正常人体每天出入量

正常人体每天出入量 正常成人24小时液体出入量为2000,2500ml 摄入量(m1) 排出量(m1) 饮水1000,1500 尿1000,1500 食物水700 粪150 无形失水850 内生水300 呼吸蒸发350 皮肤蒸发500 入量2000,2500 总出量2000,2500 一、水的平衡 (一)体液的含量及分布 人体体液及其组成成分比较恒定，只在较小范围内波动。人体内体液总量与性别、年龄及胖瘦有关，正常成年男性液体总量占体重的60 %，女性为55 %，婴幼儿为70 %,80 %，随着年龄的增长和脂肪量增多，体液量将减少。体液中细胞内液男性占体重的40,，女性 ,;细胞外液中组织间液为15,，血浆为5,。正常情况下，体液占35,，细胞外液占20 比例相对恒定，各部分之间又不断地进行交换，保持动态平衡，维持内环境的稳定，保证人体正常的生理功能。 例题:关于正常体液含量的叙述，错误的是 A 成人男性的体液总量占体重的60% B 男性多于女性 C 成人多于老年人 D 婴儿多于成人 E 肥胖者多于肌肉发达者 正确:E (二) 24小时液体出入量的平衡 正常成人24小时液体出入量为2000,2500ml 摄入量(m1) 排出量(m1) 饮水1000,1500 尿1000,1500 食物水700 粪150 meet the standard requirements. Post weld heat treatment of pipes after heat treatment, hardness tests should be conducted, hardness test sampling of not less than 10%, hardness 120%,15CrMo hardness of carbon steel pipe shall be less than base metal steel after heat treatment, hardness should not be greater than the parent material of 125%. Rate of pipeline nondestructive testing shall be carried out according to the design requirements, no no design requirements the SH3501-2002 table 10 "percentage of radiographic examination of welded joints and acceptable level", and fixed number not less than the total number of 40% weld inspection. This project has a wall thickness of 32mm 20# steel high pressure tube, x-rays cannot penetrate, the situation may not allow non-destructive testing by γ-ray, used weld backing and two-layer welds before filled by x ray detection method, the other layer by ultrasonic detector method. Should be consistent with existing national standards for radiographic testing of the ... Gas tank used chain for this project promoted the upsidedown construction. Chain reversal installation method shown in the following figure: welders Welders and welding methods to participate in this project should be in accordance with the Ministry of personnel issued by the boilers and pressure vessels welder examination rules for qualification examination, after passing the qualification certificate of welding work. Tank welding manual arc welding, automatic welding. Manual arc welding company has a number of excellent welder, took part in all kinds of large, medium and small storage tank, pressure vessel welding, with rich experience, manual welding characteristics are not subject to location restrictions, welding deformation easy to control. This engineering welding construction of shielded metal arc welding methods. 无形失水850 内生水300 呼吸蒸发350 皮肤蒸发500 入量2000,2500 总出量2000,2500 当出现异常时，如入量不足或丢失过多超出调节范围将出现脱水;相反，入量过多或排出过少将发生水潴留，甚至水中毒。了解这些变化，有助于预防体液失衡的发生。 1(无形失水 人体在正常生理条件下， 皮肤和呼吸蒸发的水分，每日约850ml，因为是不显的，又称为不显性失水。即使在高度缺水时，这部分水的丢失也是不可避免的，是人只要在进行正常生理活动就必然丢失的水分。因此，在估计病人液体入量时，要计入无形失水。在异常情况下，失水量可能更多，如体温增高可增加水分蒸发，体温每增高1?，每日每公斤体重将增加失水3,5ml;明显出汗失水更多，汗液湿透一身衬衣裤约失水1000ml;气管切开病人呼吸失水量是正常时的2,3倍;大面积烧伤和肉芽创面的病人水分丢失更为惊人。 例题:一急性肠梗阻病人，今日尿量1500ml，呕吐250ml，胃肠减压液约1000ml，无发热，无大便，其24h液体排出量约为 A 2750ml B 3100ml C 3250ml D 3600ml E 4200ml 正确答案:D 2(尿液 正常人每日尿量约1000,1500ml，尿比重为1(012。肾脏每日排泄体内固体代谢物约30,40g，每溶解1g溶质需15ml水分，故每日尿量至少需500,600ml，才能将体内固体代谢产物排出体外。此时的尿比重高达1(035，肾脏的负担很重，可见维持尿量的重要性。 3(粪便 消化道每日分泌消化液8000ml以上，但仅有约150ml的水分从粪便中排出，其余经消化道被重新吸收。 但在病理情况下，如频繁的呕吐、严重腹泻、肠瘘等水分丢失过多，可导致脱水。在肠梗阻或腹膜炎时大量液体停留在肠道内或腹腔内，被隔离于循环之外，也会造成严重的水、电解质紊乱。 4(内生水 机体在新陈代谢过程中，物质氧化到最终生成C02和水约300ml。因数量不多，对整体影响不大。但在急性肾衰竭时，需严格限制人水量，必须将内生水计入出入量。 例题:下列何种情况下，必须将内生水计算在补液总量中 A.急性肠梗阻 B.急性肾衰 meet the standard requirements. Post weld heat treatment of pipes after heat treatment, hardness tests should be conducted, hardness test sampling of not less than 10%, hardness 120%,15CrMo hardness of carbon steel pipe shall be less than base metal steel after heat treatment, hardness should not be greater than the parent material of 125%. Rate of pipeline nondestructive testing shall be carried out according to the design requirements, no no design requirements the SH3501-2002 table 10 "percentage of radiographic examination of welded joints and acceptable level", and fixed number not less than the total number of 40% weld inspection. This project has a wall thickness of 32mm 20# steel high pressure tube, x-rays cannot penetrate, the situation may not allow non-destructive testing by γ-ray, used weld backing and two-layer welds before filled by x ray detection method, the other layer by ultrasonic detector method. Should be consistent with existing national standards for radiographic testing of the ... Gas tank used chain for this project promoted the upsidedown construction. Chain reversal installation method shown in the following figure: welders Welders and welding methods to participate in this project should be in accordance with the Ministry of personnel issued by the boilers and pressure vessels welder examination rules for qualification examination, after passing the qualification certificate of welding work. Tank welding manual arc welding, automatic welding. Manual arc welding company has a number of excellent welder, took part in all kinds of large, medium and small storage tank, pressure vessel welding, with rich experience, manual welding characteristics are not subject to location restrictions, welding deformation easy to control. This engineering welding construction of shielded metal arc welding methods. C.大面积烧伤 D.高钾血症 正确答案:B (三) 体液平衡的调节 体液的稳定是通过神经-内分泌系统和肾脏进行调节，当体液失调时首先通过下丘脑-神经垂体-抗利尿激素系统恢复和维持体液的渗透压。血容量的恢复和维持是通过肾素-血管紧张素-醛固酮系统完成。这两个系统共同作用于肾，调节水和钠的代谢，维持平衡。如当人体缺水时，细胞外液渗透压增高，可刺激下丘脑神经垂体抗利尿激素系统，产生口渴，人主动饮水。同时，抗利尿激素分泌增加，作用于肾脏远曲小管和集合管上皮细胞，对水的再吸收作用加强，尿量减少，于是水分得到保留，使已增高的细胞外液渗透压回降，反之亦然。 二、电解质的平衡 1(钠的平衡 钠是细胞外液的主要阳离子，维持细胞外液的渗透压和容量。钠增多时，可引起水肿，减少时可造成体液渗透压下降、脱水或血容量不足。正常值为135,145mmol,L，平均为142mmol,L。人体钠盐目食物中获得，正常成人每日需氯化钠5,9g，由尿、粪和汗中排出，其中肾脏是排出和调节的主要部位。钠盐摄入过多时肾脏排出增加，摄入过少时肾脏排出减少，禁食时尿钠可减少至最低限度。大量消化液的丢失可导致缺钠，禁食的病人需每日输注等渗盐水500,1000ml。 例题:维持细胞外液渗透压的重要离子是 A(钙 B(钾 C(镁 D(钠 E(氯 正确答案:D 2(钾的平衡 钾是细胞内液的主要阳离子，血清钾正常值为3(5,5(5mmol,L。钾有极其重要的生理功能，钾能维持细胞膜的应激性，维持细胞的正常代谢，维持细胞内容量，维持心肌的正常功能。钾来源于食物，主要由肾脏排泄，肾对钾的调节能力很低，在禁食和低血钾时，肾脏仍继续排钾。病人禁食2天以上，应补充钾，否则将出现低钾。正常人需钾盐2,3g,d，相当于l0,氯化钾20,30ml。 例题:在同样禁食的情况下，更易缺乏的电解质是 A钠 meet the standard requirements. Post weld heat treatment of pipes after heat treatment, hardness tests should be conducted, hardness test sampling of not less than 10%, hardness 120%,15CrMo hardness of carbon steel pipe shall be less than base metal steel after heat treatment, hardness should not be greater than the parent material of 125%. Rate of pipeline nondestructive testing shall be carried out according to the design requirements, no no design requirements the SH3501-2002 table 10 "percentage of radiographic examination of welded joints and acceptable level", and fixed number not less than the total number of 40% weld inspection. This project has a wall thickness of 32mm 20# steel high pressure tube, x-rays cannot penetrate, the situation may not allow non-destructive testing by γ-ray, used weld backing and two-layer welds before filled by x ray detection method, the other layer by ultrasonic detector method. Should be consistent with existing national standards for radiographic testing of the ... Gas tank used chain for this project promoted the upsidedown construction. Chain reversal installation method shown in the following figure: welders Welders and welding methods to participate in this project should be in accordance with the Ministry of personnel issued by the boilers and pressure vessels welder examination rules for qualification examination, after passing the qualification certificate of welding work. Tank welding manual arc welding, automatic welding. Manual arc welding company has a number of excellent welder, took part in all kinds of large, medium and small storage tank, pressure vessel welding, with rich experience, manual welding characteristics are not subject to location restrictions, welding deformation easy to control. This engineering welding construction of shielded metal arc welding methods. B钾 C镁 D碳酸氢根 正确答案:B 3(氯和碳酸氢根 氯和碳酸氢根是细胞外液中的主要阴离子，与钠共同维持体液的渗透压和含水量。碳酸氢根与氯的含量有互补作用，当碳酸氢根增多时氯含量减少，反之，碳酸氢根减少时氯的含量增加，以维持细胞外液阴离子的平衡。当病人频繁呕吐丢失大量胃液时，氯离子同时大量丢失，碳酸氢根代偿性增加，引起低氯性碱中毒。又如病人输入大量氯化钠，由于氯离子增多碳酸氢根减少，而出现高氯性酸中毒。 例题:能对氯的增减起代偿性作用的离子是 +++ -A Na B K C HD HCO 3 正确答案:D 4(钙的平衡 体内钙99,以磷酸钙和碳酸钙的形式存在于牙齿和骨骼中，细胞外液中含钙很少，只占总钙量的0.1,，血清钙正常值为2.25,2.75mmol,L，相当恒定，体内钙45,为离子化钙，对维持神经和肌肉稳定起重要作用，其余半数以上为蛋白结合钙和与有机酸结合为磷酸盐、碳酸盐和枸橼酸盐。离子化钙与非离子化钙的比率受血pH影响，pH下降离子化钙增加，(pH升高离子化钙下降。血清钙受甲状旁腺功能和维生素D影响。临床以低钙多见。 5(磷的平衡 体内的磷85,存在于骨骼中，血清磷正常值为0(96,1(62mmol,L，磷对人体代谢有重要作用，磷参与核酸、磷脂、细胞膜、凝血因子的组成和高能磷酸键的合成及蛋白质的磷酸化过程，同时维持体内的钙、磷代谢及酸碱平衡等。 6(镁的平衡 镁是细胞内的主要阳离子，体内镁约50,存于骨骼中，其余绝大部分存在于细胞内，只有1,在细胞外液中，血清镁的正常值为0.70,1.10mmol,L。镁具有多种生理功能，有维持肌肉收缩和神经活动，激活体内多种酶，促进能量储存、转运和利用等作用。 三、酸碱平衡 正常血液酸碱度(pH)维持在7.35,7.45之间，这是机体进行新陈代谢最适宜的环境。机体通过血液缓冲系统、肺和肾三个途径来维持体液的酸碱平衡。 1(血液缓冲系统 作用快，能应付急需，但最终还需要肺和肾将酸排出体外，血液缓冲系-统中有很多缓冲对，其中最主要的是HCO,HC0。当体内酸增多时，由碳酸氢根与氢离323+-子结合，使酸得以中和，H+HCO ?HC0?CO?+HO。当体内碱增多时，碳酸中的氢32322 meet the standard requirements. Post weld heat treatment of pipes after heat treatment, hardness tests should be conducted, hardness test sampling of not less than 10%, hardness 120%,15CrMo hardness of carbon steel pipe shall be less than base metal steel after heat treatment, hardness should not be greater than the parent material of 125%. Rate of pipeline nondestructive testing shall be carried out according to the design requirements, no no design requirements the SH3501-2002 table 10 "percentage of radiographic examination of welded joints and acceptable level", and fixed number not less than the total number of 40% weld inspection. This project has a wall thickness of 32mm 20# steel high pressure tube, x-rays cannot penetrate, the situation may not allow non-destructive testing by γ-ray, used weld backing and two-layer welds before filled by x ray detection method, the other layer by ultrasonic detector method. Should be consistent with existing national standards for radiographic testing of the ... Gas tank used chain for this project promoted the upsidedown construction. Chain reversal installation method shown in the following figure: welders Welders and welding methods to participate in this project should be in accordance with the Ministry of personnel issued by the boilers and pressure vessels welder examination rules for qualification examination, after passing the qualification certificate of welding work. Tank welding manual arc welding, automatic welding. Manual arc welding company has a number of excellent welder, took part in all kinds of large, medium and small storage tank, pressure vessel welding, with rich experience, manual welding characteristics are not subject to location restrictions, welding deformation easy to control. This engineering welding construction of shielded metal arc welding methods. ---离子与碱作用得以中和，OH+HC0?HCO +HO。缓冲对中HCO,HC0的比值正常为233232320,1。 2(肺 是排出体内挥发性酸(碳酸)的主要器官，当血中PC02升高(H2C03增多)时，呼吸中枢兴奋，呼吸加深、加快，加速CO2排出，以降低血中碳酸浓度。反之，当血PC02降低时，呼吸变慢、变浅，以减少C02排出。 3(肾 是调节酸碱平衡的重要器官，一切非挥发性酸和过剩的碳酸氢盐都须从肾脏排泄。但肾脏调节速度是缓慢的，排出氢离子(H+)，收回钠离子和碳酸氢根离子。尿pH正常为6。 以上三种主要机制相互配合，对酸碱平衡发挥着调节和代偿作用，其中以肾为主。 例题:调节酸碱平衡最重要的器官是 A.肝 B.胃 C.肺 D.肾 E.小肠 标准答案:D meet the standard requirements. Post weld heat treatment of pipes after heat treatment, hardness tests should be conducted, hardness test sampling of not less than 10%, hardness 120%,15CrMo hardness of carbon steel pipe shall be less than base metal steel after heat treatment, hardness should not be greater than the parent material of 125%. Rate of pipeline nondestructive testing shall be carried out according to the design requirements, no no design requirements the SH3501-2002 table 10 "percentage of radiographic examination of welded joints and acceptable level", and fixed number not less than the total number of 40% weld inspection. This project has a wall thickness of 32mm 20# steel high pressure tube, x-rays cannot penetrate, the situation may not allow non-destructive testing by γ-ray, used weld backing and two-layer welds before filled by x ray detection method, the other layer by ultrasonic detector method. Should be consistent with existing national standards for radiographic testing of the ... Gas tank used chain for this project promoted the upsidedown construction. Chain reversal installation method shown in the following figure: welders Welders and welding methods to participate in this project should be in accordance with the Ministry of personnel issued by the boilers and pressure vessels welder examination rules for qualification examination, after passing the qualification certificate of welding work. Tank welding manual arc welding, automatic welding. Manual arc welding company has a number of excellent welder, took part in all kinds of large, medium and small storage tank, pressure vessel welding, with rich experience, manual welding characteristics are not subject to location restrictions, welding deformation easy to control. This engineering welding construction of shielded metal arc welding methods.