液体疗法,中南大学儿科学教研室 郭 青,第四章第三节,小 儿 液体疗法 Infantile Liquid Therapy,目的要求 Objective,概述 Summary,小儿体液平衡的特点 Characteristic of Infantile Body Fluid Balance,水电解质和酸碱平衡紊乱 Disturbances of Water, Electrolyte, & Acid-base balance,液体疗法时常用的溶液 Common Solution of Liquid Therapy,小儿腹泻液体疗法 Infantile Diarrhea Liquid Therapy,目的要求 Objective,了解小儿体液平衡的特点 Realized: Characteristic of Infantile Body Fluid Balance 熟悉小儿水、电解质和酸碱失衡的病理生理 Be familiar with: Pathophysiology of Infantile Fluid, Electrolyte & Acid-base Imbalance 掌握小儿电解质和酸碱平衡紊乱的临床表现 Mastered: Clinical menifestations of Infantile Disturbances of Water, Electrolyte & Acid-base Balance 熟悉液体疗法常用溶液的组成及临床应用 Be familiar with :Common Solution Component of Liquid Therapy 掌握小儿腹泻的液体疗法 Mastered: Liquid Therapy of Infantile Diarrhea,概述 Summary,体液是人体的重要组成部分，保持其生理平衡是维持生命的重要条件。体液中水、电解质、酸碱度、渗透压等的动态平衡依赖于神经、内分泌、肺，特别是肾脏等系统的正常调节功能，由于小儿的生理特点，这些系统的功能极易受疾病和外界环境的影响而失调，因此水、电解质和酸碱平衡紊乱在儿科临床中极为常见。 Body fluid is important component of human body and the physiological equilibrium of body fluid is an important factor for human living. The dynamic equilibrium of fluid, electrolyte, acid-base, osmotic pressure depends on normal regulating function of nerve, incretion, lung and kidney. Because of the infantile physiologic peculiarity, These systematic functions are easily affected by diseases and/or environment and are maladjusted. Therefore, the disturbances of water, electrolyte and acid-base balance is common in pediatric clinic.,小儿体液平衡的特点,一 体液的总量和分布 不同年龄的体液分布（占体重的）,Characteristic of Infantile Body Fluid Balance,A. Total body water & its distribution Body water compartments related to age (total body mass%),TBW: total body water ECF: extracellular fluid ICF: intracellular fluid ISF: interestitial fluid,小儿体液平衡的特点 Characteristic of Infantile Body Fluid Balance,二 体液的电解质组成 Electrolyte composition of body fluid 细胞外液 ECF: Na+ 、 Cl-，HCO3 - 细胞内液 ICF: K + 、Mg 2+ 、HPO4 2-、蛋白质 Protein,三 水代谢的特点 Water metabolism 1. 水的需要量大，交换率快，不显性失水多（为成人2倍）。婴儿每日水交换量为细胞外液量的1 / 2 ，成人仅为1 / 7。 Large water requirements, swift water exchange, unobvious water loss (double adults amount ). Infants water exchange amount is 1 / 2 of ECF , the adults is just 1 / 7. 体液调节功能不成熟，小儿肾脏的浓缩和稀释功能不成熟。 Immature body liquid regulating function , immature concentration and dilution function of infantile.,小儿体液平衡的特点 Characteristic of Infantile Body Fluid Balance,水电解质酸碱平衡紊乱,一 脱水程度,Disturbances of Water, Electrolyte & Acid-base Balance,A. Degree of dehydration,水电解质酸碱平衡紊乱,二 脱水性质,Disturbances of Water, Electrolyte & Acid-base Balance,B. Property of dehydration,水电解质酸碱平衡紊乱 Disturbances of Water, Electrolyte & Acid-base Balance,三 代谢性酸中毒 Metabolic acidosis （一）发生原因 Pathogeny 1. 体内碱性物质丢失过多（消化道、肾脏丢失） The lose of large amount of basic substances（gastrointestinal tract, kidneys） 2. 酸性代谢产物产生过多（饥饿、糖尿病、肾衰、缺氧） Too much Acid metabolite （hungriness, diabetes, renal failure, hypoxia） 3. 摄入酸性物质过多（长期服氯化钙、氯化镁、静滴盐酸精氨酸或盐酸赖氨酸、复合氨基酸、水杨酸等）Too much acid substance intake （long time to take calcium chloride, ammonium chloride, amino acid etc.）,（二） 分度 Degree 轻度 Mild HCO3- 1813 mmol / L 中度 Moderate HCO3- 139 mmol / L 重度 Severe HCO3- 9 mmol / L,水电解质酸碱平衡紊乱 Disturbances of Water, Electrolyte & Acid-base Balance,水电解质酸碱平衡紊乱 Disturbances of Water, Electrolyte & Acid-base Balance,四 低钾血症 Hypokalemia （一） 病因 Pathogeny 1. 摄入不足 Lack of intake 2. 丢失过多（消化液丢失、利尿从肾脏丢失） Loss of kalium from kidneys or gastrointestinal tract 3. 其他途径（烧伤、透析治疗不当） Burn, dialysis etc. 4. 钾在细胞内外分布异常（碱中毒、胰岛素治疗、周期性麻痹） Abnormal kalium distribution inside or outside cells （alkalosis, insulin therapy、periodic anesthesia）,（二） 临床表现 Clinical menifetation 1. 神经精神萎靡 Nervous system depressed 2. 肌肉 骨骼肌四肢肌乏力，肌张力，严重迟缓性瘫痪，呼吸肌麻痹 Muscleinertia of limbs，muscular tension down，severely retardant paralysis，respiratory muscle paralysis,水电解质酸碱平衡紊乱 Disturbances of Water, Electrolyte & Acid-base Balance,3. 心脏 心率，心律失常，阿期综合症，房室传导阻滞， 心肌纤维变性，局限性坏死，心肌收缩乏力，心音低钝 心电图，出现U波，UT，T波增宽、低平、倒置 Heart heart rate increasing, arrhythmia, AdamsStokes syndrome, heart rate decreasing，atrioventricular block, heart sound lowering, cardiogram: U wave appearing，UT，flattened T wave,水电解质酸碱平衡紊乱 Disturbances of Water, Electrolyte & Acid-base Balance,4. 肾脏 肾小管上皮细胞空泡变性，对ADH的反应低下，浓 缩功能减低，尿量增多，肾小管泌H 增加，回吸收HCO3- 增加，氯的回吸收减少，可发生低钾、低氯碱中毒，伴反常 性酸性尿。 Kidney concentrating function lowering, urine volume increasing,水电解质酸碱平衡紊乱 Disturbances of Water, Electrolyte & Acid-base Balance,液体疗法时常用的溶液 Common Solution of Liquid Therapy,一 非电解质溶液 Nonelectrolyte solution 5、10 glucose 二 电解质溶液 Electrolyte solution 0.9 NaCl、1.4、5 NaHCO3、10 KCl 三 混合溶液 Mixed solutions 见下表 refer to the following table,液体疗法时常用的溶液 Common Solution of Liquid Therapy,小儿腹泻液体疗法 Infantile Diarrhea Liquid Therapy,一 定量 Volume,二 定性 Quality,小儿腹泻液体疗法 Infantile Diarrhea Liquid Therapy,三 定速 Speed,小儿腹泻液体疗法 Infantile Diarrhea Liquid Therapy,四 休克扩容 Shock volume expansion，定量、定性、定速,小