儿科休克的诊治.pptVIP

儿科休克的诊治

主要内容休克的定义氧运输及心血管功能复习休克分类和病因不同休克的特点低灌注的临床判断和休克早期诊断休克的治疗休克诊治中应注意的问题

ImprovedOutcomesAssociatedWithEarlyResuscitationinSepticShock:DoWeNeedtoResuscitatethePatientorthePhysician?AileenKirbyandBrahmGoldsteinPediatrics2003;112;976-977

EarlyReversalshockandoutcomRetrospectiveclinicalstudy(from1993–2001)91infantsandchildrenwithsepticshockfromlocalcommunityhospitalsandtransporttoChildren’shospital√Shockreversal(definedbyreturnofnormalSBPandCRT)√ResuscitationpracticeconcurrencewithACCMPALSGuidelines√HospitalmortalityHan,etal.Pediatrics2003;112;793-799

EarlyReversalshockandoutcomShockstateandmanagementwithsurvivalSurvivalincreasedoddsofsurvivalShockreversedatamediantimeof75min(n=24)96%9-foldPersistentshock(n=67)63%ResuscitationconsistentwithACCM-PALSguidlines92%6-foldincreasedResuscitationnotconsistentwithACCM-PALSguidlines62%Han,etal.Pediatrics2003;112;793-799

EarlyReversalshockandoutcomShockstateandmanagementwithmortalityoddsofmortalitypassedeachhourofpersistentshock2-foldeachhourofdelayininstitutionofresuscitationconsistentwithACCM-PALSGuidelines↑50%Unfortunately,resuscitationpracticewasconsistentwithACCM-PALSGuidelinesinonly27(30%)patientsHan,etal.Pediatrics2003;112;793-799

EarlyReversalshockandoutcomComparedwithsurvivors,nonsurvivorstreatedwithmoreinotropictherapies,notincreasedfluidtherapy:√dopamine/dobutamine:42%vs20%√epinephrine/norepinephrine:42%vs6%√fluid:32.9mL/kgvs20.0mL/kgHan,etal.Pediatrics2003;112;793-799

休克的定义休克（Shock)系因循环功能不全或衰竭导致组织灌注不良，脑及全身重要器官缺氧核心问题：氧运输(oxygendelivery)不能满足代谢需要（DO2VO2)本质：多器官系统的低灌注注意：血压未列入定义中

氧运输氧运输（OxygenDelivery，DO2）指心脏每分钟向外周组织输送的氧量正常范围700~1400ml/min

Hb×SaO2×1.34+(0.003×PaO2)DO2=动脉氧含量（CaO2）×