小儿体液平衡特点及液体疗法000

小儿体液平衡特点及液体疗法000 小儿体液平衡特点及液体疗法 , 小儿体液平衡特点 ?(体液总量与分布 表1 不同年龄体液总量与分布(占体重,) 新生儿 1岁 2,14岁 成人 80 70 65 体液总量 55,60 细胞内液 35 40 40 40,45 细胞外液 45 35 25 15,20 间质液 40 25 20 10,15 5 5 5 5 血浆 , 体液分细胞内液与细胞外液，后者又分间质液与血浆。 , 年龄愈小，体液总量相对愈多，主要是细胞外液中的间质液相对愈多。 , 水在体内各组织中的含量差别较大，如骨骼肌含水量约76,，而脂肪含水量 仅10,。 ?(体液中电解质的组成 , 小儿体液中电解质与成人相似。 但生后数天内血钾5,7mmol,L,血氯104,112 mmol,L，血中碳酸盐21,23 mmol,L。 , 细胞内外液的电解质差别较大。 ，2+2-细胞内以K、Mg、HPO和蛋白质为主。 4 ，,,细胞外以Na、CL、HCO和一定量的蛋白质为主。 3 细胞外液的血浆和间质液中的电解质差别不大，仅血浆中蛋白质含量较多。 , 血浆中的电解质可精确测定，是临床判断电解质正常或紊乱的依据。 表:血浆中电解质组成 阳离子 mEq,L mmol,L 阴离子 mEq,L mmol,L rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities ，,Na HCO 142 142 27 27 3 ，,K CL 5 5 103 103 ，,2Ca HPO 5 2.5 2 1 24 ，,2Mg SO 23 1.5 41 0.5 总量 155 151 有机酸 6 6 蛋白质 16 0.8 总量 155 138.3 从上表可看出: , mEq,L与mmol,L之间的关系。 , 阴阳离子以mEq,L表示均为155。 , 阴阳离子以mmol,L为单位相加其总和可反映血浆渗透压，即151， 138.3=289.3 mmol,L,正常范围为280,320 mmol,L，<280 mmol,L 为 低渗，>320 mmol,L为高渗。 ，，因血浆中Na, 占阳离子总量的90?以上，临床上以测血Na来判断血浆渗 150mmol,L为等渗，<130为等渗，>150为高渗。简易计算公透压，130, 式: ， 血浆渗透压mmol,L,2×(Na，10) , 血浆中Na ?CL,3?2 , 阴离子间隙(AG Anion Gap) ，,, AG= Na,(CL，HCO) 3 正常范围为8,16mmol,L 对区别代酸的性质和指导治疗有一定帮助。 ?(儿童水代谢的特点 , 水的生理需要量 年龄愈小，需要量愈多。 因为:?小儿生长发育快，细胞组织增长需积蓄水; ?活动量大; ?新陈代谢旺盛; ?摄入热量、蛋白质和肾排出的溶质量较高; ?体表面积大，呼吸频率快，不显性失水多。 表:不同年龄小儿每日水的需要量 年龄(岁) <1 1,3 3,9 10,14 rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 需水量130,160 110,140 70,110 50,90 (ml/kg) 表:机体每消耗100Kcal热量所需水量(ml) 肺 14 不显性失水 皮肤 28 出汗(室温20度) 20 大便 8 小便 50,80 合计 120,150 2.水的交换: 小儿水的交换率也比成人快。 婴儿每日约为细胞外液的1/2。 成人约为1/7。 3小儿水代谢的调节机制尚不成熟 神经内分泌:肾、肺对水代谢的调节机制均不成熟。 如:小儿年龄愈小，肾脏的浓缩和稀释功能愈不成熟，新生儿和幼婴，其最大浓缩能力只能使尿液渗透压浓缩到700mmol,L(比重1020)，而成人可达1400mmol,L(比重1035)，小儿排出1mmol,L溶质需要带出水1,2ml水，成人只需0.7ml水。 由于上述特点，小儿容易发生水、电解质及酸碱平衡紊乱。 二(常见的体液代谢紊乱 ?(脱水 dehydration 指体液总量尤其是细胞外液量的减少，由于摄入不足和损失过多。除失水外 还有钠、钾及其它电解质损失。 , 脱水程度 发病后累积损失的液体量，分三度。 表:脱水程度 rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 临床表现 轻度 中度 重度 神志 精神稍萎 神萎烦躁 神志不清 皮肤 稍干，弹性稍差 干，弹性差 灰白冰冷，弹性稍差 前囟眼窝 稍凹 明显凹陷 极度凹陷 唇粘膜 稍干 干燥 干裂 尿量 稍减少 显著减少 几乎无尿 末梢循环 尚好 差 休克 失水量(占体重?) <5? 5,10? >10? 损失细胞外液量1/5约损失细胞外液量 损失细胞外液量 估计累积失水(ml/kg) 40,50 1/3约50,100 1/2约100,200 , 脱水性质 表:脱水性质 低渗 等渗 高渗 水盐丢失比 失水<失盐 失水=失盐 失水>失盐 细胞外液量 ??? ?? ? 细胞内液量 ? ? ?? 血浆渗透压(mmol,L) ?<280 280,320 ?>320 血钠(mmol,L) ?<130 130,150 ?>150 明显，肢冷、皮肤发花，可有 循环障碍症状 轻 血压下降 (中度以上脱水时) 明显，烦躁激惹、口渴神经系统症状 可昏迷 重者，萎靡、嗜睡 高热惊厥，肌张力增高 ?严重或长期腹泻 , 腹泻伴高热 ?营养不良并腹泻 , 呕吐、腹泻 , 不显性失水增多 ?慢性心肾疾病长期忌, 胃肠引流 原因 盐 , 口服或静脉输入等, 进食不足 ?大量利尿剂应用 渗或高渗溶液过多 ?补充非电解质液量多 ?(钾代谢紊乱 正常血钾为3.5,5.5mmol,L , 低钾血症 hypokalemia 血钾<3.5mmol,L 原因: ?摄入不足 ?损失过多: 胃肠道丢失(吐泻、胃肠引流) 尿中丢失 药物:排钾利尿剂，肾上腺皮质激素。 疾病:醛固铜增多症，肾小管酸中毒。 ?钾转移到细胞内 家族性周期性麻痹 输入葡萄糖加胰岛素 碱中毒 临床表现:?神经肌肉兴奋性降低:神萎，全身软弱无力，肌张力降低，腱 反射减弱或消失。弛缓性瘫痪 ?胃肠平滑肌兴奋性降低:腹胀、肠鸣减弱或消失，肠麻痹。 ?心肌张力降低:心音低钝，心率增快，心律紊乱，心电图: S,T段降低，T波倒或平坦，Q,T间期延长，U 波出现。 rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities ，，+ ?肾脏:尿浓缩功能差，尿量多，K自细胞内移出，Na、H +，移向细胞内，细胞外H降低，远曲小管排K +减少，排H增多，导致低钾性碱中毒。 诊断: 低钾血症应根据病史、临床表现、血钾测定及心电图检查进行综 合分析。 但根据测血钾浓度并不一定能准确反映机体缺钾情况，特别在脱 水时血液浓缩，尿量减少，或酸中毒时细胞内钾移向细胞外，故 血钾浓度可正常或稍高。 治疗: ?治疗原发病 ?补钾 见尿补钾，多次监测。 口服补钾 静脉补钾:浓度<40 mmol,L(<0.3?) 速度<0.3 mmol,kg.h.缓慢静滴，切勿直接静 脉注射。 量: 一般可给钾3 mmol,kg.d.严重者4,6 mmol,kg.d. 2. 高钾血症 hyperkalemia 原因: ?排出减少:肾功能衰竭、休克、严重脱水。 ?产生或进入过多:溶血、严重挤压伤、酸中毒、输入含钾溶 液浓度过高、速度过快。 mmol,L时，出现四肢和口周麻木， 临床表现:?神经肌肉系统:血钾>7 全身软弱，嗜睡，腱反射降低或消失。 ? 心脏: 心肌应激性下降，心率缓慢，传导阻滞，心 室纤颤。心电图可见T波高尖，Q,T间期延 长，传导阻滞，室性心律不齐。 治疗: 停止含钾液体及一切隐性的钾来源。 积极降低血钾:?快速静脉应用碳酸氢钠1,2 mmol,kg ?输入葡萄糖(3g)，胰岛素(1U)溶液 ?10?葡萄糖酸钙0.5 ml,kg缓慢静注 ?离子交换树脂、血液或腹膜透析 ?.酸碱平衡紊乱 正常血液的pH值维持在7.35,7.45。 pH<7.30为酸中毒;pH>7.45为碱中毒。 当肺呼吸功能障碍，使CO2排出过少或过多，使血浆中H2CO3的量增加或 减少，引起的酸碱平衡紊乱称为呼吸性酸中毒或碱中毒。 酸碱平衡紊乱时如机体通过缓冲系统的代偿，使血液中pH保持在正常 围时称为代偿性酸中毒或碱中毒，否则为失代偿酸或碱中毒。 rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 1(代谢性酸中毒 metabolic acidosis 根据AG分为?正常AG型(AG,8,16 mmol,L)，主要是失碱引起，见于碱性 物质从消化道或肾脏丢失，摄入酸性物质过多，酸性代谢产物 堆积等。 ?高AG型(AG>16 mmol,L)主要是产酸过多所致。如糖尿病酮症 酸中毒，饥饿性酮症。 临床表现:根据血浆中CO2CP测定分为轻中重三度。(见下表) 代谢性酸中毒的临床表现 轻度 中度 重度 正常或稍烦躁 烦躁或萎靡 昏睡或昏迷 精神状态 正常 樱桃红色 暗红或紫绀 口唇颜色 深而慢 深而快 不 规则 编码规则下载淘宝规则下载天猫规则下载麻将竞赛规则pdf麻将竞赛规则pdf 呼吸改变 无 无 有 周围循环衰竭 苍白 苍白或灰白 灰白或紫绀 面色 18,13 13,9 <9 mmol,L CO2CP 40,30 30,20 <20 Vol? ,治疗:?.积极治疗原发病:正常AG型治疗原则为减少HCO3的损失和补充碱 剂;高AG型原则为改善循环和机体缺氧状况。 ?.补碱:?轻度酸中毒经原发病治疗后通过机体代偿可自行恢复。 ?中重度酸中毒或pH<7.3时可静脉补充碱剂，常首选碳酸氢 钠。 ?在无条件测定血气或血气结果尚为出来前可先按提高HCO3 ,5 mmol,L计算。 有血气测定结果时可按 公式 小学单位换算公式大全免费下载公式下载行测公式大全下载excel公式下载逻辑回归公式下载 计算: ,碱剂需要量(mmol,L),(22-测得的HCO3)×0.6×体重(Kg) 或碱剂需要量(mmol,L),?,BE?×0.3×体重(Kg) 一般首次给1/2，以后酌情是否继续用药。碱剂应稀释成等 张。在呼吸功能障碍时不宜用碳酸氢钠。新生儿、缺氧、 休克和肝功能不全时不宜使用乳酸钠。 ?.在纠正过程中应注意补钾和补钙。 , 代谢性碱中毒 metabolic alkalosis ，, 由于体内H丢失或HCO蓄积所致。 3 见于严重呕吐，严重低钾血症，先天性失氯性腹泻，应用大剂量皮质 激素 ，使用过多碱性药物等。 临床表现: 典型表现为呼吸慢而浅，头痛、烦躁、手足麻木，低钾血症和血清游 离钙降低而导致的手足抽溺。 rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 治疗: , 去除病因，停用碱性药物。 , 轻症给于0.9?氯化钠溶液静脉滴注。 ,,严重者(pH>7.6; HCO3, >40mmol,L;Cl<85 mmol,L)可给予氯化铵。需 补充的氯化铵(mmol,L),(测得的HCO3-22)mmol,L×0.3×体重(kg). 先给计算量的1/2或1/3，配成0.9?氯化铵静脉滴注。 ,(0.9%氯化铵3ml/kg约可降低HCO31mmol,L)。 , 呼吸性酸中毒 respiratory acidosis 由于通气障碍导致体内CO2蓄积和H2CO3增多。 见于呼吸道堵塞;肺和胸腔疾病;呼吸中枢抑制;呼吸肌麻痹以及呼吸 肌使用不当致CO2蓄积。 临床表现: 除原发病表现以外，缺氧为突出症状。 治疗: 积极治疗原发病，改善通气和换气功能，解除呼吸道阻塞。 重症可作气管插管或气管切开，人工辅助呼吸。 , 呼吸性碱中毒 respiratory alkalosis 过度减少，血H2CO3降低。 由于通气过度，使血液中CO2 见于神经系统疾病;严重贫血、肺炎;过度通气;水杨酸中毒;CO中毒。 临床表现: 突出症状为呼吸深快;其它与代谢性碱中毒相似。 治疗: 主要是病因治疗，改善呼吸。 三(液体疗法时常用的溶液 ?(非电解质溶液: 常用5?和10?葡萄糖溶液。 特点:葡萄糖进入体内后代谢变为CO2和水，不能起到维持血浆渗透压的作 用。 用途:?供给水份?稀释电解质溶液?供给部分热量。 ?(电解质溶液 (1)0.9?氯化钠溶液(生理盐水) 特点:?等张液(308 mmol,L ) ?Na:Cl=1:1(各为154 mmol,L) ?中性溶液，对血浆来说偏酸。 用途:?补充电解质Na和Cl ?可用于扩容 ?纠正部分低氯性碱中毒 (2)3?氯化钠溶液:用于纠正低钠血症。 ， 每1ml含Na0.5 mmol,L rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities (3)10?氯化钾溶液:用于补钾。静脉滴注一般用 0.2?(含钾27 mmol,L)最高浓度不超过0.3?(含钾40 mmol,L)。不 能静脉直接推注。 (4)碱性溶液:用于纠正酸中毒。 , 5?碳酸氢钠: 为高张液(1190 mmol,L)等张液为1.4?(5?碳酸氢 钠稀释3.5倍)可直接缓冲碱，故可迅速纠正酸中毒。 ，，,(NaHCO3? Na+ HCO3+H?H2CO3?CO2+H2O) 适用于重症酸中毒、休克、缺氧及新生儿的酸中毒，但有呼吸衰竭及 CO2蓄积者慎用。 , 11.2?乳酸钠溶液: 高张液(2000 mmol,L)，1.87?为等张液 -(11.2?乳酸钠稀释6倍)需在有氧条件下经肝脏代谢生成HCO3后才有 纠酸作用，故发挥作用缓慢。 ，， (5)氯化铵: 制剂为0.9?等张液。NH4在肝内与CO2结合生成尿素，释出H -及Cl，使PH下降，用于纠正低氯性碱中毒。临床较少应用。 ?.混合溶液: 为适用于不同情况下的需要，常用非电解质溶液及电解质溶液按不同比 例配制成混合溶液应用。其目的是:?改变溶液的渗透压以适合于不同性 :2?增加电解质种类，尤其增加HCO3质脱水的需要?改变Na、CL比例接近3 ,。 常用溶液成分 ，每100ml含溶，，HCO或Na3-Na K 溶液 张力 Cl 质或液量 乳酸根 /Cl血浆 142 5 103 24 3:2 1 1 ?0.9?氯化钠 0.9g 154 154 1:1 ?5?或10?葡萄糖 5或10g 0 ?5?碳酸氢钠 5g 595 595 3.5 ?1.4?碳酸氢钠 1.4g 167 167 1 ?11.2?乳酸钠 11.2g 1000 1000 6 ?1.87?乳酸钠 1.87g 167 167 1 ?10?氯化钾 10g 1342 1342 8.9 +?0.9?氯化铵 0.9g 167 1 NH167 4 1:1含钠液 ?50ml?50ml 77 77 1:1 1/2 1:2含钠液 ?35ml?65ml 54 54 1:1 1/3 1:4含钠液 ?20ml?80ml 30 30 1:1 1/5 ?65ml?或?2:1含钠液 158 100 58 3:2 1 35ml ?33ml?50 ml 2:3:1含钠液 79 51 28 3:2 1/2 ?或?17ml ?45ml?33 ml 4:3:2含钠液 106 69 37 3:2 1/3 ?或?22ml rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 表 几种混合液的简要配制 加入溶液5%碳酸氢钠 溶液种类 张力 (ml)5%或10%10%氯化钠 (11.2%乳酸 葡萄糖 钠) 2:1 1 加至500 30 47(30) 1:1 1/2 加至500 20 —— —— 1:2 1/3 加至500 15 —— 1:4 1/5 加至500 10 2:3:1 1/2 加至500 15 24(15) 4:3:2 2/3 加至500 20 33(20) ?(口服补液盐(ORS oral rehydration salts) 80年代以后WHO推荐ORS用于防治轻中度脱水收到了良好效果，在使用中发现ORS存在一些问 题 快递公司问题件快递公司问题件货款处理关于圆的周长面积重点题型关于解方程组的题及答案关于南海问题 :高渗、口干、呕吐、顺应性差。因此在2003年WHO和UNICEF推荐一种新的ORS配方。 表 新的ORS配方组成及渗透压比较 配方g/l 渗透压mmol/l 旧ORS 新ORS 旧ORS 新ORS 氯化钠 3.5 2.6 钠 90 75 无水葡萄糖 20.0 13.5 氯 80 45 氯化钾 1.5 1.5 无水葡萄糖 111 75 枸橼酸钠 2.9 2.9 钾 20 20 总重量 27.9 20.5 枸橼酸盐 10 10 总渗透压 311 245 新ORS配方克服了旧ORS所存在的问题: ?静脉补液需求量下降了33% ?呕吐减少30% ?对霍乱同样有效 ?应用于脱水累积失水量的补充，一般按 轻度脱水40-50ml/kg 中度脱水60-80ml/kg 在4-6h内少量多次喂给 四(液体疗法 通过补充不同量及不同性质的液体纠正水电解质及酸碱平衡紊乱。 rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities ?.目的: 补缺、纠偏、去余、供需。 ?.原则: 据证定液、先盐后糖、先快后慢、见尿补钾、察情调整 ?.具体 方法 快递客服问题件处理详细方法山木方法pdf计算方法pdf华与华方法下载八字理论方法下载 : 1.补充“三个部分”:即积累损失，继续损失，生理需要。 2.作好“三定”:即定量、定性、定时 3.分阶段进行:先补充累积损失量，如系重度脱水或休克者，应先用含钠等张液扩容，要快补，再补累积损失。然后再酌情补继续损失和生理需要，应慢补。 4.见尿补钾，酌情补钙补镁。 5.严密观察，随时酌情调整补液量、成分和速度 , 如系重度脱水(或休克)，首先应以2:1含钠等张液(2分生理盐水+1分1.4%碳 酸氢钠液)按20-30ml/kg在30-60分钟内迅速静脉滴入，再继续补充余下的累积 损失量。 , 纠正酸中毒:轻中度酸中毒通过以上混合液的补充，脱水纠正，机体可自行调 节，不必另补碱。如为重度酸中毒，在补充累积失水量时，可增加碱性溶液按 提高COCP3-5mmol/l(需5%碳酸氢钠3-5ml/kg) 2 , 补钾:见前。 4) 注意补钙补镁。 ?.补液途径: , 口服补液:?米汤，盐溶液?糖盐水?QRS溶液(见前) 以上可任选一种。 2(静脉补液:(以婴儿腹泻为例) 表 婴儿腹泻第一天静脉输液 方案 气瓶 现场处置方案 .pdf气瓶 现场处置方案 .doc见习基地管理方案.doc关于群访事件的化解方案建筑工地扬尘治理专项方案下载 累积损失量ml/kg 继续损失量ml/kg.d 生理需要量 轻度40-50 10-40 60-80 定量 中度60-100 重度100-120 低渗2/3-等张 1/5张生理维定性 等渗1/2-2/3张 1/2张 持液 高渗1/5-1/3张 定时 8-12h或8-10ml/kg.h 12-16h或5-7ml/kg.h 第二天及以后补液:如脱水已纠正，可酌情补充继续损失和生理需要，并供给足够热量。 举例:9个月重型腹泻患儿，重度脱水伴休克HCO?10mmol/l，如何进行液体疗法。 3 rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities