外科休克專題宣講

SurgicalShock外科休克外科休克專題宣講第1頁DefinitionofshockShock,regardlessofthecause,maybedefinedasasyndromethatresultsfrominadequateperfusionoftissues.休克乃各種原因造成組織灌注不足所引發(fā)綜合癥群。外科休克專題宣講第2頁introductionShockisasignofcardiovascular(心血管)insufficiency（不足）.Thecardiovascularsystemismadeupofthreekeyelements:apump,tubingandafluidThepumppropels(推進(jìn))thefluidThetubingdistributesandcollectsit外科休克專題宣講第3頁CausesofshockSevereofsuddenbloodlossLargedropinbodyfluidsMajorinfectionsHighspinalinjuriesMyocardialinfarctionanaphylaxis外科休克專題宣講第4頁Pathophysiology（病理生理學(xué)）1.Microcirculatorychanges2.Thechangesofbodyfluidmetabolism3.Mediatorsofinflammationreleaseandischemicalreperfusioninjury4.Secondarylesion1.微循環(huán)改變

2.津液代謝改變

3.炎癥介質(zhì)釋放和缺血再灌注損傷

4.繼發(fā)性損害外科休克專題宣講第5頁Microcirculatorychanges

compensationofshock(1)tospeeduptheheart,cardiacoutputincreased:

(2)aredistributionofblood:

(3)tissuehypoxia:

(4)significantlyreducedthetissuefluid（1）心跳加緊，心排出量增加（2）血液重新分配（3）組織缺氧（4）組織液顯著減少外科休克專題宣講第6頁Decompensationofshockprogressivestageofshock(休克進(jìn)展期)(1)islargerthantheflowofirrigation(灌大于流);

(2)thetissueedema（組織水腫）

Refractorystageofshock(休克難治期）(1)theformationofDIC（DIC形成）

(2)cellautolysis,tissuenecrosis;（細(xì)胞自溶，組織壞死）

(3)thebleedingtendency（出血傾向）外科休克專題宣講第7頁Clinicalmanifestation(臨床表現(xiàn))Compensatoryofshock

1,mentaltension,irritability.

2,pale,coldclammyskin.

3,threadyandrapidpulse,systolicbloodpressure,diastolicbloodpressurerisehigh,pulsepressuresmaller.

4,normalordecreasedurinevolume外科休克專題宣講第8頁Inhibitorystageofshock(休克抑制期)1,indifferentmind,unresponsive,orunconsciousness,coma.

2,systemicskinmucousmembranecyanosis,coldlimbs,coldsweat

3,threadyandrapidpulseorstrokeisnotclear,bloodpressuredecreased(BP<90mmHg)orundetectable,pulsepressuresmaller.

4,decreasedurineoutputorurine(per25ml).外科休克專題宣講第9頁

5,metabolicacidosis.

6,bleedingtendencyoftenhinthasoccurred:DIC

7,respiratorydistresssyndrome:

(1)dyspneawere.

(2)althoughtoalargenumberofoxygendoesnotimprove

Thesymptomsandimprovetheoxygenpartialpressure外科休克專題宣講第10頁TypesofshockHypovolemicshock(低血容量性休克)Cardiogenicshock(心源性休克)Allergicshock（過敏性休克）Neurogenicshock(神經(jīng)性休克)Septicshock(感染性休克)外科休克專題宣講第11頁HypovolemicshockInadequatebloodvolume外科休克專題宣講第12頁Clinicalmanifestation(臨床表現(xiàn))1,hypotension.

2,heartrate.

3changes,skinandmind.

4,organdysfunction

1、低血壓。2、心率加緊。3、皮膚和神志改變。4、器官功效不全。外科休克專題宣講第13頁Hemorrhagicshock（失血性休克）Treatment:Supplementbloodcapacity

Correctionofacid-baseandelectrolyteimbalance

Thecauseofdiseasetreatmentandstopthecontinuedlossofblood

Andthelossoffluid治療：補充血容量糾正酸堿及水電解質(zhì)失衡

病因治療和制止繼續(xù)失血和失液外科休克專題宣講第14頁Traumaticshock（損傷性休克）Treatment:Inadditiontothehemorrhagicfluidshocktreatment,shouldalsostrengthenthefollowingtreatment:

1,antiinfection

2,analgesia,sedation

3,thetreatmentofwounds治療：除按失血失液性休克治療外，還應(yīng)加強(qiáng)以下治療：1、抗感染2、鎮(zhèn)痛、鎮(zhèn)靜3、處理創(chuàng)傷外科休克專題宣講第15頁

Septicshock(感染性休克)Treatment：1supplementbloodcapacity.

2controlofinfection.

3correctingacid-baseimbalance.

Applicationof4cardiovasculardrugs.

5corticalhormonetherapy.

6othernutritionalsupport,complications治療：

1補充血容量。2控制感染。3糾正酸堿失衡4心血管藥品應(yīng)用。5皮質(zhì)激素治療6其它營養(yǎng)支持、處并發(fā)癥等外科休克專題宣講第16頁Infectioncontrol（控制感染）Antibacterialdrugs（抗菌藥品）Operation（手術(shù)）外科休克專題宣講第17頁SIRST＞38℃or＜36℃Rateofheart＞90times/minR＞20times/minorabove,PaCO2＜4.3kPaNo.ofLeukocyte＞12×109/Lor＜4×109/L，orunadultLeukocyte＞10%外科休克專題宣講第18頁Diagnosis(診療)1.History:seriousinjury,bleeding,severeinfection,allergy,historyofheartdisease

2.shockaura:sweating,rapidheartrate,pulseexcited,reduceorNiaoshaosymptoms

3.shocksigns:indifferentmind,unresponsive,paleskinrapidshallowbreathing,systolicbloodpressurebelow90mmHgandoliguria,signthepatienthasenteredtheinhibitorystageofshock.外科休克專題宣講第19頁Monitors(監(jiān)測)ofshockgeneralmonitoring1,stateofmind2,skintemperature,color3,bloodpressure4,thepulse5,theamountofurineisreaction外科休克專題宣講第20頁(b)specialmonitoring1,centralvenouspressure(CVP):

Thenormalvalue:5~10cmH2O2,pulmonarycapillarywedgepressure(PCWP):6~15mmHg3,cardiacoutput(CO)andcardiacindex(CI):

AdultCO:4~6L/min;CI:2.5~3.5L/(minM2).外科休克專題宣講第21頁4,arterybloodgasanalysis(動脈血氣分析)5,arterybloodlactatedetermination（動脈血乳酸鹽測定）Thenormalvalueis:1~2mmol/L.6，LaboratoryexaminationofDIC外科休克專題宣講第2