休克补充幻灯.pptVIP

Initiation of shock 休克早期Changes of microcirculation Perfusion ↓, flow ↓ Perfusion flow (2) Effects Compensatory significance Decompensatory significance ?. venous reserved blood join the circulation Autotransfusion ?. facilitate interstitial fluid → circulation auto blood transfusion,自我输血 CA↑ venoconstriction liver/spleen venoconstriction returned blood volume ↑ blood release circulation blood volume ↑ auto fluid transfusion,自我输液 CA↑(Perfusion ↓, flow ↓,Perfusion flow) →Micrangium(毛细血管) blood volume ? →Hydrostatic pressure ? →facilitate interstitial fluid → circulation →blood volume ↑ ?.Redistribution of blood flow (血液重分布) Na+、H2O retention  CA↑↑ HR↑ tissue ischemia Compensative significance(primary) Decompensatory significance (1) DIC: endothelial injury tissue injury hypercoagulatory state  (2) Organs failure MDF（心肌抑制因子）：shock→perfusion of pancrease(胰腺) ↓ →ischemic anoxia and acidosis of pancrease→lysosome broken in exocrine cell of pancrease →protease released →protease hydrolyzed proteins→micromolecule peptide ↑ (MDF) Roles of MDF：1)myocardial contractility↓ ；2)inhibit mononuclear phagocyte system;3)vasocontriction of abdominal viscera↑ * Severe blood volume↓ Excessive expansion of vascular bed Severe cardiac pump failure Severe cellular injury and dysfunction ischemic anoxia （ auto blood transfusion,自我输血） Compensative significance(代偿意义) (auto fluid transfusion,自我输液) Autoperfusion first-line defensive response second-line defensive response Maintain blood supply to brain, heart --- the vital organs Maintain blood supply to brain, heart --- protect the vital organs blood flow to heart/brain:N or↑ blood flow to kidney/skin/viscera↓ ALD↑, ADH↑ supply blood volume ?. Arteriolar constriction Total Peripheral resistance↑ maintain B.P Pulse pressure ? ? ? Myocardial contractili