休克临床表现和治疗.pptx

于志伟副主任医师

哈尔滨医科大学从属肿瘤医院，结直肠外科;休克(Shock)定义;休克分类（TypesofShock）;PATHOPHYSIOLOGYOFSHOCKSYNDROME;MicrocirculationChange;Sympatheticnervous

systemactivates;休克病理生理过程--

微循环改变;Continuedanaerobicmetabolism

;休克病理生理过程--

微循环改变;IfLowPerfusionStatespersists:

IRREVERSIBLE DEATHIMMINENT!!!

;Decreasedperfusioncausestissuedamage/necrosis

Tissuenecrosistriggersdiffuseclotting

Diffuseclottingconsumesclottingfactors

Fibrinolysisbegins

Severe,uncontrolledsystemichemorrhageoccurs;休克病理生理过程--

微循环改变;休克病理生理改变—

体液代谢改变;休克病理生理改变—

内脏器官继发性损害;StagesofShock;Hypotension90mmHg(maybenormallevelorincreaseduetocompensatorymechanism)

Meanarterialpressure(MAP)60mmHg

Tachycardia:weakandthreadypulse

Tachypnea:blowoffCO2 respiratoryalkalosis

Decreasedurineoutput

;休克临床表现;休克抑制期：

丧失血容量20%

1.神志冷淡(Disturbanceofconsciousness)→昏迷(Coma)

2.口唇(Orallip)、肢端(Limb)发绀(Cyanosis)，出冷汗(Coldsweat)

3.脉细速(Rapidrateandthread/weakpulse)，血压下降(FallingBP)，脉压差(Pulsepressuredifference)显著缩小

4.5.尿量降低或无尿(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)，四肢冰凉

3.脉搏摸不到，血压测不出

4.无尿(Anuria)

5.器官功效衰竭表现;休克诊疗DiagnosisofShock;神志状态(Mentalstatus)

肢体温度、色泽(Limbtemperatureandcolor)

血压(Bloodpressure)

脉率(Pulse)

尿量(Urineoutput);休克监测—特殊监测

SpecialMonitor

;休克监测—特殊监测

SpecialMonitor;休克监测—特殊监测

SpecialMonitor;休克治疗

TreatmentofShock;休克治疗

TreatmentofShock;Shocktreatment;休克治疗

TreatmentofShock;Insummary,TreatmentofShock;失血性休克治疗

(TreatmentofHemorrhagicShock);中心静脉压和补液关系;损伤性休克治疗

(TreatmentofTraumaticShock);HypovolemicShock;Aimedatimprovementtissuehypoperfusion;感染性休克特点

CharacteristicsofSepticShock;感染性休克类型

TypesofSepticShock;感染性休克两种临床表现;SepticShock;TreatmentofSepticShock;Addinotropicandvasopressortherapyifneeded.Maintaincentralvenousoxygensaturationat70%.

⑵.Maintainoxygenatio