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呕吐腹泻的治疗.doc

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ManagementofDisordersoftheGastrointestinalTractOverviewofFluidTherapyforVomitingandDiarrhea Correctionofvolume,electrolyte,andacid-basedisturbancesisanessentialpartofthemanagementofpatientswithvomitinganddiarrhea.Themostappropriatetype,route,andrateoffluidreplacementarechosenonbasisofthepatient'shydration（水合）,tissueperfusion（灌注）,andelectrolyteandacid-basestatus.Thepresenceofanemia（贫血）orhypoalbuminemia（低白蛋白血症）andthepotentialforcontinuingfluidlossthroughvomiting,diarrhea,fever,andcompensatoryhyperventilationassociatedwithmetabolicacidosismustalsobetakenintoaccount.Minimalevaluationofthepatientwithgastrointestinaldiseaseshouldincludedeterminationofbodytemperature,heartrate,skinturgor（皮肤肿胀）,Capillaryrefilltime（毛细血管再充盈时间）,packedcellvolume(PCV),totalproteinconcentration,urinespecificgravity（尿比重）,andurinepHaswellasserum（血清）concentrationsofsodium,potassium,chloride,totalC02,andglucose.Measurementofbloodgases,bloodpressure(centralvenousandarterial),andunneoutputarerequiredforoptimalcareofpatientswithseveregastrointestinaldisease. Oralfluidtherapymaybeusefulforpatientswithdiarrheathatcantolerateoralintake.Subcutaneous（皮下）administrationofanisotonicbalancedelectrolytesolution（电解质平衡液）maybesufficienttocorrectmild(<_5%)fluiddeficitsbutisinsufficientforpatientswithmoderate(5-10%)orsevere(>10%)dehydration.Forpatientsmoderatetoseveredehydration,inadequateoralintake,electrolyteimbalance,orsignsofhypovolemic（血容量减少的）orendotoxicshock（内毒素性休克）intravenousfluidadministrationisnecessary. Therateoffluidadministrationdependsonthepresenceorabsenceofshock,theextentofdehydration,andthepresenceofcardiacorrenaldiseasethatmaypredisposethepatienttovolumeoverload（容量过度负荷）.Patientswithahistoryofvomitingthataremildlydehydratedareusuallyresponsivetocrystalloids(e.g.,lactatedRinger'ssolutionor0.9%NaCI)ataratethatprovidesmaintenanceneedsandreplacesexistingdeficitsandongoinglossesovera24-hperiod.Patientswithsignsofshockrequiremoreaggressivesupport.Thevolumedeficitcanbereplacedwithcrystalloidsataninitialrateof