脱水 dehydration

  • 概念

    • 体内因水分摄入不足或损失过多，造成体液总量异常减少称脱水
    • 水盐是体液的主要成分，故在失水时，都伴有不同程度的盐的损失，根据水、盐损失的比例不同，临床上把脱水分成三种类型。

  • 正常体液代谢平衡

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    体液平衡调节
    调节体液组成成分
    主要为电解质组成
    调节体液容量
    体液的等渗性调节
    体液的等容性调节

    • 细胞外液等渗性调节

      • 如大失血时,渗透压并无明显变化,仅血容量减少,可由压力感受器调节
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    刺激
    压力信息
    传到丘脑下部
    抑制
    疼痛创伤等
    体液等渗调节
    丘脑下部的视上核及周围的渗透压感受器
    ADH合成和分泌增加
    尿排出减少,水重吸收增加
    左右心房的容量感受器
    迷走N

    • 细胞外液等容性调节

      • 当循环血量增加时,则抑制肾素分泌
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    循环血量下降
    肾入球小动脉压也下降
    肾小球旁细胞肾素分泌增加
    催化血液中的血管紧张素原生成血管紧张素I/II
    肾上腺分泌醛固酮增多
    肾小管对钠重吸收增加
    继而对水重吸收增

  • 正常情况下,血液、组织间液、细胞内液(60%)相互交换,体液分布处于相对平衡状态。

  • 高渗性脱水(hypertonic dehydratior)

    • 概念：是以水分丧失为主，盐的丧失较少的一种脱水。又称缺水性脱水单纯性脱水

    • 特点

      • 血液浓缩，血清钠浓度，血浆渗透压升高，超过正常最高值
      • 细胞因脱水皱缩
      • 患畜口渴，尿少，比重增加，细胞脱水，皮肤皱缩

    • 原因

      • 水源断绝或不能进水（长期在沙漠行走，水源断绝，咽炎、食道阻塞、破伤风等）
      • 利尿药使用不当：低渗液损失过多。如过量使用利尿剂（高渗糖、尿速）；不适当的使用发汗、解表药和泻下药
      • 肾浓缩功能不全或补水不足
      • 水消耗增加（发热）

    • 临诊表现

      • 皮肤干燥，弹性降低，口干口渴，尿量减少，尿比重增加，无汗，发热
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      细胞内液渗入组织,细胞内脱水
      组织液渗入血浆,组织液渗透压升高
      血浆渗透压升高

    • 影响

      • 脱水热

        • 血液浓稠,循环障碍,腺体、皮肤、呼吸器官分泌和蒸发减少,散热困难,温热在体内蓄积,引起发热。
      • 酸中毒
        • 细胞脱水,细胞内氧化酶活性降低,代谢障碍,酸性代谢产物堆积。
      • 自体中毒
        • 血浆渗透压升高,组织间液得不到及时更新,代谢产物滞留体内。
      • 上述影响发展到严重阶段,可使大脑皮层及皮层下各级中枢机能紊乱,患畜运动失调、昏迷甚至死亡。

  • 低渗性脱水 hypotonic dehydration

    • 概念

      • 脱水时,丧失的盐多于水。血清钠浓度及血浆渗透压低于正常。
      • 又称为缺盐性脱水 salt depleting dehydration
    • 特点
      • 血浆渗透压降低
      • 细胞内水肿
      • 患畜口不渴，初期尿量增加，尿比重下降
      • 后期易发生容量性休克
    • 原因
      • 大汗、严重呕吐、腹泻、大面积烧伤

        • 补水不及时、补水不当，单纯补水，过量
      • 利尿剂使用不当
        • 如长期使用速尿、利尿酸、双克塞等排钠性利尿剂，使钠排出增加。
      • 慢性肾功能不足
        • 钠重吸收障碍，或产H+不足而致钠损失过多。
      • 代谢病
        • 如牛酮血症，为排出酮体而带走大量钠。
      • 肾上腺皮质机能降低
        • 醛固酮分泌下降，使肾小管对钠的吸收不足，而随尿排出。
      • 反复或大量排放胸、腹水也可引起H2O、钠丢失。
    • 影响
      • 细胞水肿

        • 因细胞间液的Na+不断进入血液而发生渗透压降低,则其水分进入细胞内而引起水肿。神经细胞水肿可引起颅内压升高而出现神经症状。
      • 低血容量性休克
        • 体液减少,水分又大量从尿排出,有效循环血量减少,动脉压下降,微循环灌流量不足
      • 自体中毒
        • 有效循环量不足,肾灌流量下降,细胞水肿,代谢和排泄障碍同时发生,有害产物蓄积在体内,发生自体中毒而死亡。

  • 等渗性脱水 isotonic dehydration

    • 概念

      • H2O和钠大致按比例丢失的脱水。血浆渗透压基本无变化。又称为混合性脱水
    • 特点
      • H2O和钠按比例丢失,故细胞外液渗透压仍属正常,但因肺、皮肤不断排出部分水,可使渗透压升高。
      • 与高渗性脱水相比,丢失的盐较多,缺盐现象更严重;与缺盐性脱水相比,损失的水较严重。
    • 原因
      • 呕吐、腹泻

        • 丢失大量的消化液（胰液、胆汁为等渗，胃肠液为低渗）
      • 严重腹痛、肠梗阻等
        • 肠内消化液分泌增多，大量血浆漏入腹腔
      • 中暑、烧伤、大出汗
        • 血浆由皮肤渗出，胸水、腹水的形成
      • 低渗性脱水时，未补充水分
        • 从肺、皮肤不断失水演

  • 治疗原则

    1. 控制原发病，再通过口服或静脉注射补液。
    2. 高渗性脱水，用2份5%葡萄糖加1份生理盐水
    3. 低渗性脱水，用2份生理盐水加1份5%葡萄
    4. 等渗性脱水，水钠同比例补充，盐水和糖水各1份。
    5. 输液足量的标准：患畜精神好转，脱水症状消失或减轻，脉搏、呼吸和尿量恢复正常，眼结膜由蓝紫色恢复正常色彩，实验室检查血清钠浓度、红细胞压积趋于正常。

  • 总结

类型 渗透压 临床表现 治疗原则 原因
高渗性 增高 口干口渴，尿少比重增加，发热，皮肤干燥 盐水比1:2 水源断绝，咽、食管阻塞、破伤风等饮水困难，使用利尿剂过多，肾浓缩功能不全，发热等水消耗增多
低渗性 降低 初尿多比重降低，不口渴，细胞肿胀 盐水比2:1 体液丧失后饮水过多或补液不当，严重腹泻呕吐，慢性肾机能不全钠重吸收障碍，过多使用双克塞等排钠利尿剂。
低渗性 不变 细胞脱水，尿少，血压下降 盐水比1:1 低渗性脱水时补水不充分，胸水、腹水形成，严重腹痛、梗阻时，肠消化液分泌增多，大量腹液漏入腹腔

低渗性脱水时补水不充分，胸水、腹水形成，严重腹痛、梗阻时，肠消化液分泌增多，大量腹液漏入腹腔

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