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1、FluidandElectrolyteManagementoftheSurgicalPatientReferences:克氏外科学（第15版）Maxwell,M.H.Etal:Clinicaldisordersoffluidandelectrolytemetabolism4thed.NewYork,McGraw-Hill,1987.SCHWARTZ‘SPRINCIPLESOFSURGERY-8thEd.(2005)可下载体现在各个章节疾病中原发和继发联系疾病的发病发展机理基础的基础(最基本的内环境平衡)上课讲的少,自学的不是不重要!美国没有教课书,但最后要求比较严!第一节概述：
2、Totalbodywater50%-70%oftotalbodyweightdeuteriunoxideortritiatedwater:60%formaleadultand50%forfemaleadult,bothnormalvariation±15%.(leanbodymassandage)52%and47%withelderand75%-80%fornewborninfants,at1yearofage,65%Interstitialfluid:Functioningcomponents(90%) Nonfunctioningcomponents(10%) connect
3、ivetissuewaterandtranscellularwater,whichincludescerebrospinaland jointfluids.OsmoticPressureThephysiologicandchemicalactivityofelectrolytesdependsonthenumberofparticles(presentperunitvolume(molesormillimolesperliter),thenumberofelectricalchargesperunitvolume(equivalentsormilliequvalentsperlit
4、er),andthenumberofosmolesormilliosmolesperliter)AMole=themolecularweightofthatsubstanceingramsEg:amoleofNaCl:58grams(Na,23;Cl,35)AnEquivalentofanion=itsatomicweightexpressedingramsdividedbythevalence.Eg:Ca++1millimoleequals2milliequivalentsOsmolereferstotheactualnumberofosmoticallyactivepartic
5、alspresentinsolution.1mmolNaCl,2mOsm;1mmolNa2SO4,3mOs;1mmolglucose,1mOsm.Ineachcompartmentthetotalnumberofosmoticallyactiveparticlesis290to310mOsm.Theeffectiveosmoticpressuredependsonthosesubstancesthatfailtopassthroughtheporesofthesemipermeablemembrane.Suchassodium,glucose.Thecellmembranesare
6、completelypermeabletowater.Anyconditionthatalterstheeffectiveosmoticpressureineithercompartmentcausesredistributionofwaterbetweenthecompartments.体液平衡和渗透压的调节——神经-内分泌系统渗透压：下丘脑-垂体后叶-抗利尿激素系统（敏感而弱）血容量：肾素-醛固酮系统（强）共同作用于肾二.酸碱平衡的维持血液缓冲HCO3-/H2CO3肺：CO2肾:排出固定酸、保留碱性物质Case:男，42岁。柴油烧伤60%，2-3度休克期平稳，伤后第3天行气管切
7、开，四肢削痂生物敷料覆盖、并行悬浮床治疗术后4天：有一过性烦躁，嗜睡术后5天：昏迷，Na158,Cl119血糖：704mg%BUN82,Cr3.36进量出量术后第1天52504370术后第2天52504670术后第3天65603950术后第4天52704800结果：抢救3天，死亡！！每天最基本的生理需要量0.9%氯化钠溶液500ml5-10%葡萄糖溶液1500-2000ml10%氯化钾溶液30ml第二节体液代谢的失调容量：等渗性体液的减少或增多浓度：水分增加或减少，渗
