外科休克英文课件.ppt

SurgicalShock,外科休克,Definitionofshock,Shock,regardlessofthecause,maybedefinedasasyndromethatresultsfrominadequateperfusionoftissues.休克乃各种原因导致的组织灌注不足所引起的综合症群。,introduction,Shockisasignofcardiovascular(心血管的)insufficiency（不足）.Thecardiovascularsystemismadeupofthreekeyelements:apump,tubingandafluidThepumppropels(推动)thefluidThetubingdistributesandcollectsit,Causesofshock,SevereofsuddenbloodlossLargedropinbodyfluidsMajorinfectionsHighspinalinjuriesMyocardialinfarctionanaphylaxis,Pathophysiology（病理生理学）,1.Microcirculatorychanges2.Thechangesofbodyfluidmetabolism3.Mediatorsofinflammationreleaseandischemicalreperfusioninjury4.Secondarylesion,1.微循环的变化2.津液代谢的变化3.炎症介质的释放和缺血再灌注损伤4.继发性损害,Microcirculatorychangescompensationofshock,(1)tospeeduptheheart,cardiacoutputincreased:(2)aredistributionofblood:(3)tissuehypoxia:(4)significantlyreducedthetissuefluid,（1）心跳加快，心排出量增加（2）血液重新分配（3）组织缺氧（4）组织液明显减少,Decompensationofshock,progressivestageofshock(休克进展期)(1)islargerthantheflowofirrigation(灌大于流);(2)thetissueedema（组织水肿）,Refractorystageofshock(休克难治期）(1)theformationofDIC（DIC形成）(2)cellautolysis,tissuenecrosis;（细胞自溶，组织坏死）(3)thebleedingtendency（出血倾向）,Clinicalmanifestation(临床表现),Compensatoryofshock1,mentaltension,irritability.2,pale,coldclammyskin.3,threadyandrapidpulse,systolicbloodpressure,diastolicbloodpressurerisehigh,pulsepressuresmaller.4,normalordecreasedurinevolume,Inhibitorystageofshock(休克抑制期)1,indifferentmind,unresponsive,orunconsciousness,coma.2,systemicskinmucousmembranecyanosis,coldlimbs,coldsweat3,threadyandrapidpulseorstrokeisnotclear,bloodpressuredecreased(BP90mmHg)orundetectable,pulsepressuresmaller.4,decreasedurineoutputorurine(per25ml).,5,metabolicacidosis.6,bleedingtendencyoftenhinthasoccurred:DIC7,respiratorydistresssyndrome:(1)dyspneawere.(2)althoughtoalargenumberofoxygendoesnotimproveThesymptomsandimprovetheoxygenpartialpressure,Typesofshock,Hypovolemicshock(低血容量性休克)Cardiogenicshock(心源性休克)Allergicshock（过敏性休克）Neurogenicshock(神经性休克)Septicshock(感染性休克),Hypovolemicshock,Inadequatebloodvolume,2019/12/15,13,可编辑,Clinicalmanifestation(临床表现),1,hypotension.2,heartrate.3changes,skinandmind.4,organdysfunction,1、低血压。2、心率加快。3、皮肤和神志的变化。4、器官功能不全。,Hemorrhagicshock（失血性休克）,Treatment:SupplementbloodcapacityCorrectionofacid-baseandelectrolyteimbalanceThecauseofdiseasetreatmentandstopthecontinuedlossofbloodAndthelossoffluid,治疗：补充血容量纠正酸碱及水电解质失衡病因治疗和制止继续失血和失液,Traumaticshock（损伤性休克）,Treatment:Inadditiontothehemorrhagicfluidshocktreatment,shouldalsostrengthenthefollowingtreatment:1,antiinfection2,analgesia,sedation3,thetreatmentofwounds,治疗：除按失血失液性休克治疗外，还应加强以下治疗：1、抗感染2、镇痛、镇静3、处理创伤,Septicshock(感染性休克),Treatment：1supplementbloodcapacity.2controlofinfection.3correctingacid-baseimbalance.Applicationof4cardiovasculardrugs.5corticalhormonetherapy.6othernutritionalsupport,complications,治疗：1补充血容量。2控制感染。3纠正酸碱失衡4心血管药物的应用。5皮质激素治疗6其他营养支持、处并发症等,Infectioncontrol（控制感染）,Antibacterialdrugs（抗菌药物）Operation（手术）,SIRS,T38or36Rateofheart90times/minR20times/minorabove,PaCO24.3kPaNo.ofLeukocyte12109/Lor4109/L，orunadultLeukocyte10%,Diagnosis(诊断),1.History:seriousinjury,bleeding,severeinfection,allergy,historyofheartdisease2.shockaura:sweating,rapidheartrate,pulseexcited,reduceorNiaoshaosymptoms3.shocksigns:indifferentmind,unresponsive,paleskinrapidshallowbreathing,systolicbloodpressurebelow90mmHgandoliguria,signthepatienthasenteredtheinhibitorystageofshock.,Monitors(监测)ofshock,generalmonitoring1,stateofmind2,skintemperature,color3,bloodpressure4,thepulse5,theamountofurineisreaction,(b)specialmonitoring1,centralvenouspressure(CVP):Thenormalvalue:510cmH2O2,pulmonarycapillarywedgepressure(PCWP):615mmHg3,cardiacoutput(CO)andcardiacindex(CI):AdultCO:46L/min;CI:2.53.5L/(minM2).,4,arterybloodgasanalysis(动脉血气分析)5,arterybloodlactatedetermination（动脉血乳酸盐测定）Thenormalvalueis:12mmol/L.6，Laboratorye