休克防治地现代认识.ppt

休克防治的现代认识 休克（shock） acute circulatory failure of sufficient magnitude to compromise tissue perfusion,cellular hypoxia and disturption of normal metabolic function 病理生理 有效循环 BP 组织灌注 缺O2 代谢紊乱 酸中毒 微血栓DIC 各种细胞质膜破裂 细胞自溶 组织损伤 MODS MOF 休克的生理模型研究提示 tissue hypoxia resulting from poor tissue perfusion is the basic physiologic defect of all shock syndromes 传统分类 cardiogenic shock traumatic shock neurogenic shock septic shock 新分类(1975 MH, Weil)Classification Hypovolemic 低血容量性 Cardiogenic 心源性 Distributive 分布性 Obstructive 梗阻性 Hypovolemic Blood lose 失血 -- blood volume lose =20% Injury of solid organs large vessels Fluid lose 失液 -- extracellular fluid burn, bowel obstruction, diarrhea key point -- out of circulation Preload ? Diastolic filling ? CO ? (SVR?) Cardiogenic Any type of heart failure 心功能衰竭 Myocardial infarction 心肌梗塞 Cardiaomyopathy 心肌病 Severe arrhythmia 心律失常 CHF 心源性肺水肿 Out In (flow) 瓣膜疾病 —— systolic function ? ——diastolic function ? ——CO ? Distributive Septic shock 感染中毒性休克 anaphylactic shock 过敏性休克 neurogenic shock 神经源性休克 adrenal insufficiency 肾上腺功能低下 Key point -- redistributed within circulation Preload? SVR ? or ? (CO?) myocardial depression(systolic diastolic function ? ) CO ? Obstructive 流出(入)道梗阻 Tension pneumothorax 张力性气胸 Pericardial temponade 心包 填塞 —— diastolic filling? ——diastolic function? Pulmonary embolism 肺动脉栓塞 —— ventricular afterload ? —— systolic function ? 瓣膜疾病 Clinical features 临床表现 Early stage 早期 烦躁不安 紧张头晕 口渴 呼吸浅快 面色苍白，皮肤湿冷（