心脏术后围手术期的液体管理原则及注意点.pptVIP

心脏术后围手术期的液体管理原则及注意点Peri-operative fluid management 第三军医大学新桥医院心外科 刘健 For practical consideration,most losses and gain of body fluid occur directly from the extracellular compartment 一、Body fluid compartment(体液的容量和分布）  ：成人每日水分排出量(2000-2500ml) 尿 1000-1500ml 大便 150ml（ICU病人一般不计） 皮肤 300-600ml（平均500ml） 肺 200-400ml（平均350ml） 即成人每日基本生理需要量(2000-2500ml)  ：成人每日水摄入量(2000-2500ml) 饮水 (oral) 1000-1500ml 食物水 700ml （solid food） 代谢水 300ml (water of oxidation） 即基本生理需要量(2000-2500ml)  Compositional abnormalities include changes (1)acid-base balance (酸碱) (2)concentration changes of potassium(K+), calcium(Ca2+), and magnesium(Mg2+)(电解质) Fluid change of cardiopulmonary bypass(CPB)体外循环后的液体变化 1、An intentional hemodilution （to lower blood viscosity during hypothermia ） 血液稀释预充 2、cardioplegia or the copious use of irrigation （accumulation of excess fluid ） 心脏停搏液和冲洗液的应用 3、an increase of total body water （causes impaired organ function as it accumulates in tissues ） 体液增加 四、Effects of CPB on the function of multiple organ system (体外循环对机体的影响） 1. Total body sodium and water overload（钠水超负荷） 2. Systemic inflammatory response symptom (SIRS) capillary permeability increase crystalloid and colloid partially shift to the interstitial space 3. Transient myocardial dysfunction 3. Pulmonary venous resistance(PVR) increase and abnormalities of gas exchange 5. Stress and hormonal responses leading to fluid and electrolyte disturbances