静脉输液途径

The accesses and infusions of fluid replacement,李世宽青岛大学附属医院急诊普外科,Fluid replacement via the rectum,Fluid replacement via the rectum,Intravenous (IV) infusion /therapy,历史,1831年，苏格兰医生Thomas Latta首次在霍乱(cholera)病人首次应用静脉输液技术直至1950s静脉输液才普及应用,MacGillivray, Neil (2009). Dr Thomas Latta: the father of intravenous infusion therapy. Journal of Infection Prevention 10 (Suppl. 1): 36.,输液成分/目的,药物 (Medicines)扩容剂 (Volume expander)晶体液 (Saline solution)胶体液 (Colloid solutions)缓冲液 (Buffer solutions)碳酸氢钠血液 (Blood substitutes & Blood-based products)肠外营养 (Parenteral nutrition),输液途径/工具,输液途径/工具,3 way stopcock,输液途径/工具,皮下针(Hypodermic needle) 留置针(Peripheral cannula /peripheral venous catheter, PVC)中心静脉导管(Central IV lines)Peripherally inserted central catheter, PICC Central venous lines/central venous catheter, CVC Tunnelled Lines (Hickman lines)植入式静脉输液港(Implantable ports),Hypodermic needle,PVC,CVC,CVC,Seldinger technique,PICC,Hoshal VL (May 1975). Total intravenous nutrition with peripherally inserted silicone elastomer central venous catheters. Arch Surg 110 (5): 6446.,PICC,Hickman line,/bulletin/spring_2007/alumni.html,Robert O. Hickman,Implantable port,CVC并发症,气胸 (Pneumothorax)导管相关血流感染 (Central-Line Associated Bloodstream Infections (CLABSIs) 血栓 (Thrombosis) 其他,Venous cutdown,输液设备,输液设备,输液设备,2 in 1,3(all) in 1,液体(晶体),Dextrose 5% in Water (D5W),液体(晶体),Ringers solution 6.5g NaCl, 0.42g KCl, 0.25g CaCl2 and 0.2g of sodium bicarbonate is dissolved in one litre of distilled water. Lactated Ringers solution /Hartmanns solution,液体(晶体),Sydney Ringer (1835-1910) British clinician,液体(晶体),Alexis Frank Hartmann (1898-1964) US paediatrician,液体(晶体),液体(胶体),McDonald DM, Thurston G, Baluk P. Endothelial gaps as sites for plasma leakage in inflammation. Microcirculation 1999;6:722.,Inflammatory mediator release,Albumin,18 x H2O,NaCl,Systemic capillary leak,Injury,液体(胶体),液体(胶体),液体(胶体),ALB & Plasma1940s WWII dried plasma1950s Korean war serum albumin,液体(胶体),白蛋白合成于肝脏白蛋白是人血浆含量最多的蛋白质，远远高于组织间液，在人体内它最重要的作用是维持胶体渗透压 白蛋白是血浆中主要的载体（水溶性差的物质）胆红素、脂肪酸、前列腺素、甲状腺激素、性激素、金属离子（如Cu2+、Ca2+）、药物等,液体(胶体),血浆的优势，除了白蛋白球蛋白与纤维蛋白原 凝血因子葡萄糖矿物质激素,液体(胶体),1910s WWI Gum salt1982 - Falklands War Polygeline生理特性接近细胞外液，对凝血系统无干扰，可有效改善机体循环功能每日使用量可不受限制，为其最大的优点,液体(胶体),1960s Vietnam war - Hydroxyethyl strarch (HES)HES impairs renal function and coagulation,液体(胶体),2000s - Armed conflict