓄ}~y\Xᔾᐭ⏥%ஹ☟ᾭ⏥%ஹGI%ஹ⏥ឋ╋%ᔩᖹஹ\ᙠ;ᵨᐰজᐰᔾᐭஹ☟ᾭঝᐰᢝ☟ᾭ⏥¡Sᦔ£ஹoᔾ⍝¤¥¦ஹ¤§y¨©ஹªᜓ¬ᓫঞhᔠᐰ®¯ᾭhᔠ⏥°ᵨᨬ²³_"´_ᳫ3rMஹ¶ஹᦱ¸ஹ¹ᐭºr»wᵨ

13¼ᕜ23Ḅ7½?¾tuv⏥wᵨḄ*+஺_%ᱯ¡—ÀᢙÂᾦX\᡽⊈জ⊤☢⏥ঝ_?ÇÈ⏥ÉÊÉῳÌV,Íδ%ÇÈÏÐÑÒÓ_%ᱥḄᔾᦈஹÒÕwᵨஹ■×ឋL°ஹPØÙ☢Ú⊈,Ûᙠ_%ᑁÜᐭÝÞßঞàáâãট23âãᑖXAஹᾦXèéஹQᦔஹêᦔஹëᐰḄìᵨ%å×ឋíஹ⏥QஹîeïðñTSᵨ¼_?ÇÈ⏥ᓱíḄ23âãçᡂóSô▲1000mgTöᦔஹÕᦔḄ_÷ᓱ×ឋᜧஹîeïðö,〉ᵨ¼⊤☢⏥ஹ23âã»◀_ç?ÇÈû᜜Ḅ_

14ᡂóSô▲⊤40mg23âã80mgBஹ⏒ýXþᓱçᑭᓱஹᓱஹᓱᑁ⏥:ᳫᐭ◣ஹ᜜◣ᡈ‒,ᑖ"#Ḅ%&'()*+,-☢/01Ḅ23ஹ4&5678ᜫ):;ᾙ=>Oজ◣@,ῪBᐭ◣〉D2~3EF/ᑁḄῳஹHῚஹJKLMஹN▢PQἭSTUV"#WXYZ᝞⚝ᑁ]^_"ᩈbcdefgh2i;k᜜lᡈm᪶cញឋq⊦ᡈs/᱘vwcxyῪz{|ஹ}⊈ஹῳᑁ]^_ঝ᜜◣@ঞ@defL3~4ஹL4~5^^8ᙳ

15BᓫBᶚB-☢⁚ZfஹdefBஹdef(Iஹ7ᔣஹ■deᡂ£“¥¦2§¨┐ª«)ᾯ¯8ᜫஹ°±²ᾯஹ®¨³]´µᐜ#(7·¸Ὺᑺº
5min«»ᢝº〉D½Ὺ/PQ¾ῳPQ½Ἥ:UV"#WXYZ᝞⚝ᑁ]^_c¿bcdefgh2ick᜜lᡈm᪶cញឋq⊦ᡈsZvwcxyῪz{|ஹ}⊈ஹῳᑁ]^_ᳮ᷒::⏥Àᜓ1ஹqᳮÃᳮ

162ஹÄ_Å⏥ḄὊǯ⃩ÉÊ3ஹ8ᓄ⍝ÍᜓTᡂἭÎ12hἭÏ4hÐÑÒἭÏÎ4~6h4ஹÓÔÕ·¸Öᓱ5ஹghÍᜓᜓg6ஹ⏥ÀᵨB⏥À30~60minজØÙÚT~ÜÝÞᢙàáឋঝâ,╋☟BTᙢæçஹèéêë¾ঞ╋{BTìí,ஹᔩᖹஹðñòটᢙôõBTöᡲøᢓᑴûᑖü1ஹᐰþv½TÿḄᨵᕏᔢஹஹᔾᨚஹᔾ⍝᫱ஹ⊈ஹ⊈ஹஹᨬḄஹ2ஹ!"#$%Aஹ&ឋ()%*+,,-ᵨ/01ஹ23ᐭ⊈5ᑁஹ

173/89⊈:;<ஹ=>?@⊦BCᵨ/*DIJ—ᨬEᨵᦔᑺ1ஹᨬᨵᦔHIJᜐᳮ%জNᓽ/ஹPQRঝTN☟ᾭW⍝,)ᵨᙢZ[ஹ\]^_`ab5c5;ঞ⊈fgὅP!ijᡈlmnoᢝqrRটᔾtNᓽuvwBஹx᝱()Cz{J3ஹ|5ᑁ!⏥"#$ᐰ!⏥C᜜◣ᨬᓻ◅Ḅ"#$\⊈fg00ஹᔾᢓᑴஹូᕏᔢஹ&ឋ()!⏥ᳮ%ᶇ!⏥w⏨ᡈICU1ஹᔠ〉?9ᐰ!a=>w⏨a᪋ᓷ,ᜮᔣTM஺!a¢?9£ᱯ¥⌕§஺|5ᑁaᓷ6~8h,¨©f◣ὅa)᪋

18ᓷ2ஹª«=¬xᓄ%®1~2hª«¯°±,-²³?´3ஹ"#$%ᜮµa¶¨©f◣Ḅ=>aᱯ·¸ᜮᡈᙶº»¼aᓷ½¾ᡈ¿ᜫ4ஹᜐᳮᑗÂõ%ÂÄஹÅᑁஹÆfஹ☟ᾭP╋µ/PCA=>ÈÉ╋µC╋µÊJËÌÍÎperioperativeperiodᢣ=>ÐÑÌÍÒÓÔÕᑮÌÍ×ØÙៜÛ▾CÝÞÛ▾ᑣᑮᨬ,-▾᜜àáJâtḄ,ã»laᑖÌÍÎஹÌÍÎஹÌÍÎåæ▤ã஺PC:ÌÍéêÛ⊈ஹ!⏥/ᱥஹì=ØíÌÍᳮî=ïஹðñïஹÌÍïஹæ>ïòóôïஹᨴö²÷ïí?ø⃩úøûஹ²³?´ஹ?ᓣý

19ûþÿ
ஹ▲ஹញឋஹᶭឋஹឋஹឋ;ஹஹᳮ-!"ᐳឋ$ᳮ%1ஹᯖ⇋ஹអ)2ஹ⃩+ᜫ-%./01◤⌕43ஹ56784ஹPC::⏥<᜜ஹ>?ஹᑗAஹB⊈D$ᳮEF

20ᳮ$ᳮᔠᳮI⊈JKLK35g/Lஹ⊈MLK90g/L,NOᔧPQ1Rᜫ⊝PQᘤজ⊈\%
160/100mmHgঝ^_6`ᨴbcdUஹVWef⊦hᑴ3G4ᕜঞlᔾVW%nhᑴof⊈pᑖXYZ"᪆s>tuᙠuὊxḄ{ᑁট~_ঠ^_ড_%_ὅὊxfAៜᔠsᢙu.fDhᑴ⊈ঢtuᐰ%D2ᜩᓄOḄ100mg/d,300mglᔾ⍝ᡄᜓᓄ⍝AῚ$ᳮஹἭ£¤ஹ¥¦ஹ§¨ஹ§¤©ஹª¨©

21ᜓ«ᜓᜓᜓ⊈ஹ¬®¯°±²1³ஹ
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23ᓷᜮ15G30஺ᾯ☟ᾭᾯঞஹᓷᡈ!M"ᑭ$%&■ᑗ)*+ট-./.0ᢝ2ᔾ0ᢝ456জ:;⍝=>?ᡈ@A▲ᑴ8Dஹᐰ?ᙠGHDஹᜧ72G3HJDஹKLᑁ?⏥OូQᕏᔢ6hJTDUJ⌲8WXYஹZDঝ;⍝=[\Ἥ8D2~3d,_`᣸bஹcd

24DeLJTDDf⃩hᢣjklmஹjnlmop=qrstbஹ⊈45■+vஹw;⍝≯mஹ■yzᶇ&y|}~flm%L

25ᑗ□ḄᳮஹូQᕏᔢஹJ2~3dᓣஹ
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