麻醉期间的容量治疗和血液保护试卷.ppt

1. 麻醉手术期间输血指征是什么? 2. 患者 男 29岁 52kg,诊断为重度脊柱侧弯,行脊柱侧弯矫形内固定术,术前检查良好,心电图示窦性心律,术中血压从130/70mmHg降至83/52mmhg,心律升至120次/分,此时共输液2500mL出血约2200mL,问是否需要输血?输何种类型血制品？有什么血液保护的措施？ 麻醉医生是手术室的守护神，可使病人转危为安；但也存在高风险。关键在于你用心去做。 * Crystalloid solutions will expand primarily the extracellular fluid volume. It is commonly stated that crystalloids “disappear” from the circulation in a relatively short space of time. This is not entirely correct. In reality, and the crystalloids redistributed between the intravascular and extracellular compartments in proportion to the normal distribution of fluid between these two spaces: that is approximately 1: 4. Consequently, in order to achieve full volume expansion after blood loss, three to four times in the volume lost must be replaced with crystalloids alone to replenish the intravascular losses. Furthermore, the Starling’s forces will ensure that, in the initial resuscitation phase, crystalloids will be deceptively effective, but once the capillary perfusion is re-established, the crystalloid will rapidly move out of the vascular space. The use of crystalloids will result in a reduction plasma oncotic pressure. * Isotonic colloids will not escape from the normal vascular tree and consequently will produce a plasma volume expansion equal to the volume of fluid administered. However, these colloids will not expand the extracellular fluid space, and it is necessary to accompany the colloids with some degree of crystalloid solution replacement to ensure adequate resuscitation of this important compartment. The use of isotonic colloids will also retain the normal plasma oncotic pressure. 麻醉手术期间的液体需要量 1. 每日正常生理需要量； 2. 术前禁食和/或手术前累计缺失量； 3. 麻醉手术期间的液体再分布； 4. 麻醉导致的血管扩张； 5. 术中失血失液量 人体每日生理需要量 70kg体重病人每小时生理需要量为 4×10+2×10+1×50=110ml/h 体重 　　 液体容量 输入速度 (ml/kg) 　(ml/kg/h) 第一个1０kg 100 　 　4 第二个1０kg　 　　50　　 　 2 以后每1０kg 2