單擊此處編輯母版標(biāo)題樣式,單擊此處編輯母版文本樣式,第二級(jí),第三級(jí),第四級(jí),第五級(jí),*,單擊此處編輯母版標(biāo)題樣式,單擊此處編輯母版文本樣式,第二級(jí),第三級(jí),第四級(jí),第五級(jí),*,單擊此處編輯母版標(biāo)題樣式,單擊此處編輯母版文本樣式,第二級(jí),第三級(jí),第四級(jí),第五級(jí),*,外科休克英文課件,外科休克英文課件,Definition of shock,Shock,regardless of the cause,may be defined as a syndrome that results from inadequate perfusion of tissues.,休克乃各種原因?qū)е碌慕M織灌注不足所引起的綜合癥群。,Definition of shockShock,regar,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,tubing and a fluid,The pump propels(,推動(dòng),)the fluid,The tubing distributes and collects it,introductionShock is a sign of,Causes of shock,Severe of sudden blood loss,Large drop in body fluids,Major infections,High spinal injuries,Myocardial infarction,anaphylaxis,Causes of shock Severe of sudd,Pathophysiology,（病理生理學(xué)）,1.Microcirculatory changes,2.The changes of body fluid metabolism,3.Mediators of inflammation release and ischemical reperfusion injury,4.Secondary lesion,1.,微循環(huán)的變化,2.,津液代謝的變化,3.,炎癥介質(zhì)的釋放和缺血再灌注損傷,4.,繼發(fā)性損害,Pathophysiology（病理生理學(xué)）1.Micro,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,）心跳加快，心排出量增加,（,2,）血液重新分配,（,3,）組織缺氧,（,4,）組織液明顯減 少,Microcirculatory changescompe,Decompensation of shock,progressive stage of shock(,休克,進(jìn)展,期,),(1)is larger than the flow of irrigation(,灌大于流,);(2)the tissue edema,（組織水腫）,Refractory stage of shock(,休克難治期）,(1)the formation of DIC,（,DIC,形成）,(2)cell autolysis,tissue necrosis;,（細(xì)胞自溶，組織壞死）,(3)the bleeding tendency,（出血傾向）,Decompensation of shockprogres,Clinical manifestation(,臨床表現(xiàn),),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,Clinical manifestation(臨床表現(xiàn))Co,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).,Inhibitory stage of shock(休克抑制,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,5,metabolic acidosis.6,Types of shock,Hypovolemic shock(,低血容量性休克,),Cardiogenic shock(,心源性休克,),Allergic shock,（過敏性休克）,Neurogenic shock(,神經(jīng)性休克,),Septic shock(,感染性休克,),Types of shockHypovolemic shoc,Hypovolemic shock,Inadequate blood volume,Hypovolemic shockInadequate bl,Clinical manifestation(,臨床表現(xiàn),),1,hypotension.2,heart rate.3 changes,skin and mind.4,organ dysfunction,1,、低血壓。,2,、心率加快。,3,、皮膚和神志的變化。,4,、器官功能不全,。,Clinical manifestation(臨床表現(xiàn))1,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,治療：,補(bǔ)充血容量,糾正酸堿及水電解質(zhì)失衡,病因治療和制止 繼續(xù)失血和失液,Hemorrhagic shock（失血性休克）Treatm,Traumatic shock,（損傷性休克）,Treatment:In addition to the hemorrhagic fluid shock treatment,should also strengthen the following treatment:1,anti infection2,analgesia,sedation3,the treatment of wounds,治療：除按,失血失液性休克治療外，還應(yīng)加強(qiáng)以下治療：,1,、抗感染,2,、鎮(zhèn)痛、鎮(zhèn)靜,3,、處理創(chuàng)傷,Traumatic shock（損傷性休克）Treatmen,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,治療：,1,補(bǔ)充血容量。,2,控制感染。,3,糾正酸堿失衡,4,心血管藥物的 應(yīng)用。,5,皮質(zhì)激素治療,6,其他營養(yǎng)支持、處并發(fā)癥等,Septic shock(感染性休克)Treatment：,Infection control,（控制感染）,Antibacterial drugs,（抗菌藥物）,Operation,（手術(shù)）,Infection control（控制感染）Antibac,SIRS,T,38,or,36,Rate of heart,90times/min,R,20times/min or above,PaCO,2,4.3kPa,No.of Leukocyte,1210,9,/L or,410,9,/L,，,or unadult Leukocyte,10%,SIRST38 or 36,D,iagnosis,(,診斷,),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.,Diagnosis(診斷)1.History:serio,Monitors(,監(jiān)測,)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,Monitors(監(jiān)測)of shockgeneral m,(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).,(b)special monitoring,4,artery blood gas analysis(,動(dòng)脈血?dú)夥治?),5,artery blood lactate determination,（動(dòng)脈血乳酸鹽測定）,The normal value is:12mmol/L.,6,，,Laboratory examination of DIC,