外科休克英文PPT讲稿课件.ppt

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1、外科休克英文课件Definition of shockShock,regardless of the cause,may be defined as a syndrome that results from inadequate perfusion of tissues.休克乃各种原因导致的组织灌注不足所引起的综合症群。introductionShock is a sign of cardiovascular(心血管的)insufficiency（不足）.The cardiovascular system is made up of three key elements:a pump,tubi

2、ng and a fluidThe pump propels(推动)the fluidThe tubing distributes and collects itCauses of shock Severe of sudden blood lossLarge drop in body fluids Major infectionsHigh spinal injuries Myocardial infarctionanaphylaxis Pathophysiology（病理生理学）1.Microcirculatory 1.Microcirculatory changeschanges2.The

3、changes of 2.The changes of body fluid body fluid metabolismmetabolism3.Mediators of 3.Mediators of inflammation inflammation release and release and ischemical ischemical reperfusion injuryreperfusion injury4.Secondary lesion4.Secondary lesion 1.1.微循环的变化微循环的变化2.2.津液代谢的变化津液代谢的变化3.3.炎症介质的释放和缺炎症介质的释放和

4、缺血再灌注损伤血再灌注损伤 4.4.继发性损害继发性损害 Microcirculatory changescompensation of shock (1)to speed up the (1)to speed up the heart,cardiac output heart,cardiac output increased:increased:(2)a redistribution of(2)a redistribution of blood:blood:(3)tissue hypoxia:(3)tissue hypoxia:(4)significantly(4)significantly

5、 reduced the tissue reduced the tissue fluid fluid（1 1）心跳加快，心）心跳加快，心排出量增加排出量增加 （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Decompensation of shockprogressive stage of shock(休克休克进展进展期期)(1)is larger than (1)is larger than the flow of the flow of irrigation(irrigation(灌大于流灌大于流灌大于流灌大于流););(2)t

6、he tissue(2)the tissue edemaedema（组织水肿）（组织水肿）（组织水肿）（组织水肿）Refractory stage of shock(休克难治期）(1)the formation of(1)the formation of DICDIC（DICDIC形成）形成）(2)cell autolysis,(2)cell autolysis,tissue necrosis;tissue necrosis;（细胞（细胞自溶，组织坏死）自溶，组织坏死）(3)the bleeding(3)the bleeding tendency tendency（出血倾向）（出血倾向）Cli

7、nical manifestation(临床表现)Compensatory of shock1,mental tension,irritability.1,mental tension,irritability.2,pale,cold clammy skin.2,pale,cold clammy skin.3,thready and rapid pulse,systolic blood 3,thready and rapid pulse,systolic blood pressure,diastolic blood pressure rise high,pressure,diastolic b

8、lood pressure rise high,pulse pressure smaller.pulse pressure smaller.4,normal or decreased urine volume 4,normal or decreased urine volume Inhibitory stage of shock(休克抑制期)1,indifferent mind,unresponsive,or 1,indifferent mind,unresponsive,or unconsciousness,coma.unconsciousness,coma.2,systemic skin

9、mucous membrane cyanosis,cold 2,systemic skin mucous membrane cyanosis,cold limbs,cold sweatlimbs,cold sweat3,thready and rapid pulse or stroke is not clear,3,thready and rapid pulse or stroke is not clear,blood pressure decreased(BP 90mmHg)or blood pressure decreased(BP 90mmHg)or undetectable,pulse

10、 pressure smaller.undetectable,pulse pressure smaller.4,decreased urine output or urine(per 25ml).4,decreased urine output or urine(per 25ml).5,metabolic acidosis.5,metabolic acidosis.6,bleeding tendency often hint has occurred:DIC6,bleeding tendency often hint has occurred:DIC7,respiratory distress

11、 syndrome:7,respiratory distress syndrome:(1)dyspnea were.(1)dyspnea were.(2)although to a large number of oxygen does (2)although to a large number of oxygen does not improvenot improve The symptoms and improve the oxygen partial The symptoms and improve the oxygen partial pressure pressure Types o

12、f shockHypovolemic shock(低血容量性休克)Cardiogenic shock(心源性休克)Allergic shock（过敏性休克）Neurogenic shock(神经性休克)Septic shock(感染性休克)Hypovolemic shockInadequate blood volumeClinical manifestation(临床表现)1,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。Hemorrha

13、gic shock（失血性休克）Treatment:Supplement Treatment:Supplement blood capacityblood capacityCorrection of acid-base Correction of acid-base and electrolyte imbalanceand electrolyte imbalanceThe cause of disease The cause of disease treatment and stop the treatment and stop the continued loss of bloodconti

14、nued loss of bloodAnd the loss of fluid And the loss of fluid 治疗：治疗：治疗：治疗：补充血容量补充血容量纠正酸碱及水电解质纠正酸碱及水电解质失衡失衡 病因治疗和制止病因治疗和制止 继续继续失血和失液失血和失液Traumatic shock（损伤性休克）Treatment:In addition to Treatment:In addition to the hemorrhagic fluid the hemorrhagic fluid shock treatment,should shock treatment,should al

15、so strengthen the also strengthen the following treatment:following treatment:1,anti infection1,anti infection2,analgesia,sedation2,analgesia,sedation3,the treatment of 3,the treatment of wounds 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Septic shock(感染性休克)TreatmentTreatment：1 supplement bl

16、ood capacity.1 supplement blood capacity.2 control of infection.2 control of infection.3 correcting acid-base 3 correcting acid-base imbalance.imbalance.Application of 4 cardiovascular Application of 4 cardiovascular drugs.drugs.5 cortical hormone therapy.5 cortical hormone therapy.6 other nutrition

17、al support,6 other nutritional support,complications complications 治疗：治疗：1 1 补充血容量。补充血容量。2 2 控制感染。控制感染。3 3 纠正酸碱失衡纠正酸碱失衡 4 4 心血管药物的心血管药物的 应用。应用。5 5 皮质激素治疗皮质激素治疗 6 6 其他营养支持、处并发症等其他营养支持、处并发症等Infection control（控制感染）Antibacterial drugs（抗菌药物）Operation（手术）SIRST T3838 or or 3636Rate of heartRate of heart90t

18、imes/min90times/minR R20times/min or above,PaCO20times/min or above,PaCO2 24.3kPa4.3kPaNo.of LeukocyteNo.of Leukocyte121012109 9/L or/L or 4104109 9/L/L，or unadult Leukocyteor unadult Leukocyte10%10%Diagnosis(诊断)1.History:serious injury,bleeding,severe 1.History:serious injury,bleeding,severe infect

19、ion,allergy,history of heart diseaseinfection,allergy,history of heart disease2.shock aura:sweating,rapid heart rate,pulse 2.shock aura:sweating,rapid heart rate,pulse excited,reduce or Niaoshao symptomsexcited,reduce or Niaoshao symptoms 3.shock signs:indifferent mind,unresponsive,3.shock signs:ind

20、ifferent mind,unresponsive,pale skin rapid shallow breathing,systolic blood pale skin rapid shallow breathing,systolic blood pressure below 90mmHg and oliguria,sign the pressure below 90mmHg and oliguria,sign the patient has entered the inhibitory stage of shock.patient has entered the inhibitory st

21、age of shock.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(b)special monitoring1,central venous pressure(CVP):The normal value:510cmH2O 2,pulmonary capillary wedge pressure(PCWP):615mmHg 3,cardiac outp

22、ut(CO)and cardiac index(CI):Adult CO:46L/min;CI:2.53.5L/(min M2).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 DICPrinciple of treatmentsVolume resuscitationVasoactive 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