外科休克专题宣讲

SurgicalShock外科休克外科休克专题宣讲第1页DefinitionofshockShock,regardlessofthecause,maybedefinedasasyndromethatresultsfrominadequateperfusionoftissues.休克乃各种原因造成组织灌注不足所引发综合症群。外科休克专题宣讲第2页introductionShockisasignofcardiovascular(心血管)insufficiency（不足）.Thecardiovascularsystemismadeupofthreekeyelements:apump,tubingandafluidThepumppropels(推进)thefluidThetubingdistributesandcollectsit外科休克专题宣讲第3页CausesofshockSevereofsuddenbloodlossLargedropinbodyfluidsMajorinfectionsHighspinalinjuriesMyocardialinfarctionanaphylaxis外科休克专题宣讲第4页Pathophysiology（病理生理学）1.Microcirculatorychanges2.Thechangesofbodyfluidmetabolism3.Mediatorsofinflammationreleaseandischemicalreperfusioninjury4.Secondarylesion1.微循环改变

2.津液代谢改变

3.炎症介质释放和缺血再灌注损伤

4.继发性损害外科休克专题宣讲第5页Microcirculatorychanges

compensationofshock(1)tospeeduptheheart,cardiacoutputincreased:

(2)aredistributionofblood:

(3)tissuehypoxia:

(4)significantlyreducedthetissuefluid（1）心跳加紧，心排出量增加（2）血液重新分配（3）组织缺氧（4）组织液显著减少外科休克专题宣讲第6页Decompensationofshockprogressivestageofshock(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）外科休克专题宣讲第7页Clinicalmanifestation(临床表现)Compensatoryofshock

1,mentaltension,irritability.

2,pale,coldclammyskin.

3,threadyandrapidpulse,systolicbloodpressure,diastolicbloodpressurerisehigh,pulsepressuresmaller.

4,normalordecreasedurinevolume外科休克专题宣讲第8页Inhibitorystageofshock(休克抑制期)1,indifferentmind,unresponsive,orunconsciousness,coma.

2,systemicskinmucousmembranecyanosis,coldlimbs,coldsweat

3,threadyandrapidpulseorstrokeisnotclear,bloodpressuredecreased(BP<90mmHg)orundetectable,pulsepressuresmaller.

4,decreasedurineoutputorurine(per25ml).外科休克专题宣讲第9页

5,metabolicacidosis.

6,bleedingtendencyoftenhinthasoccurred:DIC

7,respiratorydistresssyndrome:

(1)dyspneawere.

(2)althoughtoalargenumberofoxygendoesnotimprove

Thesymptomsandimprovetheoxygenpartialpressure外科休克专题宣讲第10页TypesofshockHypovolemicshock(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)外科休克专题宣讲第11页HypovolemicshockInadequatebloodvolume外科休克专题宣讲第12页Clinicalmanifestation(临床表现)1,hypotension.

2,heartrate.

3changes,skinandmind.

4,organdysfunction

1、低血压。2、心率加紧。3、皮肤和神志改变。4、器官功效不全。外科休克专题宣讲第13页Hemorrhagicshock（失血性休克）Treatment:Supplementbloodcapacity

Correctionofacid-baseandelectrolyteimbalance

Thecauseofdiseasetreatmentandstopthecontinuedlossofblood

Andthelossoffluid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外科休克专题宣讲第14页Traumaticshock（损伤性休克）Treatment:Inadditiontothehemorrhagicfluidshocktreatment,shouldalsostrengthenthefollowingtreatment:

1,antiinfection

2,analgesia,sedation

3,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、处理创伤外科休克专题宣讲第15页

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心血管药品应用。5皮质激素治疗6其它营养支持、处并发症等外科休克专题宣讲第16页Infectioncontrol（控制感染）Antibacterialdrugs（抗菌药品）Operation（手术）外科休克专题宣讲第17页SIRST＞38℃or＜36℃Rateofheart＞90times/minR＞20times/minorabove,PaCO2＜4.3kPaNo.ofLeukocyte＞12×109/Lor＜4×109/L，orunadultLeukocyte＞10%外科休克专题宣讲第18页Diagnosis(诊疗)1.History:seriousinjury,bleeding,severeinfection,allergy,historyofheartdisease

2.shockaura:sweating,rapidheartrate,pulseexcited,reduceorNiaoshaosymptoms

3.shocksigns:indifferentmind,unresponsive,paleskinrapidshallowbreathing,systolicbloodpressurebelow90mmHgandoliguria,signthepatienthasenteredtheinhibitorystageofshock.外科休克专题宣讲第19页Monitors(监测)ofshockgeneralmonitoring1,stateofmind2,skintemperature,color3,bloodpressure4,thepulse5,theamountofurineisreaction外科休克专题宣讲第20页(b)specialmonitoring1,centralvenouspressure(CVP):

Thenormalvalue:5~10cmH2O2,pulmonarycapillarywedgepressure(PCWP):6~15mmHg3,cardiacoutput(CO)andcardiacindex(CI):

AdultCO:4~6L/min;CI:2.5~3.5L/(minM2).外科休克专题宣讲第21页4,arterybloodgasanalysis(动脉血气分析)5,arterybloodlactatedetermination（动脉血乳酸盐测定）Thenormalvalueis:1~2mmol/L.6，LaboratoryexaminationofDIC外科休克专题宣讲第2