烧伤补液课件VIP免费

烧伤补液烧伤补液FluidresuscitationinBurns罗奇志重庆第三军医大学西南医院全军烧伤研究所一．成人烧伤休克期补液补液总量Ⅱ、ⅢTBSA×BW×1.5ml+水（2000ml）补液内容电解质1ml／kg/BSA胶体0.5ml／kg/BSA水2000ml电解质平衡液(乳酸Ringer’s液／碳酸氢钠Ringer’s液）配方2／3等渗盐水（生理盐水／5％GNS）1／3等渗碳酸氢钠（1／4×5％碳酸氢钠＋3／4×水）胶体血浆20%白蛋白＋150mlNS血浆代用品(Plasmasubstitute)血定安、贺斯(羟乙基淀粉)(<1000ml/24h)、中分子右旋糖酐）面积＜30％可全用代用品面积＜50％可一半代用品电：胶＝1：1补液计划姓名年龄TBSA总量院前计划胶体电解质水电解质补液速度水+5%碳酸氢钠8:00~15:00d/min胶15:00~次日7:00d/min电解质尿量维持60~80/ml水+5%碳酸氢钠根据尿量调节补液速度胶例80%烧伤病人姓名年龄40TBSA80总量80＊50＊1.5+2000院前1000计划7000胶体2000电解质4000水1000电解质GNS2600+5%碳酸氢钠350+水10005%GNS500ml+泰能100ml补液速度5%GS500ml+5%碳酸氢钠90ml8:00~15:00d/min血浆400ml15:00~次日7:00d/min5%GNS500ml尿量维持60~80/ml5%GS500ml+5%碳酸氢钠90ml根据尿量调节补液速度血浆400ml……量的调节公式所提供的补液量只是应用统计学计算的平均量，每个个体存在个体的差异，应作相应的调节满足个体的需要，常用的量的调节根据尿量、血压、心率，Hb；条件好的可根据CVP，PAWP如图所示这些指标都不够精确个性化补液TABLE5-2.NormalHemodynamicandOxygenTransportParametersTABLE5-2.NormalHemodynamicandOxygenTransportParametersAbbreviationAbbreviationParameterParameterNormalRangeNormalRangeUnitsUnitsDerivationDerivationCVPCVPCentralvenouspressureCentralvenouspressure1-81-8mm.Hg.mm.Hg.MeasuredMeasuredMAPMAPMeanarterialpressureMeanarterialpressure75-10075-100mm.Hg.mm.Hg.MeasuredMeasuredMPAPMPAPMeanpulmonaryarterialpressureMeanpulmonaryarterialpressure10-1610-16mm.Hg.mm.Hg.MeasuredMeasuredPCWPPCWPPulmonarycapillarywedgepressurePulmonarycapillarywedgepressure5-125-12mm.Hg.mm.Hg.MeasuredMeasuredCOCOCardiacoutputCardiacoutput4-64-6L./min.L./min.MeasuredMeasuredCICICardiacindexCardiacindex2.5-3.52.5-3.5L./min./m.L./min./m.22CO/BSACO/BSASVRSVRSystemicvascularresistanceSystemicvascularresistance800-1400800-1400dynes·sec./cmdynes·sec./cm55(MAP-CVP)×80/CO(MAP-CVP)×80/COSVRISVRISystemic.vascularresistanceindexSystemic.vascularresistanceindex1500-24001500-2400dynes·sec./(cmdynes·sec./(cm55·m.·m.22))SVR×BSASVR×BSAPVRPVRPulmonaryvascularresistancePulmonaryvascularresistance100-200100-200dynes·sec./cmdynes·sec./cm55(MPAP-PCWP)×80/CO(MPAP-PCWP)×80/COPVRIPVRIPulmonaryvascularresistanceindexPulmonaryvascularresistanceindex150-300150-300dynes·sec./(cm.dynes·sec./(cm.55~m.~m.22))PVR×BSAPVR×BSACaOCaO22ArterialoxygencontentArterialoxygencontent16-2216-22ml.Oml.O22/100ml.(vol.%)/100ml.(vol.%)(SaO(SaO22×Hgb.×1.39)+(PaO×Hgb.×1.39)+(PaO22×0.0031)×0.0031)CvOCvO22VenousoxygencontentVenousoxygencontent12-1712-17ml.Oml.O22/100ml.(vol.%)/100ml.(vol.%)(SaO(SaO22×Hgb.×1.39)+(PvO×Hgb.×1.39)+(PvO22x0.0031)x0.0031)C(a-v)OC(a-v)O22ArteriovenousoxygendifferenceArteriovenousoxygendifference3.5-5.53.5-5.5ml.Oml.O22/100ml.(vol.%)/100ml.(vol.%)CaOCaO22CvOCvO22DODO22OxygendeliveryOxygendelivery700-1400700-1400ml./min.ml./min.CaOCaO22×CO×10×CO×10DODO22IIOxygendeliveryindexOxygendeliveryindex400-600400-600ml./(min·mml./(min·m22))CaOCaO22×CI×10×CI×10VOVO22OxygenconsumptionOxygenconsumption150-300150-300ml./min.ml./min.C(a-v)OC(a-v)O22×CO×10×CO×10VOVO22IIOxygenconsumptionindexOxygenconsumptionindex100-...