刘保池《急诊医学精品教学》休克.docxVIP

septic shock 感染性休克cardiogenic shock 心源性休克hypovolemic shock低血容量休克distributive shock分布性休克obstructive shock梗阻性休克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，是一个由多种病因引起的综合征。Shock is defined as acute circulatory failure, a situation in which the circulation fails to provide cell with sufficient oxygen to be able to perform optimally.良好的心脏功能、正常的血管容积和充足的循环血量是保障微循环灌注的三个基本条件，而休克的本质是组织灌注不足。Diagnosis of shock is based on:Clinical表现: 四肢厥累Hemodynamic血液动力学: 血压下降Biochemical signs(乳酸升高)Shock can broadly be summarized into 3 components(病理生理表现:两低一高)Systemic arterial hypotension(低血压)Tissue hypoperfusion(低灌注)Hyperlactatemia(高乳酸血症)Systemic arterial hypotension in adultsThe SBP90mmHgThe MAP70mmHg, with associate tachycardiaTissue hypoperfusion-the 3 “windows” of the bodyCutaneous(skin that is cold and clammy)皮肤苍白Renal(urine output of0.5ml/kg/h)尿量不足Neurologic(altered mental state includes obtundation, disorientation, and confusion)Hyperlactatemiathe level1.5mmol/L in acute circulatory failureClassification of shock填空题休克的类型: 低血容量性、心源性、梗阻性、分布性(按照病理生理学分类)梗阻性(obstructive)休克的cause: pulmonary embolism、Tamponade, aortic dissection分布性休克的cause: inflammatory responsehypovolemic: hemorrhage, trauma, dehydrationcardiogenic: myocardial infarction, cardiomyopathy, valvular disease, severe arrhythmias.低血容量性休克的基本机制是循环容量的丢失心源性休克的基本机制是泵功能障碍梗阻性休克的基本机制是血流的主要通道受阻分布性休克的发生机制为血管收缩舒张功能调节异常，感染性因素导致血液重新分布。与低容量性休克的区别是，分布性休克并不是循环容量的绝对丢失，而是因为容量血管扩张导致的相对容量不足，血管舒缩调节功能异常使容量分布在异常部位。严重感染时，由于毛细血管通透性增加液体渗漏等因素导致循环血量绝对减少，这与低血容量性休克类似，但是血流分布异常才是导致休克的根本原因。简答题考感染性休克过敏性休克就是非感染性休克，首选药是肾上腺素(比如青霉素过敏)分布性休克的特点: vasodilation(扩张)感染性休克病人先麻痹，后扩张填空感染性休克最常见的病理表现: 毛细血管通透性增加导致液体渗透心源性休克特点: ventricular failure(心衰)最常见的心源性休克原因: 心梗、心肌炎低血容量性休克特点: loss of plasma or blood梗阻性休克特点: pericardial tamponade(心包填塞)Stages of shock1. initial stagebody switches from aerobic to anaerobic metabolismelevated lactic acid levelsubtle changes in clinical signs2. compensatory stagesympathetic nervous system stimulated: catecholamine release(+); cardiac contractility(+)N