休克英语分析报告.pptVIP

SHOCK Department of Surgery Ruijin Hospital, Medical College, Shanghai Jiaotong University I. Historical Aspect Western record violent impact or blow, 1743 physiologic instability, 1815 Eastern record 厥脱，内闭外脱 Initial Explanation of shock Western Thomas Latta, 1831 Patients with Cholera Infusion of fluids → improvement with the Rise of Physiology Burgeoning of Cardiovascular physiology in the end of 19CN, Crile CVP dropped after hemorrhage Animal survival was increased after the infusion of saline the Use of Cardiac Catheterization Blood volume loss →fall in Cardiac Output with the Combination of  Physiology and Biochemistry Toxin theory of shock, Cannon Bayliss impairment of oxygen transport development of acidosis toxin in severe muscle injury →loss of vasomotor tone →venous sequestration of blood →hypotension Antedate the Era of Critical Care Medicine Extensive physiologic research of Wigger, in early 1940s integrating the Concepts of impaired oxygen delivery oxygen debt tissue injury / death the concept of irreversible shock progressive systemic circulatory decompensation Controversy on Lung Kidney ARDS Introduction of the flow directed pulmonary artery catheter, in 1970 Noncardiogenic nature Not due to volume overload ARF More prompt and aggressive resuscitation Incidence ↓ II. Definition of shock A syndrome that results from inadequate perfusion of tissues insufficient to meet metabolic demand lead to cellular dysfunction, elaboration of inflammatory mediators, and celluar injury which may be limited, or widespread A continuum, ranging from subclinical deficits in perfusion to MODS or frank organ failure. Tissue hypoxia due to hypoperfusion Defects Injury A. 组织低灌注所致细胞缺氧B. 低血压C. 酸中毒D. 心功能不全E. 以上都不对 Impaired tissue perfusion Wider spectrum of shock presentations Ranging from occult tissue hypoxia to full-blown cardiovascular collapse or Multiple organ dysfunction Implication alarm earlier treat earlier Tissue h