5休克与血管活性药应用.ppt

血清乳酸浓度恢复正常时间与病人死亡率密切相关 24小时内恢复正常者， 生存率为100％ 24～48小时为78％ 48小时仅为14％ Coast TJ,Smith JE, Lockey D,et al.Early increase in blood lactate following injury[J].JR Army Med Corps,2002,148(2):140-143 全身组织是否缺氧: ------是休克更为敏感的监测指标 氧需要 OXYGEN DEMAND 氧耗 OXYGEN CONSUMPTION 氧输送 OXYGEN DELIVERY 3. SVO2 /ScVO2 1000 ml/min 250 ml/min SvO2 = 75% 750 ml/min 25% 5 L/minute Venous Oxygen Delivery Arterial Oxygen Delivery Oxygen Consumption 20 vol % = 20 ml/dl 1000 ml/min 250 ml/min SvO2 = 75% 750 ml/min 25% 5 L/minute Venous Oxygen Delivery Arterial Oxygen Delivery Oxygen Consumption 20 vol % = 20 ml/dl 1000 ml/min 250 ml/min SvO2 = 75% 750 ml/min 25% 5 L/minute Venous Oxygen Delivery Arterial Oxygen Delivery Oxygen Consumption 20 vol % = 20 ml/dl 1000 ml/min 250 ml/min SvO2 = 75% 750 ml/min 25% 5 L/minute Venous Oxygen Delivery Arterial Oxygen Delivery Oxygen Consumption 20 vol % = 20 ml/dl 1000 ml/min 250 ml/min SvO2 = 75% 750 ml/min 25% 5 L/minute Venous Oxygen Delivery Arterial Oxygen Delivery Oxygen Consumption 20 vol % = 20 ml/dl 1000 ml/min 250 ml/min SvO2 = 75% 750 ml/min 25% 5 L/minute Venous Oxygen Delivery Arterial Oxygen Delivery Oxygen Consumption 20 vol % = 20 ml/dl 1000 ml/min 250 ml/min SvO2 = 75% 750 ml/min 25% 5 L/minute Venous Oxygen Delivery Arterial Oxygen Delivery Oxygen Consumption 20 vol % = 20 ml/dl 65-75% VO2 Stress Pain Hyperthermia Shivering Work of breathing DO2 PaO2 Hgb Cardiac Output DO2 PaO2 Hgb Cardiac Output VO2 Hypothermia Anesthesia Decrease work of breathing - SvO2 or ScvO2 + pHi和PgCO2 pHi反映内脏或局部组织的灌流状态，对休克具有早期预警意义，与低血容量休克患者的预后具有相关性 PgCO2或P(g-a)CO2值越大,组织缺血越严重 4.局部组织灌注指标 重症医学专科资质培训·标准教材·2009 重症医学专科资质培训·标准教材·2009 * * CFCCS * * So therefore, the basis of our early goal-directed study is to redefine the concept of shock in terms of global tissue hypoxia, using more sensitive measures. And that has to do with the patient in terms of his oxygen supply and demand relationship. * * 虽然微循环/组织灌注与术后并发症密切相关，但它们看不见、摸不着，我们如