休克(Shock)的定义.ppt

Continued anaerobic metabolism Relaxation of precapillary sphincters Continued contraction of postcapillary sphincters Peripheral pooling of blood Decreased blood flow to the tissues causes cellular hypoxia Decreased coronary blood flow Myocardial ischemia Decreased force of contraction Decreased blood pressure Decompensated Shock 休克的病理生理过程--微循环的变化 微循环扩张期(休克抑制期)的特点: 组织灌流不足，乏氧代谢，酸性物质增多，微动脉和毛细血管前括约肌扩张，但毛细血管后静脉仍收缩 肥大细胞释放组胺,缓激肽,毛细血管扩张范围增加 扩张期结果： 毛细血管多灌少流，容积增加，血液浓缩，回心血大减，心排血量减少，血压下降，心脑灌注不足，休克加重。 If Low Perfusion States persists: IRREVERSIBLE DEATH IMMINENT!!! Decreased perfusion causes tissue damage/necrosis Tissue necrosis triggers diffuse clotting Diffuse clotting consumes clotting factors Fibrinolysis begins Severe, uncontrolled systemic hemorrhage occurs Disseminated Intravascular Coagulation (DIC) 休克的病理生理过程--微循环的变化 微循环衰竭期（DIC期）的特点： 毛细血管内形成微血栓，DIC，细胞缺氧，组织自溶，由于凝血因子消耗，纤维蛋白溶解系统激活，出现严重的出血倾向 休克的病理生理变化—体液代谢的改变 能量不足(Energy deficiency) 乏氧代谢(Anonic metabolism)致乳酸(Lactic acid)和丙酮酸(Pyruvic acid)积聚，造成酸中毒(Metabolic acidosis) 钠泵(Sodium-pump)和钙泵(Calcium pump)功能异常，致细胞肿胀 ，甚至死亡 休克的病理生理变化—内脏器官的继发性损害 多器官衰竭 (Multiple Organ Systems Failure, MOSF):几个脏器相继或同时受损： 呼吸窘迫综合征, （ ARDS: Adult respiratory distress syndrome ） 肾衰 (Renal failure):肾皮质内肾小管上皮变性坏死 3. 心：心肌受损，局灶性坏死 4. 肝功能衰竭 (Hepatic failure)：小叶中央坏死 5. 胃肠道：粘膜糜烂、出血 6. 脑：脑水肿(cerebral edema) 、脑疝(cerebral hernia) Stages of Shock Initial stage - tissues are under perfused, decreased CO, increased anaerobic metabolism, lactic acid is building Compensatory stage - Reversible. SNS activated by low CO, attempting to compensate for the decrease tissue perfusion. Progressive stage - Failing compensatory mechanisms: profound vasoconstriction from the SNS ISCHEMIA Lactic acid production is high anaerobic metabolic acidosis Irreversible or refractory stage - Cellular necrosis and Multiple Organ Dysfunction Syndrome may occur DEATH IS IMMINENT!!!! Hypotension 90 mmHg (may be normal