体液失调英文版.pptx
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1、Fluid-Electrolyte-Acid-base Management General surgery department The first affiliated hospital to Soochow Universityoverviewcompositionsofbodyfluidregulationsoffluidbalanceacid-basebalanceimportanceoffluidbalanceContentsofdiscuss fluid-electrolyte-acid-base managementfluid-electrolyte-acid-base man
2、agement catalogcatalogadjustoffluidmetabolismdemonstratechartsbasicprinciplesoftreatmentsNormalbodyfluid,osmoticpressureandelectrolytearethebasisofbodymetabolismandorganfunctions.Trauma,operationandmanyclinicaldisordersleadtofluid,electrolyteandacid-baseimbalance,managementoftheseproblemsisaveryimpo
3、rtantmatterinthesurgicaltherapy.-1fluid-electrolyte-acid-base managementfluid-electrolyte-acid-base management overviewoverviewMain components of the body fluid arewaterandelectrolytes.Body fluid is divided into intracellularfluidandextracellularfluid.Musclecontainsmuchwater.(75-80)Fatcontainslesswa
4、ter.(10-30)fluid-electrolyte-acid-base managementfluid-electrolyte-acid-base management composition compositions of body fluids of body fluidAbout 60 of weight of adult male isbodyfluid;about 55 of weightof adult female isbodyfluid;about 80 of weight of infant is bodyfluid;after 14 years old,childre
5、n are near tomanhood.fluid-electrolyte-acid-base managementfluid-electrolyte-acid-base management composition compositions of body fluids of body fluidMostintracellularfluidisinskeletalmuscle;intracellularfluidaccount40%ofbodyweightformale,forfemaleis35%.Extracellularfluidaccount20%ofbodyweightforbo
6、thofmaleandfemale.Extracellularfluidisfurtherdividedintoplasmaandinterstitialfluid;plasmaoccupy5%ofbodyweight;Interstitialfluidoccupy15%ofbodyweight.fluid-electrolyte-acid-base managementfluid-electrolyte-acid-base management composition compositions of body fluids of body fluidMostofinterstitialflu
7、idcanexchangewithplasmaorintracellularfluidquickly,andgettobalance,whichisveryimportantinfluidandelectrolytemanagement,calledfunctionalextracellularfluid.fluid-electrolyte-acid-base managementfluid-electrolyte-acid-base management composition compositions of body fluids of body fluidOtherinterstitia
8、lfluidcanonlyexchangeandgettobalanceslowly,theyhavedifferentfunctions,buttheyarelessimportantinthemaintainofbodyfluidbalance,callednonfunctionalextracelluarfluid.Connectivetissuefluidandpenetrablefluidofcell,e.g.cerebrospinalfluid,synovialfluidanddigestivejuice,andsoon,areallcallednonfunctionalextra
9、celluarfluid.fluid-electrolyte-acid-base managementfluid-electrolyte-acid-base management composition compositions of body fluids of body fluidThechangesofsomenonfunctionalextracelluarfluidcanleadtoimbalanceofbodyfluid,electrolyteandacid-baseobviously.Themostfamiliarexampleisagreatdeallossofdigestiv
10、ejuice,itcanleadtomarkedchangeofbodyfluidvolumeandelements.-2Nonfunctionalextracelluarfluidoccupies1%-2%ofbodyweight,andabout10%ofinterstitialfluid.fluid-electrolyte-acid-base managementfluid-electrolyte-acid-base management composition compositions of body fluids of body fluidThemostimportantcation
11、inextracelluarfluidisNa+,andthemainanionareCl-,HCO3-andprotein.ThemaincationinintracelluarfluidareK+andMg2+,themainanionareHPO42-andprotein.Theosmolalityofextracelluarfluidandintracelluarfluidareequal,theosmolalityofplasmais290-310mmolL.fluid-electrolyte-acid-base managementfluid-electrolyte-acid-ba
12、se management composition compositions of body fluids of body fluidThestabilityofbodyfluidandosmoticpressureisadjustedbynerve-incretionsystem.Thenormalosmoticpressureofbodyfluidisresumedandmaintainedbythalamo-posthypophysis-antidiureticsystem.Thevolumeofbloodisresumedandmaintainedbyrenin-aldosterone
13、system.fluid-electrolyte-acid-base managementfluid-electrolyte-acid-base management fluid balance and osmotic pressure adjustfluid balance and osmotic pressure adjustextracellularextracellularosmoticosmoticpressurepressure thalamo-thalamo-posthypophysis-antidiuretic-antidiureticsystemsystemantidiure
14、tichormoneisverysensitivetothechangesofextracellularosmoticpressure,evenoverstep2extra-extra-cellularcellularosmoticosmoticpressurepressurefalltofalltonormalnormalwaterlosethirst,drinkmorewaterresorburinereducewaterisreserved keephomeostasis fluid-electrolyte-acid-base managementfluid-electrolyte-ac
15、id-base management fluid balance and osmotic pressure adjustfluid balance and osmotic pressure adjuststimulatestimulate reninrenin adrenaladrenalaldosteronealdosterone withincreasedresorptionofwithincreasedresorptionofnatrium,morewaterisresorbnatrium,morewaterisresorbextra-extra-cellularcellularosmo
16、ticosmoticpressurepressurefalltofalltonormalnormalbloodvolumebloodpressureNa+resorbK+drainageH+drainagekeephomeostasis fluid-electrolyte-acid-base managementfluid-electrolyte-acid-base management fluid balance and osmotic pressure adjustfluid balance and osmotic pressure adjustBothofthetwosystemsall
17、actonBothofthetwosystemsallactonkidneytoadjusttheabsorptionandkidneytoadjusttheabsorptionanddrainageofelectrolyteaswateranddrainageofelectrolyteaswaterandnatriumandsoon,togetthebodyfluidnatriumandsoon,togetthebodyfluidbalanceandinternalenvironmentbalanceandinternalenvironmentstability.stability.Theb
18、loodvolumeismoreimportantThebloodvolumeismoreimportantthanosmoticpressureforbody.thanosmoticpressureforbody.fluid-electrolyte-acid-base managementfluid-electrolyte-acid-base management fluid balance and osmotic pressure adjustfluid balance and osmotic pressure adjustSoasthebloodvolumereducedgreatlya
19、ndinthesametimetheplasmaosmoticpressurereduced,theaccelerationforantidiuretichormonebyformerplayamuchmoreimportantrolethanthedepressionforthehormonebylatter.-3Thepurposeisatfirsttokeepandresumebloodvolume,ensuretheenoughbloodforvitals,maintainthesafeofpatientslife.fluid-electrolyte-acid-base managem
20、entfluid-electrolyte-acid-base management fluid balance and osmotic pressure adjustfluid balance and osmotic pressure adjustThenormalphysiologicalandmetabolismfunctionneednormalbodyfluidwithproperhydrogen.UsuallythebodyfluidmaintainacertainconcentrationofH+,alsomaintainacertainpH(arterialplasmaspHbe
21、tween7.400.05).Butintheprocessofmetabolism,bodypersistentlyproduceacidandalkalisubstance,inthisway,theconcentrationofH+alsochangesregularly.fluid-electrolyte-acid-base managementfluid-electrolyte-acid-base management management of acid-base balancemanagement of acid-base balanceInordertokeepthefluct
22、uationofconcentrationofH+inasmallrange,thebodyadjusttheacidandalklaibybuffersystem,breathingwithlungandexcretionwithkidney.ThemostimportantbuffersysteminbloodisHCO3-/H2CO3.fluid-electrolyte-acid-base managementfluid-electrolyte-acid-base management management of acid-base balancemanagement of acid-b
23、ase balanceThenormalmeanvalueofHCO3-is24mmolL,H2CO3is1.2mmolL,theratioofHCO3-/H2CO3=241.2=20:1.nomatterhowhigherorlowertheHCO3-andH2CO3are,theratioofHCO3-/H2CO3stillkeepsin20:1,pHofplasmaisremaining7.40.-4e.g.H+HCO3-=H2CO3=H2OCO2 fluid-electrolyte-acid-base managementfluid-electrolyte-acid-base mana
24、gement management of acid-base balancemanagement of acid-base balanceBreathoflungadjusttheacid-basebalancebydischargingCO2fromlung,thiscanreducePaCO2inblood,inthesametime,alsoadjustH2CO3inblood.Ifrespiratoryisinsufficiency,itwillleadacid-basedisorder,anditwillalsodepressitscompensatorycapacityofacid
25、-basebalance.fluid-electrolyte-acid-base managementfluid-electrolyte-acid-base management management of acid-base balancemanagement of acid-base balanceKidneyplaythemostimpotantmanangementroleintheacid-basebalancesystem,kidneymaintainnormalconcentrationofHCO3-inplasmabychangingoutputoffixedacidandal
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