荟萃10休克课件.ppt
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1、Our greatest weakness lies in giving up.The most certain wayto succeed is always to tryjust one more time 休休克克Our greatest weakness lies in giving up.The most certain wayto succeed is always to tryjust one more time?各种强烈的致病因子作用于机体引起的微循环血液灌流量急剧减少导致机体重要器官血液灌流减少和细胞器官功能障碍而引起的全身性危重病理过程。一、概念Our greatest w
2、eakness lies in giving up.The most certain wayto succeed is always to tryjust one more time 休克的分类-原因分类脱水性休克烧伤性休克创伤性休克失血性休克感染性休克过敏性休克心源性休克神经源性休克Our greatest weakness lies in giving up.The most certain wayto succeed is always to tryjust one more time 病因和分类病因和分类?一、病因分类?失血性休克失血性休克(Hemorrhagic shock)?外伤、
3、消化道溃疡等疾病引起的急性大失血等。?体液大量丢失使有效循环血量锐减,也可导致休克。常见于剧烈呕吐、腹泻、肠梗阻、大量出汗等。Our greatest weakness lies in giving up.The most certain wayto succeed is always to tryjust one more time?休克的发生与否取决于机体血容量丢失的速度和程度,一般15分钟内失血少于全血量的10%时,机体能够通过代偿保持血压和组织血液灌流量处于稳定状态,但若迅速失血超过总血量的20%左右,即可引起休克,超过总血量的50%则往往迅速导致死亡。Our greatest wea
4、kness lies in giving up.The most certain wayto succeed is always to tryjust one more time?脱水性休克:由于呕吐、腹泻、肠梗阻、大出汗导致丢失体液,引起有效循环血量大出汗导致丢失体液,引起有效循环血量锐减。微循环灌注减少。Our greatest weakness lies in giving up.The most certain wayto succeed is always to tryjust one more time?创伤性休克(Traumatic shock)?严重创伤可导致创伤性休克,这种休
5、克的发生与疼痛和失血有关。?烧伤性休克(Burn shock)?大面积烧伤伴有血浆大量渗出时可引起烧伤性休克。此型休克的发生与血容量减少及疼痛有关。晚期若合并感染,可发展为败血症性休克。?以上四种休克的共同环节都有血容量降低,可统称为低血容量性休克。Our greatest weakness lies in giving up.The most certain wayto succeed is always to tryjust one more time?感染性休克(Infectious shock)?严重感染引起的休克称为感染性休克。最常见的致病原因为革兰氏阴性菌感染,约占感染性休克病因的
6、7080%。细菌内毒素在此型休克中具有重要作用,故又称内毒素性休克(endotoxic shock)。Our greatest weakness lies in giving up.The most certain wayto succeed is always to tryjust one more time?心源性休克(Cardiogenic shock)?大面积急性心肌梗塞、弥漫性心肌炎、心包填塞、严重心律失常等疾病均可使心泵功能严重障碍,心输出量急剧减少,有效循环血量和组织灌流量下降而引起休克,称为心源性休克。Our greatest weakness lies in giving u
7、p.The most certain wayto succeed is always to tryjust one more time?过敏性休克(Anaphylactic shock)?某些药物(如青霉素)、血清制剂或疫苗等过敏可引起过敏性休克,属I型变态反应。发病机制与 IgE及抗原在肥大细胞表面结合,引起组胺和缓激肽等血管活性物质入血,造成血管床容积扩张,毛细血管通透性增加有关Our greatest weakness lies in giving up.The most certain wayto succeed is always to tryjust one more time?神
8、经源性休克(Neurogenic shock)?高位脊髓麻醉或损伤、剧烈疼痛,通过影响交感神经的缩血管功能,降低血管紧张性,使外周血管扩张、血管容量增加、循环血量相对不足,从而引起神经源性休克。Our greatest weakness lies in giving up.The most certain wayto succeed is always to tryjust one more time 二、按休克发生的始动环节分类血容量充足心泵功能正常血管容量正常正常血液循环Our greatest weakness lies in giving up.The most certain way
9、to succeed is always to tryjust one more time 三、按休克发生的始动环节分类血容量?低血容量性休克心泵功能障碍心源性休克血管容量?血管源性休克休克失血、失液、烧伤、创伤、大出汗、腹泻、呕吐等,血容量剧减,静脉回流减少,心输出量减少,血压降低,交感兴奋,外周血管收缩,组织灌流更少。急性心肌梗死、心肌缺血再灌注损伤,心外科手术等心泵功能失常,灌注锐减血管活性物质扩张血管,外周血不能回流,有效循环下降,组织灌流不足Our greatest weakness lies in giving up.The most certain wayto succeed i
10、s always to tryjust one more time 休克的发病过程和机制休克时微循环的变化休克发生的机制Our greatest weakness lies in giving up.The most certain wayto succeed is always to tryjust one more time 休克早期(缺血缺氧期)休克期(淤血缺氧期)休克晚期(微循环衰竭期)休克的分期和微循环的变化(The stages and mechanisms of microcirculatory disorder of shock)Our greatest weakness li
11、es in giving up.The most certain wayto succeed is always to tryjust one more time(一一)缺血缺氧期缺血缺氧期(Ischemic hypoxic stage)Our greatest weakness lies in giving up.The most certain wayto succeed is always to tryjust one more time 1.缺血缺氧期微循环变化缺血缺氧期微循环变化(the alteration of microcirculation)?微循环小血管持续收缩?毛细血管前
12、阻力后阻力?关闭的毛细血管增多?血液经动静脉短路和直捷通路迅速流入微静脉?灌流特点:少灌少流、灌少于流Our greatest weakness lies in giving up.The most certain wayto succeed is always to tryjust one more time Our greatest weakness lies in giving up.The most certain wayto succeed is always to tryjust one more time 2.微循环缺血缺氧的机制微循环缺血缺氧的机制(the mechanism
13、of microcirculatory ischemic hypoxia)Our greatest weakness lies in giving up.The most certain wayto succeed is always to tryjust one more time 失血、创伤等交感交感-肾上腺髓质系统兴奋肾上腺髓质系统兴奋微血管显著收缩v皮肤、骨骼肌、腹腔内脏微血管的受体动-静脉短路的受体动-静脉短路开放vCA大量释放大量释放Our greatest weakness lies in giving up.The most certain wayto succeed is a
14、lways to tryjust one more time 3.微循环缺血缺氧对机体的影响微循环缺血缺氧对机体的影响the effect of Microcirculatoryischemic hypoxiaOur greatest weakness lies in giving up.The most certain wayto succeed is always to tryjust one more time 回心血量自身输血:儿茶酚胺等缩血管物质大量释放,使微静脉、小静脉等容量血管收缩,迅速而短暂地增加回心血量,以利于维持动脉血压。自身输液:由于毛细血管前阻力比后阻力增加显著,使毛细
15、血管内压降低,因而就有较多的组织间液进入毛细血管,致使回心血量增加(1)有利于维持动脉BP醛固酮和ADH:肾小管重吸收钠水Our greatest weakness lies in giving up.The most certain wayto succeed is always to tryjust one more time?心输出量心输出量(心源性休克除外)?心率,收缩力,回心血量外周阻力Our greatest weakness lies in giving up.The most certain wayto succeed is always to tryjust one more
16、 time(2)有利于心脑血供脑血管:交感缩血管纤维分布稀疏;受体密度低冠状动脉:受体兴奋扩血管效应强于受体兴奋缩血管效应BP维持正常Our greatest weakness lies in giving up.The most certain wayto succeed is always to tryjust one more time 4.微循环缺血期的主要表现微循环缺血期的主要表现(manifestations of microcirculatory ischemia stage)Our greatest weakness lies in giving up.The most cer
17、tain wayto succeed is always to tryjust one more time 交感-肾上腺髓质系统兴奋儿茶酚胺 出冷汗腹腔内脏、皮肤小血管收缩皮肤缺血汗腺分泌中枢神经系统兴奋外周阻力BP()脉搏细速脉压差肾缺血少尿面色苍白四肢冰冷烦躁不安心率心肌收缩力Our greatest weakness lies in giving up.The most certain wayto succeed is always to tryjust one more time?此期时抢救的最好时期,如能及时采取输血、输液等措施,则休克可停止发展,逐渐恢复。输液等措施,则休克可停止发
18、展,逐渐恢复。但由于此期血压不降,容易麻痹,如得不到有效治疗,则很快发展进入休克期。Our greatest weakness lies in giving up.The most certain wayto succeed is always to tryjust one more time(二二)淤血缺氧期淤血缺氧期(Stagnant hypoxic stage)Our greatest weakness lies in giving up.The most certain wayto succeed is always to tryjust one more time 1.淤血期微循环变
19、化淤血期微循环变化?前阻力血管扩张,微静脉持续收缩?前阻力小于后阻力?毛细血管开放数目增多灌流特点:灌而少流,灌大于流Our greatest weakness lies in giving up.The most certain wayto succeed is always to tryjust one more time Our greatest weakness lies in giving up.The most certain wayto succeed is always to tryjust one more time 2.微循环淤血的机制微循环淤血的机制(the mechan
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