文档介绍：1
Fluids and Electrolytes Management of the Surgical Patient
Zongfang Li(李宗芳),
Professor of General Surgery
******@.
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和谐社会
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旱灾
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水灾
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Case 1:
王某,女,23岁。以“呕吐、腹泻36小时”入院
患者于36小时前,吃剩饭后即感上腹不适,继则腹痛、呕吐频繁,呕吐出大量食物和胃液,并腹泻十余次,为大量黄色稀水便。逐渐出现口渴、尿少、恶心、厌食、软弱无力。半小时前便后起立时,突然晕倒在厕所,救醒后速送医院求治。
入院查体:℃,脉搏120次/(28次/分),血压90/70mmHg,体重50Kg,神志淡漠,面色苍白,皮肤弹性差,眼眶凹陷。肢端湿泠,腹部轻度深压痛。
化验:①血常规:RBC550万/mm3,Hb12g%,WBC15000/mm3,N80%;②尿常规:,强酸性;③粪常规:黄色稀水便,WBC(+);④血清Na+138 mEg/L、 K+ mEg/L、CO2CP 30VOL%,BUN39mg/ml。
Diagnosis:? Prescription:?
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Case 2
赵××,男性,60岁,体重65Kg
“胆囊切除,胆总管探查术后第一天”
术后从胃管内共抽出液体 600 ml。
T管引流出胆汁 400 ml。
烟卷引流出渗液约 240 ml
℃
Prescription of fluid replacement:?
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Body Fluid & partments
Composition: Water+Electrolytes
Volume: 50%(female) ~ 60%(male)
80%(infant)of body weight
FACTOR:sex、age、lean & fat
Distribution (figure 1):
Extracellular Fluid(20%) Plasma 5%、Interstitial Fluid 15%
Intracellular Fluid(35%~40%) Skeletal muscle 35%
Electrolyte:ECF:Na+/CI-、HCO3-、protein
ICF:K+、Mg++/P3-、 protein
The effective osmotic pressure in the partments are considered equal, about 290-310mOsm/L.
以上的稳定持机体新陈代谢正常进行的保证
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Function of Water
Water is one of the most important material to maintain the mormal functions of human body. 人只饮水可生存十日之久,无水只能生存数日
①调节体温 Regulate body heat
②促进物质代谢 Facilitate metabolism:
溶解dissolve, 、运输 transportation
③润滑作用 lubrication
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Function of Electrolytes
①Maintaining the Osmotic Pressure and the balance of water:
K+/HPO4- ;Na+/CI-
②Maintaining Acid-base Balance:Buffer system in body fluids.
③Maintaining the excitability of nerve and muscle:
[Na+]+[K+]
the excitability ∝
[Ca++]+[Mg++]+[H+]
④K+ is the activator of many enzymes in human body:
K + take part in the biosynthesis of glycogen and protein.
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水的摄入与排出Water gain and loss
每天代谢产生固体废物35~40g,每g至少需尿15ml将它排出。因此,每天尿量不应少于500ml().但每天尿量1500ml±()时肾脏负担最轻。
∴A normal adult need at least 1500ml water everyday , but 2500ml is more reasonabl