兒科學(xué) 液體療法(英文)

FluidTherapyreviewⅠfluidbalanceinchild1.Thetotalamountofbodyfluidsinchildren：

Theyounger,thegreatertheproportionofwater

Neonate80%1month75%

Infant70%

Child65%

Adult

60%．2.Thedistributionofbodyfluids：

Theyounger,

thevolumeofextracellularfluidmorerelatively

bodyfluids：

IntracellularFluid

ExtracellularFluid：Interstitialfluid,plasma,lymphfluid,cellsecretion血漿間質(zhì)液細(xì)胞內(nèi)液ThedistributionofBodyfluidsinallages（accountedfor

Weight

%）血5%間質(zhì)40%細(xì)胞內(nèi)35%間質(zhì)20%間質(zhì)10~15%間質(zhì)25%細(xì)胞內(nèi)40%血5%血5%血5%細(xì)胞內(nèi)40%細(xì)胞內(nèi)40~45%新生兒80%~1歲70%2~14歲65%成人55~60%43.Waterdemandvolume

Childrenneedalargenumberofwater,poorofRegulatoryfunction,PronetodisordersofwatermetabolismInaperiodofrapidgrowthanddevelopment,Dailyintakeofwatertoretainthe0.5%~3%

forthephysicalgrowthRelativelymorewaterlossisnotdominant:about2timesofadultsFluidexchangeofthedigestivetractfasterWatermetabolismishigh：infant:Accountedforhalfofthetotalliquidvolume；Adult:comparedwith1/7Watermetabolismregulatoryfunctionofpoor:kidney,lung。5ⅡElectrolyteComponentPediatricelectrolyteComponentofbodyfluidssimilartoadults.ExtracellularFluidNa+、Cl-、Hco3-IntracellularFluidK+、Mg

、Hpo4=proteinNeonatuscharacteristic：Afewdaysafterbirth,serumpotassium,chlorine,phosphorusandlactateHigher,Sodium,calcium,bicarbonatelowerAfewdaysafterbirth,dischargehydrogenpoor,pronetoacidosis6ⅢbalanceandadjustmentHumoralregulationofacid-basebalance

BuffersystemNaHCO3/H2CO3=20:1Na2HPO4/NaH2PO4plasmaproteinsbuffersystemLung：DischargeoraccumulateCO2（Respiratory）Kidney：

DischargehydrogenaccumulateSodium

（Metabolism）

regulatedHCO3-NaHCO3/H2CO3=20:1Thereisalimitcompensatoryadjustment7

Ⅳacid-basebalancemarkerbloodgasanalysis：(normalvalue)

PH：7.4(7.35~7.45)

PaCO2：40(34~45)mmHg(respiratory)

HCO3-：24(22~27)mmol/L(SB)(Metabolism)

BE：-3~+3mmol/L(Metabolism)

CO2CP：22(18~27)mmol/L8Disturbanceofacid-basebalancerespiratoryacidosisrespiratoryalkalosismetabolicacidosismetabolicalkalosis

（Compensatory,Decompensatory）9FluidTherapyTreatmentⅠPurposeofFluidTherapy

Restoreandmaintainbloodvolume,osmolality,pHandelectrolytecompositionTorestorenormalphysiologicalfunctionCorrecttothebodyofwater,electrolytedisturbance(Alreadyexists)11ⅡTheway

ofFluidTherapy

OralInjectionofvein12ⅢFluidtherapy1）accumulatedlossvolume

2）Continuedlossvolume

3）Physiologicalneeds

Theamountofliquid,thecompositionandcompletiontime

13CumulativelosssupplementTodetermine

thevolumemild：50ml/kgmoderate：50~100ml/kgsevere：100~120ml/kgAccordingtothedegreeofdehydration,decisionrehydrationvolume,composition,speed(Ⅰ)Cumulativelosssupplement14Todetermine

thecomponentIsotonicdehydration：2/3~1/2張Hypotonicdehydration：等張~2/3張Hypertonicdehydration：1/3~1/8張Todetermine

thespeedPrinciple：firstquickly,thenslowSevere：fluidexpansion：

20ml/kg

within30’~1htherest：completedin8~12hCumulativelosssupplement15Common:1/2~1/3張10~40ml/kg.d(Ⅱ)

ContinuedlosssupplementTodetermine

thevolumeTodetermine

thecomponentTodetermine

thespeedContinuedlosssupplementShouldbeinstillationevenlywithin24hoursShouldbeinstillationafterendupacumulativelosswithin14~16h16Common:1/5張60~80ml/kg.d（Includingoral）(Ⅲ)

PhysiologicalneedssupplementTodetermine

thevolumeTodetermine

thecomponentTodetermine

thespeedPhysiologicalneeds

supplementShouldbeinstillationevenlywithin24hoursShouldbeinstillationpluscontinuedlosswithin14~16h17(Ⅲ)Tocorrectacidosismild：

dealwith

to

causeModerate,severe：

(40-所測CO2CPVol%)

2.2

=(22-所測CO2CPmmol/L)

0.6

kg=BE

0.3

kg=

0.6

kgUsuallyusehalftheamount需堿性液

mmol18Ⅳ

PrinciplesofTherapy1、先快后慢2、先濃后淡3、見尿補鉀4、隨時調(diào)整19SupplementPotassiumNotesGivepotassiumaftergeturineConcentrationofSupplementPotassiuminveins<0.3%SupplementPotassiumspeed:>4~6hoursSeverityhypokalaemia：Potassiumsupplementshouldbecontinued4to6days20Conversionthesolutionused10%NaCl：1ml=1.7mmol5%NaHCO3：1ml=0.6mmol11.2%NaL：1ml=1mmol10%KCl：1ml=1.34mmol21OralRehydrationSalts

(ORS)sodiumchloride：3.5gsodiumbicarbonate(sodiumcitrate)：2.5g(2.9g)potassiumchloride：1.5g

glucose：20gAddwaterto1000ml，tobecome2/3張．（Na+90mmol/L，K+20mmol/L）childShouldbediluted22ORS機制Na+-glucosecoupling,transferofsmallintestineNa+–葡萄糖載體小腸上皮細(xì)胞刷狀緣Na+葡萄糖Na