外科休克-英文.ppt
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外科休克-英文.ppt
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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,rogressivestageofshock(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,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,LaboratoryexaminationofDIC,Principleoftreatments,VolumeresuscitationVasoactivetherapy:
Dopamine(多巴胺)Dobutamine(多巴酚丁胺)Norepinephrine(去甲肾上腺激素)Vasopressin(抗利尿激素)Endpointsofresuscitation,Thankyou!
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