Fluid balance concepts in medicine: Principles and practice.
Fluid balance concepts in medicine: Principles and practice.
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DOI：
10.5527/wjn.v7.i1.1
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发表时间：
2018-01-06
期刊：
影响因子：
--
通讯作者：
Tzamaloukas AH
中科院分区：
文献类型：
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作者：
Roumelioti ME;Glew RH;Khitan ZJ;Rondon-Berrios H;Argyropoulos CP;Malhotra D;Raj DS;Agaba EI;Rohrscheib M;Murata GH;Shapiro JI;Tzamaloukas AH
体液平衡的调节是健康和疾病中的关键问题，包括三个概念。第一个概念涉及总身体水分（TBW）和总有效溶质之间的关系，并以体液的张力表示。张力紊乱是导致细胞体积变化的主要因素，这会严重影响脑细胞的功能和存活。几乎完全分布在细胞外室（主要是钠盐）和细胞内室（主要是钾盐）中的溶质有助于张力，而分布在TBW中的溶质对张力没有影响。第二体液平衡概念涉及钠盐平衡和细胞外容量异常的调节和测量。细胞外容积的估计比TBW的测量更复杂且更容易出错。细胞外容量（定义为有效动脉血容量（EABV））的一个关键功能是确保细胞和器官的充分灌注。其他因素，包括心输出量，动脉和静脉的总容量和局部容量，毛细血管中的Starling力和重力也会影响EABV。总的来说，这些因素与细胞外容积密切相关，其中一些在某些急性和慢性严重疾病中发生了重大变化。它们的变化不仅导致细胞外容积扩张，而且与健康个体相比需要更大的细胞外容积。评估严重疾病中的细胞外容积是具有挑战性的，因为在许多疾病中，通过常用方法对该容积的估计容易出现较大误差。此外，最佳细胞外容积可能因疾病而异，仅部分基于传统方法的容积测量，并且尚未针对每种疾病确定。需要进一步的研究来确定几种疾病的最佳细胞外容积水平。由于这些原因，严重疾病的细胞外容量值得单独的体液平衡的第三个概念。
The regulation of body fluid balance is a key concern in health and disease and comprises three concepts. The first concept pertains to the relationship between total body water (TBW) and total effective solute and is expressed in terms of the tonicity of the body fluids. Disturbances in tonicity are the main factor responsible for changes in cell volume, which can critically affect brain cell function and survival. Solutes distributed almost exclusively in the extracellular compartment (mainly sodium salts) and in the intracellular compartment (mainly potassium salts) contribute to tonicity, while solutes distributed in TBW have no effect on tonicity. The second body fluid balance concept relates to the regulation and measurement of abnormalities of sodium salt balance and extracellular volume. Estimation of extracellular volume is more complex and error prone than measurement of TBW. A key function of extracellular volume, which is defined as the effective arterial blood volume (EABV), is to ensure adequate perfusion of cells and organs. Other factors, including cardiac output, total and regional capacity of both arteries and veins, Starling forces in the capillaries, and gravity also affect the EABV. Collectively, these factors interact closely with extracellular volume and some of them undergo substantial changes in certain acute and chronic severe illnesses. Their changes result not only in extracellular volume expansion, but in the need for a larger extracellular volume compared with that of healthy individuals. Assessing extracellular volume in severe illness is challenging because the estimates of this volume by commonly used methods are prone to large errors in many illnesses. In addition, the optimal extracellular volume may vary from illness to illness, is only partially based on volume measurements by traditional methods, and has not been determined for each illness. Further research is needed to determine optimal extracellular volume levels in several illnesses. For these reasons, extracellular volume in severe illness merits a separate third concept of body fluid balance.