外科休克英文_培训课件.ppt

Surgical Shock 外科休克 Definition of shock Shock,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。 introduction Shock is a sign of cardiovascular (心血管的) insufficiency（不足） . The cardiovascular system is made up of three key elements:a pump,tubing and a fluid The pump propels(推动) the fluid The tubing distributes and collects it Causes of shock Severe of sudden blood loss Large drop in body fluids Major infections High spinal injuries Myocardial infarction anaphylaxis Pathophysiology（病理生理学） 1. Microcirculatory changes 2. The changes of body fluid metabolism 3. Mediators of inflammation release and ischemical reperfusion injury 4. 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 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）心跳加快，心排出量增加 （2）血液重新分配 （3）组织缺氧 （4）组织液明显减 少 Decompensation of shock progressive stage of shock( 休克进展期) (1) is larger than the flow of irrigation(灌大于流);(2) the tissue edema（组织水肿） Refractory 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） Clinical manifestation(临床表现) Compensatory 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 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). 5, metabolic acidosis.6, bleeding ten