医学精品课件：休克判断与急诊管理.pptx

1、休克判断与急诊管理李佩青annie_课件出处：2010版PALS教材什么是休克?Shock is a critical condition that results from inadequate tissue delivery of O2 and nutrients to meet tissue metabolic demand.Tissue ischaemic sensitivity-heart,brain,lung:4-6 min-GI tract,liver,kidney:45-60 min-muscle,skin:2-3 hours休克的生理基础 Unit of life=cell

2、Cells get energy(ATP)from cellular respiration:O2+Glucose ATP+water+CO2 No O2 =no energy No energy =no life Remember:Damage to Cell Damage to Tissues Damage to Organ Damage to Body Damage to Organ SystemComponents of tissue oxygen deliveryCompensatoryCompensated ShockHypotensive Shock休克的病理生理机制影响氧输送的

3、因素PreloadContractilityAfterloadStroke VolumeXHeart RateCardiac Output XO2 ContentO2 Delivery影响血流灌注的因素 心泵功能血容量 血管容积 正正常常血血流流灌灌注注休克的代偿机制Compensation MechanismAreaSignIncreased HRHeartTachycardiaIncreased SVRSkinCold,pale,mottled,diaphoreticPeripheral circulationDelayed capillary refillPulsesWeak perip

4、heral pulses,narrow pluses pressureIncreased renal and splanchnic vascular resistanceKidneyOliguria(decrease urine output)IntestineVomiting,ileus休克的失代偿机制Systolic blood pressure:normal rangeTissue perfusion:inadequateMaintain normal blood flow to vital organs (brain,heart)低血压休克的机制Hypotension:Neonatal

5、 SBP 60mmHg;Infant SBP 70mmHg;110 years of age SBP65mmHg 尿量 1ml/kg per hour CVP=812cmH2O ScvO2 70%Lac 70%监护&监测&目标导向治疗Lac 组织缺氧/糖产出/肝衰 目标 增加组织灌注、纠正酸中毒ABG PH 目标 液体疗法、通气、纠酸ScvO2休克的药物治疗：血管活性药种类药品效果正性肌力药InotropesDopamine，多巴胺Epinephrine，肾上腺素Dobutamine，多巴酚丁胺增加心肌收缩力快心率影响SVR磷酸二酯酶抑制剂PhosphodiesteraseMilrinone，

6、米力农Inamrinone，乳酸米力农降低SVR增加冠状动脉血流增加心肌收缩力血管扩张剂VasodilatorsNitroglycerin，硝酸甘油Nitroprusside，硝普钠降低SVR和静脉张力升压药VasopressorsEpinephrine(0.3mcg/kg per min)Norepinephrine，去甲肾上腺素Dopamine(10mcg/kg per min)Vasopressin，血管加压素增加SVR增加心肌收缩力 （除外 Vasopressin）休克管理流程PEDIATRIC TACHYCARDIA WITH A PULSE AND POOR PERFUSION ALGORITHMPEDIATRIC BRADYCARDIA WITH A PLUS AND POOR PERFUSION ALGORITHMPEDIATRIC SEPSIS SHOCK ALGORITHMPEDIATRIC SEPSIS SHOCK ALGORITHM谢谢聆听！