休克的病理生理学.ppt
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休克的病理生理学.ppt
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SHOCKPathophysiologyIntroductionwhatisshock?
whatisshock?
Comatose?
Comatose?
SectionIOverviewIntroductionDropinBPDropinBP?
SectionIOverviewCaseanalysisCaseanalysisChiefcomplaintChiefcomplaint:
Male,45yearsofage,severelacerationoftheleftleginaMale,45yearsofage,severelacerationoftheleftleginacaraccident.caraccident.PhysicalExaminationPhysicalExamination:
AppearspaleandindifferentbutwithclearAppearspaleandindifferentbutwithclearconsciousness.Multiplesofttissuecontusion.Leftinguinalconsciousness.Multiplesofttissuecontusion.Leftinguinalbrieflycovered,butwithlargeamountofexudation.BPbrieflycovered,butwithlargeamountofexudation.BP105/85mmHg,HR96/min.Sonogramindicatesruptureofthe105/85mmHg,HR96/min.Sonogramindicatesruptureofthespleenwithanestimated600mlspleenwithanestimated600mlofbloodaccumulationintheofbloodaccumulationintheabdomen.abdomen.SectionIOverviewCaseanalysisCaseanalysisTreatmentTreatment:
Alacerationwoundof7cmintheleftinguinal.Alacerationwoundof7cmintheleftinguinal.PartialPartialseparationofthefemoralarteryandveinwitharupturedspleen.separationofthefemoralarteryandveinwitharupturedspleen.Vascularprosthesisandsplenectomywereconducted.400mlofVascularprosthesisandsplenectomywereconducted.400mlofbloodtransfusionduringoperation.bloodtransfusionduringoperation.55GlucosesolutionI.V.afterGlucosesolutionI.V.aftersurgery.surgery.2hpost-surgeryBP80/50mmHg.Epinephrineanddopamine2hpost-surgeryBP80/50mmHg.EpinephrineanddopaminearegivenI.V.,butBPremainslow(85/60mmHg).ClammyskinandaregivenI.V.,butBPremainslow(85/60mmHg).Clammyskinandanuriaanuria.BPdropsto70/40mmHgthenextmorning.BPdropsto70/40mmHgthenextmorning.I.V.epinephrineI.V.epinephrinewithnoeffect.PatientgoesintocomawithB.P.at7:
30.Weakwithnoeffect.PatientgoesintocomawithB.P.at7:
30.Weakrespirationandheartbeat.Pronounceddeadat7:
50.respirationandheartbeat.Pronounceddeadat7:
50.SectionIOverviewQuestions:
Questions:
11、ThispatienthasanormalBPuponadmission.WhydoeshisBPThispatienthasanormalBPuponadmission.WhydoeshisBPdropdramaticallyafterthesurgerytorepairinjuredvessels?
dropdramaticallyafterthesurgerytorepairinjuredvessels?
22、WhydothevasoconstrictorsfailtorestoreBP?
WhydothevasoconstrictorsfailtorestoreBP?
33、Howwouldyoumodifythetreatmentstrategyforthispatient?
Howwouldyoumodifythetreatmentstrategyforthispatient?
SectionIOverviewThetermwasoriginatedfromGreek.Itsinitialmeaningwas:
Inthe1730s,thistermwasre-coinedbyaFrenchdoctortodescribeShockApathologicalprocesscausedbytraumaAviolentcollisionoraheavyblowtotheheadSectionIOverviewUnderstandingshock:
aprogressivehistoryFromtheuseofvasoconstrictor(restorationofBP)Fromtheuseofvasoconstrictor(restorationofBP)totheuseofvasodilatortotheuseofvasodilatorUnderstandingshock:
aprogressivehistorymicrocirculationAcutecirculatoryfailureAcutecirculatoryfailure3MicrocirculationdisturbanceMicrocirculationdisturbancetheeffectsofpro-inflammatorymediatorstheeffectsofpro-inflammatorymediatorsandanti-inflammatorymediatorsandanti-inflammatorymediatorsShockReductionofECBVInadequateperfusionofvitalorgansCellularmetabolismdisturbanceDysfunctionoforgansThepathogenesisofshockiscomplex,involving:
Shockisageneralpathologicprocess,characterizedby:
Including:
SectionIOverviewShocksyndromeClassicclinicalpresentationofshock:
Classicclinicalpresentationofshock:
ShockperipheralvasoconstrictionseverelydiminishedCOinadequatebloodflowtothebrainandkidneysrespiratorycompensationformetabolicacidosispalepaleandandcoldclammyskincoldclammyskinhyperventilationhyperventilationoliguriaoliguriadulleddulledsensoriumsensoriumrangingfromagitationtostupororcomarangingfromagitationtostupororcomatachycardiawithathreadypulsetachycardiawithathreadypulsehypotensionwithanarrowedpulsepressurehypotensionwithanarrowedpulsepressureSectionIOverviewSectionIIEtiologyandClassificationofShockHypovolemicshockSectionII
(1)Basedoncauses1)LossofbloodorfluidBloodlossHemorrhagicshockFluidlossDehydrationshockBurnBurnshock2)TraumaTraumicshock3)InfectionInfectious(endotoxic,septic)shock4)AnaphylaxisAnaphylacticshock5)AcuteheartfailureCardiogenicshock6)StrongstimulationonnervesystemNeurogenicshockPerfectperfusion
(2)BasedonpathogenesisSufficientbloodvolumeheartpumpfunctionNormalfunctionVascularbedvolume3majordeterminantsofeffectiveperfusion:
3majordeterminantsofeffectiveperfusion:
SectionIINormalvasoconstrictionandvasodilationAnyoneofthesedeterminantsmayinfluencetheefficiencyofperfusionEffectivecirculatorybloodvolumeReferredtoasthevolumeofbloodcirculatingthroughReferredtoasthevolumeofbloodcirculatingth
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- 关 键 词:
- 休克 病理 生理学