于志伟 副主鹊奈医师哈尔滨医科大学附属肿瘤医院,结直肠外科.ppt

于志伟 副主任医师 哈尔滨医科大学附属肿瘤医院，结直肠外科;休克(Shock)的定义;休克的分类（Types of Shock）;PATHOPHYSIOLOGY OF SHOCK SYNDROME;Microcirculation Change;Sympathetic nervous system activates;休克的病理生理过程--微循环的变化;Continued anaerobic metabolism ;休克的病理生理过程--微循环的变化;If Low Perfusion States persists: IRREVERSIBLE DEATH IMMINENT!!! ;Decreased perfusion causes tissue damage/necrosis Tissue necrosis triggers diffuse clotting Diffuse clotting consumes clotting factors Fibrinolysis begins Severe, uncontrolled systemic hemorrhage occurs;休克的病理生理过程--微循环的变化;休克的病理生理变化—体液代谢的改变;休克的病理生理变化—内脏器官的继发性损害;Stages of Shock;Hypotension 90 mmHg (may be normal level or increase due to compensatory mechanism) Mean arterial pressure (MAP) 60 mmHg Tachycardia: weak and thready pulse Tachypnea: blow off CO2 respiratory alkalosis Decreased urine output ;休克的临床表现;休克抑制期： 丧失血容量20% 1. 神志淡漠 (Disturbance of consciousness) →昏迷 (Coma) 2. 口唇 (Oral lip)、肢端 (Limb)发绀 (Cyanosis) ，出冷汗 (Cold sweat) 3. 脉细速 (Rapid rate and thread / weak pulse) ，血压下降 (Falling BP) ，脉压差 (Pulse pressure difference)明显缩小 4. 5. 尿量减少或无尿 (Anuria) ;重度休克： 血容量丧失40% 1. 昏迷 (Coma) 2. 全身皮肤粘膜紫绀 (Cyanosis)，四肢冰冷 3. 脉搏摸不到，血压测不出 4. 无尿 (Anuria) 5. 器官功能衰竭的表现;休克的诊断Diagnosis of Shock; 神志状态 (Mental status) 肢体温度、色泽 (Limb temperature and color) 血压 (Blood pressure) 脉率 (Pulse) 尿量 (Urine output) ;休克的监测—特殊监测Special Monitor ;休克的监测—特殊监测 Special Monitor ;休克的监测—特殊监测 Special Monitor ;休克的治疗Treatment of Shock;休克的治疗 Treatment of Shock;Shock treatment;休克的治疗Treatment of Shock;In summary, Treatment of Shock;失血性休克的治疗(Treatment of Hemorrhagic Shock);中心静脉压和补液的关系;损伤性休克的治疗 (Treatment of Traumatic Shock);Hypovolemic Shock;Aimed at improvement tissue hypoperfusion ;感染性休克的特点Characteristics of Septic Shock;感染性休克的类型Types of Septic Shock;感染性休克的两种临床表现;Septic Shock;Treatment of Septic Shock; Add inotropic and vasopressor therapy if needed. Maintain central venous oxygen saturation at 7