刘保池《急诊医学精品教学》2017年复旦本科休克.pdfVIP

SHOCK 1 2 In the ICU ■ Shock is affecting about 30% patients in the ICU who were assigned to receive either dopamine or norepinephrine ■ septic shock occurred in 62% ■ cardiogenic shock in 16% ■ hypovolemic shock in 16% ■ distributive shock in 4% ■ obstructive shock in 2%. 3 Introduction ■ 休克是指各种原因引起有效循环血量减少、组织灌注 不足、细胞代谢紊乱和功能受损的病理生理过程。 （ 中华医学会重症医学分会指南） ■ Shock is defined as acute circulatory failure, a situation in which the circulation fails to provide cells with sufficient oxygen to be able to perform optimally. 4 ■ The word ‘shock’--French surgeon Henri LeDran; ‘choc’ in the English translation--”Shock”; 厥症 ■ In 1827 English surgeon, George Guthrie first used the word “shock” in association with a physiological response to injury ■ Dr. Thomas Latta in 1831- intravenous fluids for Hypovolemia ■ the key early contributor was Dr. Max Harry Weil ■ Died of prostate cancer July 29, 2011 at his home. ■ “He believed very strongly that we should be able to save more lives, thats what he was working his whole life to do. 5 6 ■ Systemic arterial hypotension in adults: ■ the SBP90mmHg ■ the MAP70mmHg, with associated tachycardia. ■ Tissue hypoperfusion-the three “windows” of the body: ■ cutaneous (skin that is cold and clammy) ■ renal (urine output of0.5ml/kg/h) ■ neurologic (altered mental state includes