感染中毒休克-课件.ppt

1、2022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS12022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS22022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS32022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS4l感染性

2、休克，亦称脓毒性休克，是指由微生物及其毒素等产物所引起的脓毒病综合征伴休克。l感染灶中的微生物及其毒素、胞壁产物等侵入血循环，激活宿主的各种细胞和体液系统；产生细胞因子和内源性介质，作用于机体各种器官、系统，影响其灌注，导致组织细胞缺血缺氧、代谢紊乱、功能障碍，甚至多器官功能衰竭。这一危重综合征即为感染性休克。2022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS5l重症感染：是指伴发一个以上器官功能衰竭的感染。l这种病人病情发展迅速，病死率非常高。从开始感染，到出现脓毒症、严重脓毒症、脓毒性休克和多脏

3、器功能障碍综合征，在感染的不同阶段，病死率显著不同。l每增加一个器官衰竭，病死率可上升。2022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS6l休克早期：寒战高热，个别严重病人可有体温不升反降低休克早期：寒战高热，个别严重病人可有体温不升反降低之表现，血压正常或稍偏低，但脉压差小，面色苍白，皮之表现，血压正常或稍偏低，但脉压差小，面色苍白，皮肤湿冷，眼底检查可见动脉痉挛，唇指轻度发绀，神志清肤湿冷，眼底检查可见动脉痉挛，唇指轻度发绀，神志清楚但表现有烦躁不安，呼吸深而快，尿量减少，部分患者楚但表现有烦

4、躁不安，呼吸深而快，尿量减少，部分患者初期可表现为暖休克。初期可表现为暖休克。l休克中期：主要表现为低血压和酸中毒。休克中期：主要表现为低血压和酸中毒。l休克晚期：可出现休克晚期：可出现DICDIC和多器官功能衰竭。和多器官功能衰竭。DICDIC时表现为顽时表现为顽固性低血压和广泛出血，并有多脏器功能减退或衰竭的表固性低血压和广泛出血，并有多脏器功能减退或衰竭的表现（常见急性心功能不全、急性肾功能衰竭、休克肺等）。现（常见急性心功能不全、急性肾功能衰竭、休克肺等）。2022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospi

5、tal SUMS7 致致 病病 因因 子子 葡葡 萄萄 球球 菌菌2022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS8链链 球球 菌菌 大大 肠肠 杆杆 菌菌2022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS92022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS10 中 毒 性 休 克 综 合 征 的 定 义 致

6、 病 因 子 1）噬 菌 体 1 组 金 葡 菌 产 生 的 肠 毒 素 F（SEF）和 致 热 原 性 外 毒 素（PEC）；统 称 中 毒 性 外 毒 素（TSST1）2）或 A 组 链 球 菌 有 关2022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS112022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS12(一)发 病 机 制 微生物及其毒素和胞 壁成分革兰阴性杆菌 的内毒素，是最强的 激活剂 革兰

7、阳性球菌的肽聚 糖/脂磷壁复合 物；中毒性休克毒素等外 毒素单核巨噬细胞、中性粒细胞、内皮细胞、血小板、嗜碱细胞和肥大细胞等2022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS13感染性休克产生多种内源性递质（细胞因子起主要作用）2022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS14微循环衰竭期2022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3

8、rd Hospital SUMS15 （1）呼吸链功能障碍代谢紊乱 （2）氧化磷酸化功能 、ATP （3）离子泵障碍，K+、Ca2+丢失，胞浆内 Ca2+2022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS162022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS17紊 乱2022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital S

9、UMS18 休克早期 休克发展期 休克晚期神经系统 神志尚清、烦躁或意识不清 昏迷，一过性 烦躁、焦虑 抽搐、肢体瘫 痪、瞳孔、呼 吸改变。循环系统 面色和皮肤苍 皮肤湿冷发绀、皮肤粘膜广泛 白，口唇和甲床 常明显发花，出血，顽固性 轻度紫绀、肢端 表浅静脉萎陷，低血压，心律 湿冷。血压尚正 心音低顿，脉 失常，中心静 常或偏低，脉压 搏细速。脉压升高。小，眼底动脉痉 挛。2022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS19 休克早期休克早期 休克发展期休克发展期 休克晚期休克晚期呼吸系统呼吸系统

10、 深而快深而快 浅促浅促 增快，增快，ARDSARDS表现表现 POPO2 29.33kPa9.33kPa肾功能肾功能 尿量减少尿量减少 尿量更少或尿量更少或 少尿或无尿少尿或无尿 无尿无尿胃肠功能胃肠功能 可有恶心、可有恶心、鼓肠或出血鼓肠或出血 呕吐呕吐2022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS20。，。2022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS21。2022-12-30The 3rd

11、 Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS22、2022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS232022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS24(一)预 后 好 1.治 疗 反 应 2.原 发 感 染 灶 能 彻 底 清 除 和 控 制(二)预 后 差 1.伴严重酸中毒和高乳酸血症 2.并发DIC或多器官功能衰竭 3.有严重

12、原发基础疾病者2022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS252022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS262022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS27：2022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospita

13、l SUMS28、2022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS29、2022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS30、。2022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS31 2022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Ho

14、spital SUMS322022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS332022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS34多，2022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS352022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd

15、Hospital SUMS362022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS372022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS38 3)急 性 肾 功 能 衰 竭 防 治 要 点 (1)补 足 血 容 量 (2)20 甘 露 醇 250 ml,利 尿 合 剂，或 速 尿 (3)血 液 透 析：2022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS39：2022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS40内 啡 2022-12-30The 3rd Hospital SUMSThe 3rd Hospital SUMSThe 3rd Hospital SUMS41