急诊课件：休克 完整版.pptx

休克Circulatory Shock同济大学附属医院 重症医学科马少林 1737年法国外科医生Le Dran为描述创伤对人体构成严重的“打击”，引入“oboc”。1743年英国医生译音为“shock”。中国音译为‘休克” 。概念的演变 Induced HypothermiaWe recommend targeted temperature management as opposed to no targeted temperature management for adults with OHCA with an initial shockable rhythm who remain unresponsive after ROSC.?We suggest targeted temperature management as opposed to no targeted temperature management for adults with OHCA with an initial nonshockable rhythm who remain unresponsive after ROSC.Strong recommendationModerate quality evidenceweak recommendation very low-quality evidence 休克的定义为多种病因引起，最终共同以循环血容量减少，组织灌注不足，细胞代谢紊乱和功能受损为主要病理生理改变的综合征。休克的本质是组织/细胞低灌注休克的定义 2014年欧洲危重病医学会休克及血流动力学监测共识2014-12-22 休克定义为危及生命的血流分布异常，导致不能提供和（或）利用足够的氧，从而造成组织缺氧。We recommend that shock be defined as a life-threatening, generalized maldistribution of blood flow resulting in failure to deliver and/or utilize adequate amounts of oxygen, leading to tissue dysoxia. 2007 Consensus on circulatory shock and hemodynamic monitoring 循环休克定义为危及生命的急性循环功能衰竭，伴有细胞的氧利用障碍。We define circulatory shock as a life-threatening, generalized form of acute circulatory failure associated with inadequate oxygen utilization by the cells. 2014 Consensus on circulatory shock and hemodynamic monitoring Shock is best defined as a life-threatening, generalized form of acute circulatory failure associated with inadequate oxygen utilization by the cells. It is a state in which the circulation is unable to deliver sufficient oxygen to meet the demands of the tissues, resulting in cellular dysfunction.The result is cellular dysoxia, i.e. the loss of the physiological independence between oxygen delivery and oxygen consumption, associated with increased lactate levels. 低血压并非诊断休克的必备条件：机体的生理代偿机制可以通过血管收缩维持血压在正常范围，但组织灌注和氧合情况可能已经出现显著降低，此时可表现为中心静脉血氧饱和度下降和乳酸水平升高。推荐诊断休克时，合并动脉低血压（定义为收缩压90mmHg，或平均动脉压65mmHg，或较基线下降≥ 40mmHg）并非必要条件，尽管休克时常常合并低血压。低血压和休克 病因分类 病理生理 机制 实验室 辅助检查 治 疗 临床特点 诊 断 鉴别诊断 休 克 第一节 概 述 分 类休 克 病 因 分 类 血 流 动