新生儿休克课件_2.ppt

THE HULK Agents Used to Treat Neonatal Shock Agent Type Agent Dosage Comments Volume expanders Isotonic sodium chloride solution 10-20 mL/kg IV Inexpensive, available Albumin (5%) 10-20 mL/kg IV Expensive Plasma 10-20 mL/kg IV Expensive Lactated Ringer solution 10-20 mL/kg IV Inexpensive, available Isotonic glucose 10-20 mL/kg IV Inexpensive, available Whole blood products 10-20 mL/kg IV Limited availability Reconstituted blood products 10-20 mL/kg IV Use O neg Vasoactive drugs Dopamine 5-20 mcg/kg/min IV Never administer intra-arterially Dobutamine 5-20 mcg/kg/min IV Never administer intra-arterially Epinephrine 0.05-1 mcg/kg/min IV Never administer intra-arterially Hydralazine 0.1-0.5 mg/kg IV q3-6h Afterload reducer Isoproterenol 0.05-0.5 mcg/kg/min IV Never administer intra-arterially Nitroprusside 0.5-8 mcg/kg/min IV Afterload reducer Norepinephrine 0.05-1 mcg/kg/min IV Never administer intra-arterially Phentolamine 1-20 mcg/kg/min IV Afterload reducer During and following restoration of circulation, varying degrees of organ damage may remain and should be actively sought out and managed. For example, acute tubular necrosis may be a sequela of uncompensated shock. Once hemodynamic parameters have improved, consider fluid administration according to urine output and renal function as assessed by serum creatinine and electrolytes and blood urea nitrogen concentrations. Despite adequate volume restoration, myocardial contractility may still be a problem as a consequence of the prior poor myocardial perfusion, in which case inotropic agents and intensive monitoring may need to be continued. During the process of shock, production of chemical mediators may initiate disseminated intravascular coagulopathy (DIC), which requires careful monitoring of coagulation profiles and management with fresh frozen plasma, platelets, and/or cryoprecipitate. The liver and bowel may be damaged by shock, leading to gastrointestinal bleeding and increasing the risk for necrotizing