外科休克 英文课件

1、Surgical Shock外科休克Definition of shockShock,regardless of the cause,may be defined as a syndrome that results from inadequate perfusion of tissues.休克乃各种原因导致的组织灌注不足所引起的综合症群。introductionShock is a sign of cardiovascular (心血管的) insufficiency（不足） .The cardiovascular system is made up of three key element

2、s:a pump,tubing and a fluidThe pump propels(推动) the fluidThe tubing distributes and collects itPathophysiology（病理生理学）1. Microcirculatory changes2. The changes of body fluid metabolism3. Mediators of inflammation release and ischemical reperfusion injury4. Secondary lesion 1.微循环的变化2.津液代谢的变化3.炎症介质的释放和

3、缺血再灌注损伤 4.继发性损害 Microcirculatory changescompensation of shock (1) to speed up the heart, cardiac output increased:(2) a redistribution of blood:(3) tissue hypoxia:(4) significantly reduced the tissue fluid （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Decompensation of shockprogressive stage of shock(

4、休克进展期) (1) is larger than the flow of irrigation(灌大于流);(2) the tissue edema（组织水肿） Refractory stage of shock(休克难治期） (1) the formation of DIC（DIC形成）(2) cell autolysis, tissue necrosis;（细胞自溶，组织坏死）(3) the bleeding tendency （出血倾向）Clinical manifestation(临床表现)Compensatory of shock1, mental tension, irritab

5、ility.2, pale, cold clammy skin.3, thready and rapid pulse, systolic blood pressure, diastolic blood pressure rise high, pulse pressure smaller.4, normal or decreased urine volume 5, metabolic acidosis.6, bleeding tendency often hint has occurred: DIC7, respiratory distress syndrome: (1) dyspnea wer

6、e. (2) although to a large number of oxygen does not improve The symptoms and improve the oxygen partial pressure Hypovolemic shockInadequate blood volumeHemorrhagic shock（失血性休克）Treatment: Supplement blood capacityCorrection of acid-base and electrolyte imbalanceThe cause of disease treatment and st

7、op the continued loss of bloodAnd the loss of fluid 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Traumatic shock（损伤性休克）Treatment:In addition to the hemorrhagic fluid shock treatment, should also strengthen the following treatment:1, anti infection2, analgesia, sedation3, the treatment of wounds 治疗：除按失血失液性休克治疗

8、外，还应加强以下治疗： 1、抗感染 2、镇痛、镇静 3、处理创伤Septic shock(感染性休克)Treatment： 1 supplement blood capacity.2 control of infection.3 correcting acid-base imbalance.Application of 4 cardiovascular drugs.5 cortical hormone therapy.6 other nutritional support, 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

9、质激素治疗 6 其他营养支持、处并发症等Infection control（控制感染）Antibacterial drugs（抗菌药物）Operation （手术）SIRST38 or 36Rate of heart90times/minR20times/min or above, PaCO24.3kPaNo.of Leukocyte12109/L or 4109/L， or unadult Leukocyte10%Monitors(监测) of shockgeneral monitoring1, state of mind 2, skin temperature, color 3, bloo

10、d pressure 4, the pulse 5, the amount of urine is reaction (b) special monitoring1, central venous pressure (CVP):The normal value: 510cmH2O 2, pulmonary capillary wedge pressure (PCWP): 615mmHg 3, cardiac output (CO) and cardiac index (CI):Adult CO: 46L/min; CI:2.53.5L/ (min M2). Principle of treatm