重症急性胰腺炎治疗现状与发展.pptxVIP

重症急性胰腺炎治疗现状与发展第1页/共44页 Western recordviolent impact or blow, 1743physiologic instability, 1815Eastern record厥脱，内闭外脱I. Historical Aspect Initial records of shock第2页/共44页 Initial Explanation of shockWesternThomas Latta, 1831Patients with CholeraInfusion of fluids → improvementHypovolemiaEastern邪毒内陷气随血脱阴亏气脱气机郁闭阴绝阳脱第3页/共44页 with the Rise of PhysiologyBurgeoning of Cardiovascular physiology in the end of 19CN, CrileCVP dropped after hemorrhageAnimal survival was increased after the infusion of salinethe Use of Cardiac CatheterizationBlood volume loss →fall in Cardiac Output第4页/共44页 with the Combination of  Physiology and BiochemistryToxin theory of shock, Cannon Baylissimpairment of oxygen transportdevelopment of acidosistoxin in severe muscle injury →loss of vasomotor tone →venous sequestration of blood →hypotension第5页/共44页 Antedate the Era of Critical Care MedicineExtensive physiologic research of Wigger, in early 1940sintegrating the Concepts of impaired oxygen deliveryoxygen debttissue injury / death the concept of irreversible shockprogressive systemic circulatory decompensation第6页/共44页 Controversy on Lung KidneyARDS Introduction of the flow directed pulmonary artery catheter, in 1970 Noncardiogenic nature Not due to volume overloadARF More prompt and aggressive resuscitationIncidence ↓ATN happens: hypoperfusionARDS happens:Defects in Cell Membrane Function and Vascular Permeability Hypovolemia / Toxin /CytokineHypoxiaARDS第7页/共44页 A syndrome that results from inadequate perfusion of tissues insufficient to meet metabolic demandlead to cellular dysfunction, elaboration of inflammatory mediators, and celluar injury which may be limited, or widespread A continuum, ranging from subclinical deficits in perfusion to MODS or frank organ failure.Tissue hypoxia due to hypoperfusionDefectsInjuryII. Definition of shock 第8页/共44页 A. 组织低灌注所致细胞缺氧B. 低血压C. 酸中毒D. 心功能不全E. 以上都不对休克的根本问题是:第9页/共44页 Impaired tissue perfusion Wider spectrum of shock presen