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1、FluidandElectrolyteManagementoftheSurgicalPatientReferences:克氏外科学（第15版）Maxwell,M.H.Etal:Clinicaldisordersoffluidandelectrolytemetabolism4thed.NewYork,McGraw-Hill,1987.Mengoli,L.R.:Excerptsfromthehistoryofpostoperativefluidtherapy.Am.J.Surg.121:311,1971.第一节概述：Totalbodywater50%-70
2、%oftotalbodyweightdeuteriunoxideortritiatedwater:60%formaleadultand50%forfemaleadult,bothnormalvariation±15%.(leanbodymassandage)52%and47%withelderand75%-80%fornewborninfants,at1yearofage,65%题外话我的学、教经历我的困惑我的体会Interstitialfluid:Functioningcomponents(90%) Nonfunctioningcomponents
3、(10%) connectivetissuewaterandtranscellularwater,whichincludescerebrospinaland jointfluids.OsmoticPressureThephysiologicandchemicalactivityofelectrolytesdependsonthenumberofparticles(presentperunitvolume(molesormillimolesperliter),thenumberofelectricalchargesperunitvolume(equiva
4、lentsormilliequvalentsperliter),andthenumberofosmolesormilliosmolesperliter)AMole=themolecularweightofthatsubstanceingramsEg:amoleofNaCl:58grams(Na,23;Cl,35)AnEquivalentofanion=itsatomicweightexpressedingramsdividedbythevalence.Eg:Ca++1millimoleequals2milliequivalentsOsmolerefer
5、stotheactualnumberofosmoticallyactiveparticalspresentinsolution.1mmolNaCl,2mOsm;1mmolNa2SO4,3mOs;1mmolglucose,1mOsm.Ineachcompartmentthetotalnumberofosmoticallyactiveparticlesis290to310mOsm.Theeffectiveosmoticpressuredependsonthosesubstancesthatfailtopassthroughtheporesofthesemi
6、permeablemembrane.Suchassodium,glucose.Thecellmembranesarecompletelypermeabletowater.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
7、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！！每天生理需要量5%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
8、：等渗性体液的减少或增多浓度：水分增加或减少，渗透压改变成分：钠以外的其他离子改变先细胞外液，
