--外科病人的体液失调.ppt

Concentration Changes Serum sodium level: 135-150mmol/L Hyponatremia Hypernatremia Composition Changes Potassium Abnormalities Calcium Abnormalities Magnesium Abnormalities Phosphate Abnormalities Acid-Base Disorders Acid-Base Disorders pH 7.35-7.45 判断酸碱平衡的依据 ABG：pH, PaCO2, BE, SB CO2CP Fluid and Electrolyte Therapy Parenteral Solutions Preoperative Fluid Therapy Intraoperative Management of Fluids Postoperative Management of Fluids Key Points for Fluid Therapy Composition of Parenteral Fluids Electrolyte Content (mEq./L.) Cations Anions Solution Na K Ca Mg Cl HCO3 Extracellular fluid 142 4 5 3 103 27 Lactated Ringer’s 130 4 2.7 109 28* 0.9% sodium chloride 154 154 0.45% sodium chloride 77 77 *Present in solution as lactate, which is converted to bicarbonate 手术前的液体治疗 Correction of Volume Changes：mild-4％BW, moderate 6-8％BW, severe 10％BW, pulse, blood pressure, urine Rate of Fluid Administration：1000ml/hr, CVP、PCWP Correction of Concentration Changes： Hyponatremia 120 mmol /L, Hypernatremia Composition and Miscellaneous Considerations 手术中的液体治疗 Replacement of ECF Blood transfusion: blood loss 500ml 补充术中丢失ECF 指导：① Blood,② The replacement of ECF,③ Balanced salt solution 0.5-1l/h,2-3l/4h abdominal operation 手术后的液体治疗 了解术中ECF丢失和补充情况 补充生理需要量 一般情况术后24h不需补钾 术后补液要考虑额外丢失量 术后病人可能出现：Volume Excess, Hyponatremia, Hypernatremia, High-output Renal Failure 术后输液治疗的液体量 尿量＋500~1000ml 满足患者的基本生理需求 水：1500～2000 ml 能量：10－15kcal/kg/d，由葡萄糖或果