2011培训班-休克总汇.pptVIP

低心排 CO ? 急性循环衰竭 低血压 AP ? 阻力血管失张 SVR ? ? 血管收缩药 对抗血管 扩张 ? ? 液体 补充前负荷 不足 ? 正性肌力 药对抗心衰 先看组织灌注，再看血压，再看心排 稳定循环的策略 复苏终点 心率、血压、中心静脉压、心排量、尿量等传统指标恢复正常---不能作为复苏的终点指标； 血清乳酸含量、碱剩余、组织、粘膜pHi 与休克及预后的关系密切； 血清乳酸含量增加，碱剩余负值增加，pHi 下降的患者预后差； 持续测定组织氧分压、二氧化碳分压、pH在评判液体复苏效果中有独特优势。 总结 休克是以组织氧合障碍和低灌注为特征。 依据血流动力学特点区分休克类型为： 低血容量性、分布性、心源性、梗阻性休克。 休克的临床表现取决于组织氧合和灌注不足，代偿性的反应和引起休克的特殊病因。 对大多数类型的休克来说治疗方法是补充晶体或胶体以增加有效血容量。 休克时血管活性药物的选择应根据个体血流动力学效应的差异和药物的药理机制。 应排除可逆性的急性少尿原因并选择最适宜的晶/胶体进行扩容治疗。 谢谢！ * The immediate priority is to rapidly determine the cause of shock. This is easily done if one remembers the relationship between cardiac output, peripheral resistance and mean arterial pressure. If the mean arterial pressure is normal but peripheral resistance is high then the cardiac output must be low. Alternatively if the mean arterial pressure is low either the cardiac output must be low or the peripheral resistance must be low. As peripheral resistance is one of the two determinants of blood pressure it is clearly vital that we assess this, which we can do this by feeling the hands and feet and assessing the peripheral perfusion Cardiac output is determined by heart rate and stroke volume so it is vital to know the heart rate Stroke volume is determined by preload, afterload and contractility. Preload can be estimated from the JVP, CVP or pulmonary artery occlusion pressure but afterload and contractility are difficult to assess clinically. This is self-evident if remembers that there are homeostatic mechanisms which maintain blood pressure even when cardiac output falls. Thus a fall in cardiac output and blood pressure results in vasoconstriction and tachycardia in an attempt to maintain a constant blood pressure. It is only when these compensatory responses are overwhelmed or malfunctioning that the blood pressure falls. It is therefore just as importat to assess the magnitude of the compensatory respon