做一个自己的读书心得的贴

mycookqi

  有时候，读书的时候，会对某一段文字觉的眼前一亮。通过建立这个帖子，与坛友分享，加深印象，并以便日后做一个复习与回顾。

mycookqi

0001  The kidneys receive 20% of total cardiac output, with the renal cortex receiving 94% of total blood flow. The renal medulla receives only 6% of total renal blood flow but extracts approximately 80% of the oxygen that it receives, making it very susceptible to ischemia, particularly the medullary thick ascending loop of Henle。麻省8版4章
肾血流量虽然占了心排血量的20%，但因为肾皮质和肾髓质血流的分配不均，肾髓质血流少，需氧量却占大头，就可以理解为什么肾血流量那么大，却还是对缺血相对敏感。

mycookqi

0002  Generally, acute normalization of the serum [Na+] is not necessary. It should be corrected at a rate of 0.5 mEq/L/hour until 120 mEq/L is reached to prevent complications from rapid correction (e.g., cerebral edema, central pontine myelinolysis, and seizures). At this point, the patient should be out of danger, and the [Na+] should be normalized slowly over a period of days. Treatment depends on the volume status of the patient.
(a) Hypervolemic hyponatremia due to renal failure, congestive heart failure, cirrhosis, or nephrotic syndrome is treated by sodium and water restriction and possibly with diuresis.
(b) Hypovolemic hyponatremia from diuretics, vomiting, or bowel preparations is treated with normal saline. For severe hypovolemic hyponatremia, the [Na+] may be partially corrected to 125 mEq/L or a serum osmolality of 250 mmol/L over 6 to 8 hours with 3.5% hypertonic saline. Hypertonic saline is dangerous in volume-expanded salt-retaining states such as congestive heart failure.
(c) Normovolemic hyponatremia from the syndrome of inappropriate ADH secretion, hypothyroidism, drugs that impair renal water excretion, or water intoxication is treated by fluid restriction.
以每小时0.5mmol/L的速度补钠逐渐纠正到120mmol/L，防止过快补钠带来颅脑的并发症。治疗的前提是根据血容量的不同来选择，对水钠潴留病人，输注高渗盐水具有危险。临床并不是见啥低就积极补啥，积极而盲目有时是一种伤害。治疗前提，是根据病理生理来调整用药。

mycookqi

Intermediate-acting neuromuscular blocking drugs, vecuronium and rocuronium, are highly dependent on hepatobiliary excretion and metabolism (both are excreted, 50% unchanged, in the bile). This translates to a decreased clearance and a prolonged effect in patients with liver disease. Cisatracurium is degraded via Hofmann elimination and is unaffected by liver disease。麻省8版
中效神经肌肉阻滞药，维库溴铵和罗库溴铵主要经过肝胆系统代谢和排泄，肝病、胆道梗阻病人清除率下降，药物作用时间延长。

mycookqi

0004                           The hepatopulmonary syndrome  
is a triad of liver disease, increased alveolar–arterial oxygen gradient, and intrapulmonary
vascular dilatations. The syndrome of platypnea–orthodeoxia may be seen (postural
hypoxemia and dyspnea induced by upright posture) as the presence of a hyperdynamic
circulation, and low pulmonary resistance results in the rapid transit of blood through the
lungs and potentiates the transit of deoxygenated blood to the systemic circulation.
Because of gravity, shifting of blood to the dilated precapillary beds of the lung bases
results in an increased hypoxemic dyspnea when the patient is in the upright position.                             
肝肺综合征是一种三联症：包括肝賍疾病、肺泡-动脉血氧分压梯度增加及肺内血管舒张。病人存在高动力循环状态时可能出现斜卧呼吸-直立缺氧综合征（姿势性低血氧症和直立位呼吸困难）。原因是体位改变使得肺血重新分布，加上肺循环阻力低，血流通过快速，人体循环未氧合的血增加。

mycookqi

不愧为四大临床杂志之一。虽然已经是03年的文章了。