瑞金医院外科教学幻灯2——休克.ppt

SHOCK Department of Surgery Ruijin Hospital Shanghai Second Medical University How to Learn Shock I. Historical Aspect First use the word shock to refer to violent impact or blow, 1743 to refer to physiologic instability, 1815 厥症 Initial Recognition of shock Thomas Latta, 1831 Patients with Cholera Infusion of intravenous fluids → improvement the Rise of Physiology in 19 CN Burgeoning of Cardiovascular physiology in the end of 19CN, Crile CVP dropped after hemorrhage Animal survival was increased after the infusion of saline with the Combination of Biochemistry and Physiology Toxin theory of shock, Cannon Bayliss, Physiology impairment of oxygen transport development of acidosis toxin in severe muscle injury →loss of vasomotor tone →venous sequestration of blood →hypotension the Use of Cardiac Catheterization Blood volume loss →fall in Cardiac Output Antedate the Era of Critical Care Medicine Extensive physiologic research of Wigger, in early 1940s the concept of irreversible shock progressive systemic circulatory decompensation integrating the Concepts of impaired oxygen delivery oxygen debt tissue injury / death Organ Failure More prompt and aggressive resuscitation Incidence of ARF ↓ ARDS Introduction of the flow directed pulmonary artery catheter, in 1970 Noncardiogenic nature Not due to volume overload II. Summary - Definition of shock A syndrome that results from inadequate perfusion of tissues insufficient to meet metabolic demand lead to cellular dysfunction, elaboration of inflammatory mediators, and celluar injury which may be limited, or widespread A continuum, ranging from subclinical deficits in perfusion to MODS or frank organ failure. Tissue hypoxia Oxygen less available increased organ demands A. 组织细胞缺氧B. 低血压C. 酸中毒D. 心功能不全E. 以上都不对 III. Classificaion of Shock (i) Hypovolemic Shock Hemorrhage - Plasma losses - Cardiogenic Shock Intrinsic - Extrinsic Compressive - Obstructive - III. Classificaion of Shock (ii)