休克诊断与治疗演示文稿.pptVIP

补液原则 补液量 补液种类 实施 晶/胶比3:1 Hct﹤0.25或Hb＜60g/L时,补充RBC 低血容量性休克 － 补充血容量 先快后慢 失血量的2－4倍 速度和量根据监测结果调整 血压 脉搏 尿量 中心静脉压 红细胞比容等 有条件可行血流动力学监测 补液监测 灌注良好指标 尿量＞0.5ml/(kg?h) SBP＞100mmHg 脉压＞30mmHg CVP:5.1-10.2cmH2O 低血容量休克 1 休克纠正:生命体征平稳 肢体变暖 2 补液量不足:5-10min输液200ml后血压不变 3 心功能不全:补液量足,无出血,而血压仍低 4 交感神经过度兴奋:病人烦躁、血压增高 低血容量休克补液评价 感染性休克 － 病因 革兰阴性 G-杆菌感染 病 毒 革兰阳性 G+球菌感染 其他 致病微生物 真 菌 常见病因 与感染相关的定义 全身炎性反应综合征 脓毒症 感染性休克 多器官衰竭 感染性休克的病理生理特点 低血容量 相对 绝对 心肌抑制 氧摄取的障碍 感染性休克 － 分型 Physical examination To begin with an assessment of the airway, breathing, and circulation. pulse rate, skin perfusion, respiratory rate Pulse pressure, urine Consciousness Blood pressure -Do not rely on systolic BP as the main indicator of shock , and this practice results in delayed diagnosis . Class I hemorrhage (loss of 0-15%) only minimal tachycardia Usually, no changes in BP, pulse pressure, or respiratory rate occur. A delay in capillary refill of longer than 3 seconds corresponds to a volume loss of approximately 10%. Class II hemorrhage (loss of 15-30%) tachycardia (rate 100 beats /min) decrease in pulse pressure cool clammy skin delayed capillary refill slight anxiety. -The decrease in pulse pressure is a result of increased catecholamine levels, which causes an increase in peripheral vascular resistance and a subsequent increase in the diastolic BP. Class III hemorrhage (loss of 30-40%) decreased systolic BP Marked tachypnea and tachycardia oliguria confusion or agitation -30-40% is the smallest amount of blood loss that consistently causes a decrease in systolic BP. Class IV hemorrhage (loss of 40%) Marked tachycardia decreased systolic BP narrowed pulse pressure (or immeasurable diastolic pressure) markedly decreased (or no) urinary output depressed mental status (or loss of consciousness) cold and pale skin -This amount of hemorrhage is immediately life threatening. 休克治疗的总原则 重新建立机体 氧的供需平衡! 休克治疗 去除原因、诱因 恢复有效循环血量 纠正微循环障碍 增进心脏功能 加强呼吸管理/改善氧合功能 治 疗 － 治疗原则 1 镇静 吸氧