外科休克专题宣讲.pptx

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Surgical Shock,外科休克,外科休克专题宣讲,第1页,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,introduction,Shock is a sign of cardiovascular(心血管)insufficiency（不足）.,The cardiovascular system is made up of three key elements:a pump,tubing and a fluid,The pump propels(推进)the fluid,The tubing distributes and collects it,外科休克专题宣讲,第3页,Causes of shock,Severe of sudden blood loss,Large drop in body fluids,Major infections,High spinal injuries,Myocardial infarction,anaphylaxis,外科休克专题宣讲,第4页,Pathophysiology（病理生理学）,1.Microcirculatory changes,2.The changes of body fluid metabolism,3.Mediators of inflammation release and ischemical reperfusion injury,4.Secondary lesion,1.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,Microcirculatory changes,compensation 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,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;（细胞自溶，组织坏死）(3)the bleeding tendency（出血倾向）,外科休克专题宣讲,第7页,Clinical manifestation(临床表现),Compensatory of shock,1,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,外科休克专题宣讲,第8页,Inhibitory stage 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).,外科休克专题宣讲,第9页,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,外科休克专题宣讲,第10页,Types of shock,Hypovolemic shock(低血容量性休克),Cardiogenic shock(心源性休克),Allergic shock（过敏性休克）,Neurogenic shock(神经性休克),Septic shock(感染性休克),外科休克专题宣讲,第11页,Hypovolemic shock,Inadequate blood volume,外科休克专题宣讲,第12页,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,Hemorrhagic shock（失血性休克）,Treatment:Supplement blood capacityCorrection 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,外科休克专题宣讲,第14页,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,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,Infection control（控制感染）,Antibacterial drugs（抗菌药品）,Operation（手术）,外科休克专题宣讲,第17页,SIRS,T38,or 36,Rate of heart90times/min,R20times/min or above,PaCO,2,4.3kPa,No.of Leukocyte12,10,9,/L or 4,10,9,/L，,or unadult Leukocyte10%,外科休克专题宣讲,第18页,D,iagnosis,(诊疗),1.History:serious injury,bleeding,severe infection,allergy,history of heart disease,2.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 patient has entered the inhibitory stage of shock.,外科休克专题宣讲,第19页,Monitors(监测)of shock,general monitoring,1,state of mind,2,skin temperature,color,3,blood pressure,4,the pulse,5,the amount of urine is reaction,外科休克专题宣讲,第20页,(b)special monitoring,1,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).,外科休克专题宣讲,第21页,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,外科休克专题宣讲,第22页,Principle of treatments,Volume resuscitation,Vasoactive 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,外科休克专题宣讲,第23页,Thank you!,外科休克专题宣讲,第24页,