外科休克英文.ppt
外科休克英文现在学习的是第1页，共24页Definition of shockwShock,regardless of the cause,may be defined as a syndrome that results from inadequate perfusion of tissues.w休克乃各种原因导致的组织灌注不足所引起的综合症群。现在学习的是第2页，共24页introductionwShock is a sign of cardiovascular(心血管的)insufficiency（不足）.wThe cardiovascular system is made up of three key elements:a pump,tubing and a fluidwThe pump propels(推动)the fluidwThe tubing distributes and collects it现在学习的是第3页，共24页Causes of shock wSevere of sudden blood losswLarge drop in body fluids wMajor infectionswHigh spinal injuries wMyocardial infarctionwanaphylaxis 现在学习的是第4页，共24页Pathophysiology（病理生理学）1.Microcirculatory changes2.The changes of body fluid metabolism3.Mediators of inflammation release and ischemical reperfusion injury4.Secondary lesion 1.微循环的变化2.津液代谢的变化3.炎症介质的释放和缺血再灌注损伤 4.继发性损害 现在学习的是第5页，共24页Microcirculatory changescompensation of shock (1)to speed up the heart,cardiac output increased:(2)a redistribution of blood:(3)tissue hypoxia:(4)significantly reduced the tissue fluid（1 1）心跳加快，心排）心跳加快，心排出量增加出量增加 （2 2）血液重新分配）血液重新分配 （3 3）组织缺氧）组织缺氧（4 4）组织液明显减）组织液明显减 少少现在学习的是第6页，共24页Decompensation of shockwprogressive stage of shock(休克休克进展期进展期)(1)is larger than the flow of irrigation(灌大灌大于流于流);(2)the tissue edema（组（组织水肿）织水肿）wRefractory stage of shock(休克难治期）(1)the formation of DIC（DIC形成）(2)cell autolysis,tissue necrosis;（细胞自溶，组织坏死）(3)the bleeding tendency（出血倾向）现在学习的是第7页，共24页Clinical manifestation(临床表现)wCompensatory of shock1,mental tension,irritability.2,pale,cold clammy skin.3,thready and rapid pulse,systolic blood pressure,diastolic blood pressure rise high,pulse pressure smaller.4,normal or decreased urine volume 现在学习的是第8页，共24页Inhibitory stage of shock(休克抑制期)1,indifferent mind,unresponsive,or unconsciousness,coma.2,systemic skin mucous membrane cyanosis,cold limbs,cold sweat3,thready and rapid pulse or stroke is not clear,blood pressure decreased(BP 90mmHg)or undetectable,pulse pressure smaller.4,decreased urine output or urine(per 25ml).现在学习的是第9页，共24页 5,metabolic acidosis.6,bleeding tendency often hint has occurred:DIC7,respiratory distress syndrome:(1)dyspnea were.(2)although to a large number of oxygen does not improve The symptoms and improve the oxygen partial pressure 现在学习的是第10页，共24页Types of shockwHypovolemic shock(低血容量性休克)wCardiogenic shock(心源性休克)wAllergic shock（过敏性休克）wNeurogenic shock(神经性休克)wSeptic shock(感染性休克)现在学习的是第11页，共24页Hypovolemic shockwInadequate blood volume现在学习的是第12页，共24页Clinical manifestation(临床表现)w1,hypotension.2,heart rate.3 changes,skin and mind.4,organ dysfunction 1、低血压。2、心率加快。3、皮肤和神志的变化。4、器官功能不全。现在学习的是第13页，共24页Hemorrhagic shock（失血性休克）wTreatment:Supplement blood capacityCorrection of acid-base and electrolyte imbalanceThe cause of disease treatment and stop the continued loss of bloodAnd the loss of fluid 治疗：治疗：补充血容量纠正酸碱及水电解质失衡 病因治疗和制止 继续失血和失液现在学习的是第14页，共24页Traumatic shock（损伤性休克）wTreatment:In addition to the hemorrhagic fluid shock treatment,should also strengthen the following treatment:1,anti infection2,analgesia,sedation3,the treatment of wounds 治疗：除按失血失液性休克治疗外，还应加强以下治疗：1、抗感染 2、镇痛、镇静 3、处理创伤现在学习的是第15页，共24页Septic shock(感染性休克)Treatment：1 supplement blood capacity.2 control of infection.3 correcting acid-base imbalance.Application of 4 cardiovascular drugs.5 cortical hormone therapy.6 other nutritional support,complications 治疗：1 补充血容量。2 控制感染。3 纠正酸碱失衡 4 心血管药物的 应用。5 皮质激素治疗 6 其他营养支持、处并发症等现在学习的是第16页，共24页Infection control（控制感染）wAntibacterial drugs（抗菌药物）wOperation（手术）现在学习的是第17页，共24页SIRSwT38 or 36wRate of heart90times/minwR20times/min or above,PaCO24.3kPawNo.of Leukocyte12109/L or 4109/L，or unadult Leukocyte10%现在学习的是第18页，共24页Diagnosis(诊断)w1.History:serious injury,bleeding,severe infection,allergy,history of heart diseasew2.shock aura:sweating,rapid heart rate,pulse excited,reduce or Niaoshao symptomsw 3.shock signs:indifferent mind,unresponsive,pale skin rapid shallow breathing,systolic blood pressure below 90mmHg and oliguria,sign the patient has entered the inhibitory stage of shock.现在学习的是第19页，共24页Monitors(监测)of shock(a)general monitoring1,state of mind 2,skin temperature,color 3,blood pressure 4,the pulse 5,the amount of urine is reaction 现在学习的是第20页，共24页(b)special monitoring1,central venous pressure(CVP):The normal value:510cmH2O 2,pulmonary capillary wedge pressure(PCWP):615mmHg 3,cardiac output(CO)and cardiac index(CI):Adult CO:46L/min;CI:2.53.5L/(min M2).现在学习的是第21页，共24页4,artery blood gas analysis(动脉血气分析)5,artery blood lactate determination（动脉血乳酸盐测定）The normal value is:12mmol/L.6，Laboratory examination of DIC现在学习的是第22页，共24页Principle of treatmentswVolume resuscitationwVasoactive therapy:Dopamine(多巴胺)Dobutamine(多巴酚丁胺)Norepinephrine(去甲肾上腺激素)Vasopressin（抗利尿激素）Endpoints of resuscitation现在学习的是第23页，共24页感谢大家观看2022/9/26现在学习的是第24页，共24页
