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1、外科休克英文课件,Definition of shock,Shock,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。,introduction,Shock is a sign of cardiovascular(心血管的)insufficiency（不足）.The cardiovascular system is made up of three key elements:a pump,
2、tubing and a fluidThe pump propels(推动)the fluidThe tubing distributes and collects it,Causes of shock,Severe of sudden blood lossLarge drop in body fluids Major infectionsHigh spinal injuries Myocardial infarctionanaphylaxis,Pathophysiology（病理生理学）,1.Microcirculatory changes2.The changes of body flui
3、d 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)significant
4、ly 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 shock,progressive stage of shock(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
5、溶，组织坏死）(3)the bleeding tendency（出血倾向）,Clinical manifestation(临床表现),Compensatory of shock1,mental tension,irritability.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,Inhibitory stag
6、e of shock(休克抑制期)1,indifferent mind,unresponsive,or unconsciousness,coma.2,systemic skin mucous membrane cyanosis,cold limbs,cold sweat3,thready and rapid pulse or stroke is not clear,blood pressure decreased(BP 90mmHg)or undetectable,pulse pressure smaller.4,decreased urine output or urine(per 25ml
7、).,5,metabolic acidosis.6,bleeding tendency often hint has occurred:DIC7,respiratory distress syndrome:(1)dyspnea were.(2)although to a large number of oxygen does not improve The symptoms and improve the oxygen partial pressure,Types of shock,Hypovolemic shock(低血容量性休克)Cardiogenic shock(心源性休克)Allerg
8、ic shock（过敏性休克）Neurogenic shock(神经性休克)Septic shock(感染性休克),Hypovolemic shock,Inadequate blood volume,Clinical manifestation(临床表现),1,hypotension.2,heart rate.3 changes,skin and mind.4,organ dysfunction,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。,Hemorrhagic shock（失血性休克）,Treatment:Supplement blood capacityCorrec
9、tion of acid-base and electrolyte imbalanceThe cause of disease treatment and stop 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
10、:1,anti infection2,analgesia,sedation3,the treatment of wounds,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,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 nutr
11、itional 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）,SIRS,T38 or 36Rate of heart90times/minR20times/min or above,PaCO24.3kPaNo.of Leukocyte12109/L or 4109/L，or unadult Leukocyte10%,Diagnosis(诊断),1.
12、History:serious injury,bleeding,severe infection,allergy,history of heart disease2.shock aura:sweating,rapid heart rate,pulse excited,reduce or Niaoshao symptoms 3.shock signs:indifferent mind,unresponsive,pale skin rapid shallow breathing,systolic blood pressure below 90mmHg and oliguria,sign the p
13、atient has entered the inhibitory stage of shock.,Monitors(监测)of shock,general monitoring1,state of mind 2,skin temperature,color 3,blood 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 p
14、ressure(PCWP):615mmHg 3,cardiac output(CO)and cardiac index(CI):Adult CO:46L/min;CI:2.53.5L/(min M2).,4,artery blood gas analysis(动脉血气分析)5,artery blood lactate determination（动脉血乳酸盐测定）The normal value is:12mmol/L.6，Laboratory examination of DIC,Principle of treatments,Volume resuscitationVasoactive therapy:Dopamine(多巴胺)Dobutamine(多巴酚丁胺)Norepinephrine(去甲肾上腺激素)Vasopressin（抗利尿激素）Endpoints of resuscitation,
