湘雅兒科精品PPT課件-小兒腹瀉

1、小兒腹瀉小兒腹瀉中南大學兒科學教研室中南大學兒科學教研室郭郭 青青第十一章第八節(jié)Vocabulary hypochlorhydria胃酸過少 normal flora正常菌叢colibacillus大腸桿菌 campylobacter彎曲菌Yersinia耶爾松菌adenyl cyclase腺苷酸環(huán)化酶guanylic cyclase 鳥苷酸環(huán)化酶microvillares微絨毛Staphylocaccus aureus金黃色葡萄球菌pseudomembranous enterocolitis偽膜性小腸結(jié)腸炎 小小 兒兒 腹腹 瀉瀉 Infantile Diarrhea目的要求 Objecti

2、ve概述 Summary病因 Etiology發(fā)病機制 Pathogenesis臨床表現(xiàn) Clinical menifestations診斷、鑒別診斷 Diagnosis &Differential Diagnosis 治療原則 Principle of Treatment目的要求目的要求 Objective掌握掌握本病的病因、發(fā)病機制與臨床表現(xiàn)本病的病因、發(fā)病機制與臨床表現(xiàn)Mastered：Etiology , Pathogenesis & Clinical menifetation 掌握掌握本病的診斷與治療本病的診斷與治療Mastered：Diagnosis & T

3、reatment 熟悉熟悉本病的鑒別診斷本病的鑒別診斷Be familiar with：Differential Diagnosis 了解了解本病的預(yù)防本病的預(yù)防Realized： Prevent 概述概述 Summary小兒腹瀉小兒腹瀉(腹瀉病腹瀉病)，是由多病原、多因素引起以腹瀉為，是由多病原、多因素引起以腹瀉為主的一組疾病，容易并發(fā)水、電解質(zhì)、酸堿平衡紊亂。根據(jù)主的一組疾病，容易并發(fā)水、電解質(zhì)、酸堿平衡紊亂。根據(jù)病因可分為感染性（較多見）和非感染性兩類，發(fā)病年齡多病因可分為感染性（較多見）和非感染性兩類，發(fā)病年齡多在在 2 歲以下，歲以下，1 歲以內(nèi)者約占半數(shù)歲以內(nèi)者約占半數(shù)。近。近30

4、年來本病發(fā)病率和年來本病發(fā)病率和病死率已明顯降低，但仍是小兒的常見病和死亡原因。病死率已明顯降低，但仍是小兒的常見病和死亡原因。Infantile diarrhea is caused by multi-pathogeny & multifactor. The main symptom is diarrhea. It is easily complicated by disturbances of water, electrolyte and acid-base balance. According as pathogeny, it can be classified by the i

5、nfected (most) and the non-infected. It occurs usually less than 2 years old, about 50% less than 1 year. Although the incidence and the mortality of the disease have evidently decreased by late 30 years, it often occurs in infants and results in infants death.病因病因 Etiology一一 、易感因素、易感因素 Predisposing

6、 factors 1. 消化系統(tǒng)特點消化系統(tǒng)特點(胃酸胃酸,消化酶消化酶,酶活性酶活性,生長發(fā)育快生長發(fā)育快) Characteristic of digestive system (hypochlorhydria, digest enzyme, enzymatic activity, fast developing and growth) 2. 機體防御功能較差機體防御功能較差(胃酸胃酸,免疫球蛋白免疫球蛋白,SIgA ,正常菌叢正常菌叢) Organism defense hypofunction (hypochlorhydria, immune globulin, SIgA , norm

7、al flora ) 3. 人工喂養(yǎng)人工喂養(yǎng) Non-human-milk feed病因病因 Etiology二二 感染因素感染因素 Infected factors 1. 腸道內(nèi)感染腸道內(nèi)感染(細菌、真菌、病毒、寄生蟲細菌、真菌、病毒、寄生蟲) Intestinal tract infection (bacteria, fungus, virus, parasite) 2. 腸道外感染腸道外感染(中耳炎、上感、肺炎、皮膚感染等中耳炎、上感、肺炎、皮膚感染等) Extraintestinal tract infection (tympanitis, upper respiratory trac

8、t infection, pneumonia, skin infection etc)三三 非感染因素非感染因素Noninfectious factors 1. 飲食因素飲食因素 Food 2. 氣候因素氣候因素 Climate病因病因 Etiology腸內(nèi)感染常見病原腸內(nèi)感染常見病原 Pathogeny of infection inside intestinal tract 1. 大腸桿菌大腸桿菌 Colibacillus (EPEC ETEC EIEC EHEC EAEC） 2. 彎曲菌彎曲菌 Campylobacter 1972 Belgium 1981 Shanghai 3. 耶爾松

9、菌耶爾松菌 Yersinia 1973 USA 1980 Fujian 4. 抗生素誘發(fā)的腸炎抗生素誘發(fā)的腸炎 Enteritis resulted from antibiotics 5. 輪狀病毒輪狀病毒 Rotavirus 1973 Australia 1978 Beijing腸毒素腸毒素不耐熱腸毒素不耐熱腸毒素耐熱腸毒素耐熱腸毒素腺苷酸環(huán)化酶腺苷酸環(huán)化酶鳥苷酸環(huán)化酶鳥苷酸環(huán)化酶CGMPCAMPNa+ Cl- H2O小腸液分泌小腸液分泌腹瀉腹瀉細菌侵襲腸粘膜細菌侵襲腸粘膜充血、水腫、潰瘍充血、水腫、潰瘍血或粘凍狀便血或粘凍狀便發(fā)病機制發(fā)病機制痢疾樣改變痢疾樣改變細菌性腸炎細菌性腸炎Ente

10、rotoxin Heat-intolerant enterotoxinHeat-resistant enterotoxin Adenyl cyclase Guanylic cyclase cGMPcAMPNa+ Cl- H2OSmall intestine juice secreteDiarrhea Bacteria invasive oral mucosaCongest, dropsy, ulcerStool (blood, mucus shreds, pus)PathogenesisBacterial enteritis糖類分解吸收障礙糖類分解吸收障礙腸粘膜上皮細胞脫落，絨毛變短腸粘膜上皮

11、細胞脫落，絨毛變短腸道內(nèi)乳酸腸道內(nèi)乳酸腸道內(nèi)鈉、葡萄糖腸道內(nèi)鈉、葡萄糖雙糖酶活性雙糖酶活性水樣瀉水樣瀉鈉葡萄糖載體的偶聯(lián)轉(zhuǎn)運障礙鈉葡萄糖載體的偶聯(lián)轉(zhuǎn)運障礙鈉、葡萄糖吸收障礙鈉、葡萄糖吸收障礙回吸收水電解質(zhì)能力回吸收水電解質(zhì)能力病毒性腸炎發(fā)病機制病毒性腸炎發(fā)病機制腸滲透壓腸滲透壓病毒顆粒病毒顆粒小腸粘膜帶有微絨毛的上皮細胞小腸粘膜帶有微絨毛的上皮細胞Carbohydrate decomposition & absorption disorderShedding of epithelial cells on intestine mucous membrane, intestinal vil

12、lus shorteningIntestinal lactic acidIntestinal Na + & glucoseDisaccharidase activityWatery diarrheaNa +, glucose coupling transporter disorderNa +, glucose absorption disorderReabsorbed water-electrolytePathogenesis of Viral Enteritis Intestines osmotic pressureVirus particlesMicrovillares epith

13、elial cells on Small intestine mucous membrane 胃內(nèi)食物積滯，胃酸少，腸道下段細菌上移繁殖胃內(nèi)食物積滯，胃酸少，腸道下段細菌上移繁殖腸內(nèi)滲透壓腸內(nèi)滲透壓腸蠕動腸蠕動細菌、毒性產(chǎn)物細菌、毒性產(chǎn)物滲透性腹瀉滲透性腹瀉分解產(chǎn)生短鏈有機酸分解產(chǎn)生短鏈有機酸胺類胺類門脈系統(tǒng)進入血循環(huán)門脈系統(tǒng)進入血循環(huán)非感染性腹瀉發(fā)病機制非感染性腹瀉發(fā)病機制中毒癥狀中毒癥狀(內(nèi)源性感染內(nèi)源性感染)飲食不當飲食不當Gastric stanated food，less gastric acid, lower intestinal bacteria up-moving &

14、propagationIntestinal osmotic pressureEnterokinesiaBacteria & toxicity productsOsmotic diarrheaDecomposition producing shout chain organic acidAminesPortal vein system entering blood circulationPathogenesis of Noninfectious DiarrheaToxicosis symptom (endogenous infection)Improper diet臨床表現(xiàn) Clinic

15、al Menifestations一一 根據(jù)病程分類根據(jù)病程分類Classified by course急性小兒腹瀉（急性小兒腹瀉（2周）周） Acute infantile diarrhea（2月）月） Chronic infantile diarrhea（ 2 months ）二二 根據(jù)病情分類根據(jù)病情分類Classified by patients condition輕型腹瀉輕型腹瀉 無明顯脫水及全身中毒癥狀無明顯脫水及全身中毒癥狀 Mild diarrhea Dehydration & toxicosis symptom are less evidently 重型腹瀉重型腹瀉

16、有較明顯的脫水有較明顯的脫水,電解質(zhì)紊亂電解質(zhì)紊亂,全身中毒癥狀全身中毒癥狀Severe diarrhea Dehydration, disturbances of electrolyte and acid-base balance and toxicosis symptom are evidently三三 根據(jù)病因分類根據(jù)病因分類 Classified by pathogeny 輪狀病毒腸炎輪狀病毒腸炎 Rotavirus enteritis，大腸桿菌腸炎，大腸桿菌腸炎 Escherichia coli enteritis 空腸彎曲菌腸炎空腸彎曲菌腸炎 Campylobacter jejun

17、i enteritis, 耶爾森菌小腸結(jié)炎耶爾森菌小腸結(jié)炎 Yersinia enterocolitis四四 抗生素誘發(fā)的腸炎抗生素誘發(fā)的腸炎 Antibiotic provocative enteritis金黃色葡萄球菌腸炎金黃色葡萄球菌腸炎 Staphylocaccus aureus enterocolitis , 偽膜性小偽膜性小腸結(jié)腸炎腸結(jié)腸炎 pseudomembranous enterocolitis , 真菌性結(jié)腸炎真菌性結(jié)腸炎 fungal colonitis 臨床表現(xiàn) Clinical Menifestations診斷和鑒別診斷診斷和鑒別診斷Diagnosis & D

18、ifferential Diagnosis 非侵襲性腸炎：生理性腹瀉、小腸吸收功能障礙非侵襲性腸炎：生理性腹瀉、小腸吸收功能障礙Non-invasive enteritis Physiologic diarrhea，Intestinal malabsorption侵襲性腸炎：菌痢、壞死性腸炎侵襲性腸炎：菌痢、壞死性腸炎Invasive enteritis Bacillary dysentery，Enteritis necroticcans治療原則治療原則 Principle of Treatment一一 合理飲食合理飲食 Reasonable Diet二二 合理選擇抗生素合理選擇抗生素 Ant

19、ibiotic treatment三三 加強護理加強護理 Intensive nursing care 四四 液體療法液體療法 Liquid therapy 口服補液口服補液 Oral rehydration salts, 靜脈補液靜脈補液 Vein fluid replacement五五 慢性腹瀉治療原則慢性腹瀉治療原則 Principle of chronic diarrhea treatment 消除病因消除病因 Eliminating Etiology, 調(diào)整飲食調(diào)整飲食 Adjusting diet, 慎用抗生素慎用抗生素 Careful using antibiotics, 微生態(tài)

20、療法微生態(tài)療法 Micro-ecological therapy小小 兒兒 液體療法液體療法Infantile Liquid Therapy 目的要求目的要求 Objective概述概述 Summary小兒體液平衡的特點小兒體液平衡的特點 Characteristic of Infantile Body Fluid Balance水電解質(zhì)和酸堿平衡紊亂水電解質(zhì)和酸堿平衡紊亂Disturbances of Water, Electrolyte, & Acid-base balance液體療法時常用的溶液液體療法時常用的溶液Common Solution of Liquid Therapy

21、小兒腹瀉液體療法小兒腹瀉液體療法Infantile Diarrhea Liquid Therapy目的要求目的要求 Objective了解了解小兒體液平衡的特點小兒體液平衡的特點 Realized: Characteristic of Infantile Body Fluid Balance熟悉熟悉小兒水、電解質(zhì)和酸堿失衡的病理生理小兒水、電解質(zhì)和酸堿失衡的病理生理 Be familiar with: Pathophysiology of Infantile Fluid, Electrolyte & Acid-base Imbalance 掌握掌握小兒電解質(zhì)和酸堿平衡紊亂的臨床表現(xiàn)小兒

22、電解質(zhì)和酸堿平衡紊亂的臨床表現(xiàn) Mastered: Clinical menifestations of Infantile Disturbances of Water, Electrolyte & Acid-base Balance 熟悉熟悉液體療法常用溶液的組成及臨床應(yīng)用液體療法常用溶液的組成及臨床應(yīng)用 Be familiar with :Common Solution Component of Liquid Therapy 掌握掌握小兒腹瀉的液體療法小兒腹瀉的液體療法 Mastered: Liquid Therapy of Infantile Diarrhea概述概述 Summa

23、ry 體液是人體的重要組成部分，保持其生理平衡是維持生命的體液是人體的重要組成部分，保持其生理平衡是維持生命的重要條件。體液中水、電解質(zhì)、酸堿度、滲透壓等的動態(tài)平衡依重要條件。體液中水、電解質(zhì)、酸堿度、滲透壓等的動態(tài)平衡依賴于神經(jīng)、內(nèi)分泌、肺，特別是腎臟等系統(tǒng)的正常調(diào)節(jié)功能，由賴于神經(jīng)、內(nèi)分泌、肺，特別是腎臟等系統(tǒng)的正常調(diào)節(jié)功能，由于小兒的生理特點，這些系統(tǒng)的功能極易受疾病和外界環(huán)境的影于小兒的生理特點，這些系統(tǒng)的功能極易受疾病和外界環(huán)境的影響而失調(diào)，因此水、電解質(zhì)和酸堿平衡紊亂在兒科臨床中極為常響而失調(diào)，因此水、電解質(zhì)和酸堿平衡紊亂在兒科臨床中極為常見。見。 Body fluid is im

24、portant 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 phy

25、siologic 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.小兒體液平衡的特點小兒體液平衡的特點一一 體液的總量和分布體液的總量和分布不同年齡的體液分布不同年齡的體液分布（占體重的）（占體重的） 年齡年齡 總量總量

26、 細胞外液細胞外液 細胞內(nèi)液細胞內(nèi)液血漿血漿間質(zhì)液間質(zhì)液足月新生兒足月新生兒78637351歲歲7052540214歲歲6652040成人成人5566510154045Characteristic of Infantile Body Fluid BalanceA. Total body water & its distributionBody water compartments related to age (total body mass%) AgeAge TBWTBWECFECF ICFICFPlasmaISFISFNewborn infant78637351 year70525

27、40214 years6652040Adult5566510154045TBW: total body water ECF: extracellular fluid ICF: intracellular fluid ISF: interestitial fluid小兒體液平衡的特點小兒體液平衡的特點Characteristic of Infantile Body Fluid Balance二二 體液的電解質(zhì)組成體液的電解質(zhì)組成 Electrolyte composition of body fluid 細胞外液細胞外液 ECF: Na+ 、 Cl-，HCO3 - 細胞內(nèi)液細胞內(nèi)液 ICF: K

28、 + 、Mg 2+ 、HPO4 2-、蛋白質(zhì)、蛋白質(zhì) Protein三三 水代謝的特點水代謝的特點 Water metabolism 1. 水的需要量大，交換率快，不顯性失水多（為成人水的需要量大，交換率快，不顯性失水多（為成人2倍）。嬰兒倍）。嬰兒每日水交換量為細胞外液量的每日水交換量為細胞外液量的1 / 2 ，成人僅為，成人僅為1 / 7。 Large water requirements, swift water exchange, unobvious water loss (double adults amount ). Infants water exchange amount is

29、 1 / 2 of ECF , the adults is just 1 / 7.2. 體液調(diào)節(jié)功能不成熟，小兒腎臟的濃縮和稀釋功能不成熟。體液調(diào)節(jié)功能不成熟，小兒腎臟的濃縮和稀釋功能不成熟。 Immature body liquid regulating function , immature concentration and dilution function of infantile. 小兒體液平衡的特點小兒體液平衡的特點Characteristic of Infantile Body Fluid Balance水電解質(zhì)酸堿平衡紊亂水電解質(zhì)酸堿平衡紊亂一一 脫水程度脫水程度表現(xiàn)程度表現(xiàn)

30、程度失水量失水量神神 態(tài)態(tài)眼眶、眼眶、前囟前囟皮膚彈皮膚彈性性口唇粘膜口唇粘膜眼淚眼淚尿量尿量休克休克輕度脫水輕度脫水5（50ml / kg）精神稍差，精神稍差，略有煩躁略有煩躁不安不安稍凹陷稍凹陷稍差稍差略干燥略干燥有有稍少稍少無無中度脫水中度脫水510（50100ml / kg）精神萎靡，精神萎靡，煩躁不安煩躁不安明顯凹陷明顯凹陷差差干燥干燥少少明顯明顯減少減少無無重度脫水重度脫水10（100120ml / kg）昏睡，昏昏睡，昏迷迷深陷深陷極差極差極干燥極干燥無無極少極少或無或無有有Disturbances of Water, Electrolyte & Acid-base Ba

31、lanceA. Degree of dehydration DehydrationMildModerateSevereDecrease in body weight5(50ml / kg)510(50100ml / kg)10(100120ml / kg)PsycheDepressed, hyperirritableDepressed, hyperirritableLethargic,comaOrbit, FontanelSunken Sunken Severely sunkenSkin turgorNormal Decrease Markedly decreaseMucous membran

32、esDry Dry Severely dryTearsDecrease DecreaseAbsentUrineMild oliguria oliguriaAnuriaBlood pressureNormalNormalLow 水電解質(zhì)酸堿平衡紊亂水電解質(zhì)酸堿平衡紊亂二二 脫水性質(zhì)脫水性質(zhì)臨床表現(xiàn)臨床表現(xiàn)脫水性質(zhì)脫水性質(zhì)病因病因血清納血清納病理生理及臨床特點病理生理及臨床特點等滲脫水等滲脫水多見急性胃多見急性胃腸液丟失腸液丟失130150mmol / L細胞外液量減少，細胞內(nèi)外滲細胞外液量減少，細胞內(nèi)外滲透壓相等脫水量與脫水體征平行透壓相等脫水量與脫水體征平行低滲脫水低滲脫水多見慢性胃多見慢性胃

33、腸液丟失腸液丟失150mmol / L細胞內(nèi)液減少明顯，脫水征細胞內(nèi)液減少明顯，脫水征比其他兩種為輕比其他兩種為輕Type of dehydrationPathogenySerum sodiumPathophysiology & clinical characteristicIsosmoticAcute gastrointestinal fluid lose130150mmol / LECF: decrease, Osmotic pressure (intracellular = extracellular)Dehydrant volume accord with dehydrant

34、physical signHypotonicChronic gastrointestinal fluid lose150mmol / LICF: severely decrease, Milder dehydrant sign than the other two kindsDisturbances of Water, Electrolyte & Acid-base BalanceB. Property of dehydration水電解質(zhì)酸堿平衡紊亂水電解質(zhì)酸堿平衡紊亂Disturbances of Water, Electrolyte & Acid-base Balance

35、三三 代謝性酸中毒代謝性酸中毒 Metabolic acidosis（一）發(fā)生原因（一）發(fā)生原因 Pathogeny1. 體內(nèi)堿性物質(zhì)丟失過多（消化道、腎臟丟失）體內(nèi)堿性物質(zhì)丟失過多（消化道、腎臟丟失） The lose of large amount of basic substances（gastrointestinal tract, kidneys）2. 酸性代謝產(chǎn)物產(chǎn)生過多（饑餓、糖尿病、腎衰、缺氧）酸性代謝產(chǎn)物產(chǎn)生過多（饑餓、糖尿病、腎衰、缺氧） Too much Acid metabolite （hungriness, diabetes, renal failure, hypoxi

36、a）3. 攝入酸性物質(zhì)過多（長期服氯化鈣、氯化鎂、靜滴鹽酸精氨攝入酸性物質(zhì)過多（長期服氯化鈣、氯化鎂、靜滴鹽酸精氨酸或鹽酸賴氨酸、復合氨基酸、水楊酸等）酸或鹽酸賴氨酸、復合氨基酸、水楊酸等）Too much acid substance intake （long time to take calcium chloride, ammonium chloride, amino acid etc.）（二）（二） 分度分度 Degree輕度輕度 Mild HCO3- 1813 mmol / L中度中度 Moderate HCO3- 139 mmol / L重度重度 Severe HCO3- 9 mmo

37、l / L水電解質(zhì)酸堿平衡紊亂水電解質(zhì)酸堿平衡紊亂Disturbances of Water, Electrolyte & Acid-base Balance水電解質(zhì)酸堿平衡紊亂水電解質(zhì)酸堿平衡紊亂Disturbances of Water, Electrolyte & Acid-base Balance四四 低鉀血癥低鉀血癥 Hypokalemia（一）（一） 病因病因 Pathogeny1. 攝入不足攝入不足 Lack of intake2. 丟失過多（消化液丟失、利尿從腎臟丟失）丟失過多（消化液丟失、利尿從腎臟丟失） Loss of kalium from kidneys

38、 or gastrointestinal tract3. 其他途徑（燒傷、透析治療不當）其他途徑（燒傷、透析治療不當） Burn, dialysis etc.4. 鉀在細胞內(nèi)外分布異常（堿中毒、胰島素治療、周期性麻痹）鉀在細胞內(nèi)外分布異常（堿中毒、胰島素治療、周期性麻痹） Abnormal kalium distribution inside or outside cells （alkalosis, insulin therapy、periodic anesthesia）（二）（二） 臨床表現(xiàn)臨床表現(xiàn) Clinical menifetation1. 神經(jīng)神經(jīng)精神萎靡精神萎靡 Nervous s

39、ystem depressed2. 肌肉肌肉 骨骼肌骨骼肌四肢肌乏力，肌張力四肢肌乏力，肌張力，嚴重遲緩性癱瘓，呼，嚴重遲緩性癱瘓，呼吸肌麻痹吸肌麻痹 Muscleinertia of limbs，muscular tension down，severely retardant paralysis，respiratory muscle paralysis水電解質(zhì)酸堿平衡紊亂水電解質(zhì)酸堿平衡紊亂Disturbances of Water, Electrolyte & Acid-base Balance3. 心臟心臟 心率心率，心律失常，阿期綜合癥，房室傳導阻滯，心律失常，阿期綜合癥，房室

40、傳導阻滯， 心心肌纖維變性，局限性壞死，心肌收縮乏力，心音低鈍肌纖維變性，局限性壞死，心肌收縮乏力，心音低鈍 心電圖，出現(xiàn)心電圖，出現(xiàn)U波，波，UT，T波增寬、低平、倒置波增寬、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水電解質(zhì)酸堿平衡紊亂水電解質(zhì)酸堿平衡紊亂Distur

41、bances of Water, Electrolyte & Acid-base Balance4. 腎臟腎臟 腎小管上皮細胞空泡變性，對腎小管上皮細胞空泡變性，對ADH的反應(yīng)低下，濃的反應(yīng)低下，濃 縮功能減低，尿量增多，腎小管泌縮功能減低，尿量增多，腎小管泌H 增加，回吸收增加，回吸收HCO3- 增加，氯的回吸收減少，可發(fā)生低鉀、低氯堿中毒，伴反常增加，氯的回吸收減少，可發(fā)生低鉀、低氯堿中毒，伴反常 性酸性尿。性酸性尿。 Kidney concentrating function lowering, urine volume increasing水電解質(zhì)酸堿平衡紊亂水電解質(zhì)酸堿平衡紊

42、亂Disturbances of Water, Electrolyte & Acid-base Balance液體療法時常用的溶液液體療法時常用的溶液Common Solution of Liquid Therapy一一 非電解質(zhì)溶液非電解質(zhì)溶液 Nonelectrolyte solution5、10 glucose二二 電解質(zhì)溶液電解質(zhì)溶液 Electrolyte solution 0.9 NaCl、1.4、5 NaHCO3、10 KCl三三 混合溶液混合溶液 Mixed solutions見下表見下表 refer to the following table液體療法時常用的溶液液體

43、療法時常用的溶液Common Solution of Liquid Therapy常用混合液常用混合液Common mixed solution0.9%NaCl1.4%NaHCO3510%G.S2:1(等張含鈉液等張含鈉液)2份份1份份3:2:1(1/2張含鈉液張含鈉液)2份份1份份3份份4:3:2(2/3張含鈉液張含鈉液)4份份2份份3份份1/3張含鈉液張含鈉液2份份1份份6份份小兒腹瀉液體療法小兒腹瀉液體療法Infantile Diarrhea Liquid Therapy一一 定量定量 Volume總總 量量 Total volume累積損失量累積損失量Cumulated losing

44、volume維持輸入階段（生理需要，維持輸入階段（生理需要，繼續(xù)損失）繼續(xù)損失）Keep transfusing period（physiological need, losing continuing）輕輕 90120ml/kg4560ml/kg4560ml/kg中中 120150ml/kg 6075ml/kg6075ml/kg重重 150180ml/kg7590ml/kg7590ml/kg二二 定性定性 Quality脫水種類脫水種類Dehydrant category累積損失量累積損失量Cumulated losing volume維持輸入階段（生理需要，維持輸入階段（生理需要，繼續(xù)損失

45、）繼續(xù)損失）Keep transfusing period（physiological need, losing continuing）低滲性脫水低滲性脫水Hypotonic dehydration4:3:21/31/4張含鈉液張含鈉液Sodic solution等滲性脫水等滲性脫水Isosmotic dehydration3:2:11/31/4張含鈉液張含鈉液Sodic solution高滲性脫水高滲性脫水 Hyperosmotic Dehydration1/3張含鈉液張含鈉液Sodic solution1/31/4張含鈉液張含鈉液Sodic solution小兒腹瀉液體療法小兒腹瀉液體療法

46、Infantile Diarrhea Liquid Therapy三三 定速定速 Speed總總 量量Total volume累積損失量累積損失量Cumulated losing volume維持輸入階段（生理需要，繼續(xù)維持輸入階段（生理需要，繼續(xù)損失）損失）Keep transfusing period（physiological need, losing continuing）24h812h1216h810ml / kg /h5ml / kg /h小兒腹瀉液體療法小兒腹瀉液體療法Infantile Diarrhea Liquid Therapy四四 休克擴容休克擴容 Shock volum

47、e expansion，定量、定性、定速，定量、定性、定速擴擴 容容 量量Volume溶溶 液液 名名 稱稱Solution速速 度度Speed20ml/kg2:1或或1.4NaHCO33060min小兒腹瀉液體療法小兒腹瀉液體療法Infantile Diarrhea Liquid Therapy注：總量不超過注：總量不超過300ml Total volume 300ml五五 代謝性酸中毒的治療代謝性酸中毒的治療 Treatment of metabolic acidosis 輕、中度代謝性酸中毒不須另行處理。輕、中度代謝性酸中毒不須另行處理。 Mild or moderate metabolic acidosis metabolic acidosis: No special treatment 重度代謝性酸中毒重度代謝性酸中毒 Severe metabolic acidosis： 1.4%NaHCO3 3ml/kg， HCO3- level can increase abo