2013-NEJM-circulatory shock休克.pdfVIP

T h e n e w e ngl a nd j o u r na l o f m e dic i n e review article critical care medicine Simon R. Finfer, M.D., and Jean-Louis Vincent, M.D., Ph.D., Editors Circulatory Shock Jean-Louis Vincent, M.D., Ph.D., and Daniel De Backer, M.D., Ph.D. From the Department of Intensive Care, hock is the clinical expression of circulatory failure that Erasme Hospital, Université Libre de Brux- results in inadequate cellular oxygen utilization. Shock is a common condi- elles, Brussels. Address reprint requests to Stion in critical care, affecting about one third of patients in the intensive care Dr. Vincent at the Department of Intensive Care, Erasme University Hospital, Rte. de 1 unit (ICU). A diagnosis of shock is based on clinical, hemodynamic, and bio- Lennik 808, B-1070 Brussels, Belgium, or chemical signs, which can broadly be summarized into three components. First, at jlvincen@ulb.ac.be. systemic arterial hypotension is usually present, but the magnitude of the hypoten- N Engl J Med 2013;369:1726-34. sion may be only moderate, especially in patients with chronic hypertension. Typi- DOI: 10.1056/NEJMra1208943 cally, in adults, the systolic arterial pressure is less than 90 mm Hg or the mean Copyright © 2013 Massachusetts Medical Society. arterial pressure is less than 70 mm Hg, with associated tachycard