外科休克surgical+shock.ppt

Department of Pediatric Surgery Union Hospital of Huazhong University of Science and Technology Objectives Understand what is shock ？ Define types of shock Understand pathophysiology of shock Understand how to treat shock Development of the concept of shock A history of the 200 years to recognize shock: “shake”, “attack” From superficial syndrome to microcirculatory level , cellular level, molecular level Circulatory level： blood pressure Microcirculatory level： inadequate tissue perfusion Cellular level and molecular level： Frontier Exploratory stage，experimental therapies WHAT IS SHOCK? Shock results from poor tissue perfusion and tissue hypoxia from inadequate circulatory compensations needed to sustain acutely increased body metabolism. A breakdown of effective circulation Inadequate tissue perfusion Decreased oxygen supply Anaerobic metabolism Accumulation of metabolic waste Multiple organ failure A clinical syndrome What is effective circulatory blood volume? Various types of shock result from failure in one or more of the 3 major components of the circulatory system： Blood volume Pump Peripheral resistance Causes of Shock Severe or sudden blood loss Large drop in body fluids Major infections High spinal injuries Myocardial infarction Anaphylaxis Extreme heat or cold Types of Shock Hypovolemic Shock: haemorrhagic traumatic dehydration Other causes of shock Septic Shock Cardiogenic Shock Neurogenic Shock Hypersensitive Shock Pathophysiology 1. Microcirculatory changes 2. The changes of body fluid metabolism 3. Mediators of inflammation release and ischemical reperfusion injury 4. Secondary lesion 1. Microcirculation Precapillary resistance vessel： arteriole、metarteriole、precapillary sphincter Postcapillary resistance vessel：veinule Microcirculation perfusion： Compensatory significance Clinical manifestation of Shock Early Stage (compensated shock): Compensatory mechanisms are able to maintain perfusion of vital or