休克的临床表现和治疗
合集下载
相关主题
- 1、下载文档前请自行甄别文档内容的完整性，平台不提供额外的编辑、内容补充、找答案等附加服务。
- 2、"仅部分预览"的文档,不可在线预览部分如存在完整性等问题,可反馈申请退款(可完整预览的文档不适用该条件!)。
- 3、如文档侵犯您的权益，请联系客服反馈,我们会尽快为您处理(人工客服工作时间：9:00-18:30)。
12
Distributive Shock: Pathophysiology
Normal
MAP = CO x SVR
Distributive
MAP = co x ↓ SVR
co MAP = ↑ x ↓ SVR
↑co ↓MAP =
x ↓↓ SVR
13
Distributive Shock: Causes
Heart fails to pump blood out
MAP = CO x SVR HR Stroke Volume
7
Cardiogenic Shock: Pathophysiology
Normal
Cardiogenic
MAP = CO x SVR
MAP = ↓CO x SVR
MAP = ↓CO x ↑ SVR SVR ↓MAP = ↓↓CO x ↑
Mechanical Dysfunction – (Papillary muscle rupture postMI, Severe Aortic Stenosis, rupture of ventricular aneurysms etc)
Arrhythmia – (Heart block, ventricular tachycardia, SVT, atrial fibrillation etc.)
= ↓MAP ↑CO (HR x SV) x ↓ SVR
Loss of Vessel tone
Inflammatory cascade Sepsis and Toxic Shock Syndrome Anaphylaxis Post resuscitation syndrome following cardiac arrest
11
Distributive Shock: Pathophysiology
Heart pumps well, but there is peripheral vasodilation due to loss of vessel tone
MAP = CO x SVR
HR x Stroke volume
17
2、小血管舒缩状态及口径变化
(1) 微动脉、微静脉、小静脉受神经
体液的调节
神经调节 体液调节
交感神经
缩血管：儿茶酚胺、血管紧张素II 舒血管：组胺、激肽
Hemorrhagic - trauma, GI bleed, AAA rupture, ectopic pregnancy Hypovolemic - burns, GI losses, dehydration, third spacing (e.g.
pancreatitis, bowel obstruction), Adesonian crisis, Diabetic Ketoacidosis
5
Pathophysiology: Overview
Tissue perfusion is determined by Mean Arterial Pressure (MAP) MAP = CO x SVR
Heart rate Stroke Volume
6
Cardiogenic Shock: Pathophysiology
1
由多种原因引起的以组织有效循环血容量减 少的急性微循环障碍，导致细胞代谢和重要器官
功能障碍的综合征。
休克其最新版英文定义是：Shock, regardless of the cause, may be defined as a syndrome that results from inadequate perfusion of tissues.
14
二 微循环的组成和生理特点 休 克 的 发 病 机 制
15
微循环 是指微 动脉和 微静脉 之间的 血液循 环。
微动脉 后微动脉 毛细血管前括约肌 真毛细血管 微静脉 直捷通路 动-静脉吻合支
16
1、毛细血管血流量
全身性因素： 心输出量、血容量、血压 局部性因素： 微动脉、毛细血管前括约
肌及小静脉的舒缩状态
8
Cardiogenic Shock: Causes
↑ ↓MAP = ↓ CO (HR x Stroke Volume) x SVR
Decreased Contractility (Myocardial Infarction, myocarditis, cardiomypothy, Post resuscitation syndrome following cardiac arrest)
Decreased sympathetic nervous system function Neurogenic - C spine or upper thoracic cord injuries
Toxins Due to cellular poisons -Carbon monoxide, methemoglobinemia, cyanide Drug overdose (a1 antagonists)
HR x Stroke volume
10
Hypovolemic Shock: Causes
↑ ↓MAP = ↓ CO (HR x Stroke Volume) x SVR
Decreased Intravascular volume (Preload) leads to Decreased Stroke Volume
Cardiotoxicity (B blocker and Calcium Channel Blocker 9
Hypovolemic Shock: Pathophysiology
Heart pumps well, but not enough blood volume to pump
MAP = CO x SVR
休克的分类
Leabharlann Baidu
1、按原因分类
失血性休克 创伤性休克 感染性休克 心源性休克 过敏性休克
3
低血容量性休克
2、按休克的起始环 节分类
心源性休克
血管源性休克
3、按休克时血液动 低排高阻型休克 力学的特点分类 高排低阻型休克
4
分类
低血容量性休克—失血性、失液性 心源性休克— 原发性、继发性 血流分布性休克—感染性、过敏性、溶血性
Distributive Shock: Pathophysiology
Normal
MAP = CO x SVR
Distributive
MAP = co x ↓ SVR
co MAP = ↑ x ↓ SVR
↑co ↓MAP =
x ↓↓ SVR
13
Distributive Shock: Causes
Heart fails to pump blood out
MAP = CO x SVR HR Stroke Volume
7
Cardiogenic Shock: Pathophysiology
Normal
Cardiogenic
MAP = CO x SVR
MAP = ↓CO x SVR
MAP = ↓CO x ↑ SVR SVR ↓MAP = ↓↓CO x ↑
Mechanical Dysfunction – (Papillary muscle rupture postMI, Severe Aortic Stenosis, rupture of ventricular aneurysms etc)
Arrhythmia – (Heart block, ventricular tachycardia, SVT, atrial fibrillation etc.)
= ↓MAP ↑CO (HR x SV) x ↓ SVR
Loss of Vessel tone
Inflammatory cascade Sepsis and Toxic Shock Syndrome Anaphylaxis Post resuscitation syndrome following cardiac arrest
11
Distributive Shock: Pathophysiology
Heart pumps well, but there is peripheral vasodilation due to loss of vessel tone
MAP = CO x SVR
HR x Stroke volume
17
2、小血管舒缩状态及口径变化
(1) 微动脉、微静脉、小静脉受神经
体液的调节
神经调节 体液调节
交感神经
缩血管：儿茶酚胺、血管紧张素II 舒血管：组胺、激肽
Hemorrhagic - trauma, GI bleed, AAA rupture, ectopic pregnancy Hypovolemic - burns, GI losses, dehydration, third spacing (e.g.
pancreatitis, bowel obstruction), Adesonian crisis, Diabetic Ketoacidosis
5
Pathophysiology: Overview
Tissue perfusion is determined by Mean Arterial Pressure (MAP) MAP = CO x SVR
Heart rate Stroke Volume
6
Cardiogenic Shock: Pathophysiology
1
由多种原因引起的以组织有效循环血容量减 少的急性微循环障碍，导致细胞代谢和重要器官
功能障碍的综合征。
休克其最新版英文定义是：Shock, regardless of the cause, may be defined as a syndrome that results from inadequate perfusion of tissues.
14
二 微循环的组成和生理特点 休 克 的 发 病 机 制
15
微循环 是指微 动脉和 微静脉 之间的 血液循 环。
微动脉 后微动脉 毛细血管前括约肌 真毛细血管 微静脉 直捷通路 动-静脉吻合支
16
1、毛细血管血流量
全身性因素： 心输出量、血容量、血压 局部性因素： 微动脉、毛细血管前括约
肌及小静脉的舒缩状态
8
Cardiogenic Shock: Causes
↑ ↓MAP = ↓ CO (HR x Stroke Volume) x SVR
Decreased Contractility (Myocardial Infarction, myocarditis, cardiomypothy, Post resuscitation syndrome following cardiac arrest)
Decreased sympathetic nervous system function Neurogenic - C spine or upper thoracic cord injuries
Toxins Due to cellular poisons -Carbon monoxide, methemoglobinemia, cyanide Drug overdose (a1 antagonists)
HR x Stroke volume
10
Hypovolemic Shock: Causes
↑ ↓MAP = ↓ CO (HR x Stroke Volume) x SVR
Decreased Intravascular volume (Preload) leads to Decreased Stroke Volume
Cardiotoxicity (B blocker and Calcium Channel Blocker 9
Hypovolemic Shock: Pathophysiology
Heart pumps well, but not enough blood volume to pump
MAP = CO x SVR
休克的分类
Leabharlann Baidu
1、按原因分类
失血性休克 创伤性休克 感染性休克 心源性休克 过敏性休克
3
低血容量性休克
2、按休克的起始环 节分类
心源性休克
血管源性休克
3、按休克时血液动 低排高阻型休克 力学的特点分类 高排低阻型休克
4
分类
低血容量性休克—失血性、失液性 心源性休克— 原发性、继发性 血流分布性休克—感染性、过敏性、溶血性