外科休克英文PPT讲稿
合集下载
外科休克13.ppt
㈣ 纠正酸碱平衡失调
既要纠正代谢性酸中毒，又要防止呼吸性碱 中毒
㈤ 血管活性药物的应用
⒈ 血管收缩剂 ⒉ 血管扩张剂 ⒊ 强心药
㈥ 治疗DIC，改善微循环
肝素、抗血小板黏附和聚集药物
㈦ 皮质类固醇及其它药物的应用
皮质类固醇的作用：①阻断α-受体兴奋 作用；②保护细胞内溶酶体； ③增强心肌 收缩力；④增进线粒体功能和防止白细胞 凝集； ⑤促进糖异生。
高 15°～ 20°
㈡ 补充血容量：
首先采用晶体液和人工胶体液复苏，必要时成 分输血。
㈢ 积极处理原发病
低血容量性休克 (大血管破裂、肝脾破裂、上 消化道 大出血等）：积极争取机会手术止血。
感染性休克 （急性腹膜炎、胆道感染、绞窄性 肠梗阻 、大面积烧伤脓毒症等）：积极争取机会手 术修补穿孔、清除坏死组织或引流脓液。
创伤、感染、休克可刺激机体释放过量炎症介 质，包括白细胞介素、肿瘤坏死因子、集落刺激 因子、干扰素和一氧化氮等
缺血再灌注时释放出氧自由基 以上因素均导致内皮细胞和脏器实质细胞的 损伤。
㈣ 内脏器官的继发损害
肺： 急性呼吸窘迫综合征（休克肺） 肾： 急性肾衰竭 脑：脑缺氧 →脑水肿→ 颅内压增高 心：心肌灶性坏死，收缩功能障碍 胃肠道：应激性溃疡、肠源性感染
病例二
男性，30岁，从三楼跌下伤及左腹部， 入院后初诊为脾破裂，肠破裂， 意识模糊， T 38.5℃皮肤青紫，肢端冰冷，脉搏细弱， 血压70/50mmHg,, 全腹压痛，反跳痛， 无 尿。
休克的治疗
㈠ 一般紧急治疗： 创伤制动、大出血止血、保证呼吸道 通畅；
吸氧、保温； 休克体位：头和躯干抬高20°～ 30°、下肢抬
创伤性休克
病理生理
外科休克精品课件
细胞缺氧、溶酶体破裂
细胞自溶
组织器编官辑版损p伤pt
7
代谢改变
• 能量代谢
组织灌注不足 细胞缺氧
无氧酵解
乳酸盐 丙酮酸盐
代谢性酸中毒
微循环障碍不能及时清除酸性代谢产物 肝对乳酸代谢能力
代酸 能量不足
细胞膜功能障碍
编辑版ppt
8
炎症介质释放和缺血再灌注损伤
• 炎症介质“瀑布样”释放，连锁放大。 • 代谢性酸中毒和能量不足使细胞膜通透性
严重休克 编辑版ppt
19
休克的一般监测
• 尿量：反应肾脏血流灌注情况。 尿量＜25ml/h、比重增加，提示肾血管
收缩和供血量不足； 血压正常，但尿量仍少，且比重偏低，
提示急性肾功能衰竭； 尿量＞30ml/h，休克纠正。
编辑版ppt
20
休克特殊监测
中心静脉压(CVP)：正常值0.49-0.98Kpa（5-10 cmH20）
的利用，重新建立氧的供需平衡，和
保持正常的细胞功能。
编辑版ppt
2
维持有效循环的三个要素
• 充足的血容量 • 足够的心排出量 • 适宜的外周血管阻力
编辑版ppt
3
分类
• 低血容量性休克(hypovolemic shock) • 感染性休克(septic shock) • 心源性休克(cardiogenic shock) • 神经性休克(neurogenic shock) • 过敏性休克(anaphylactic shock)
100 －
200 次/ 分钟
收缩压 为 90 －
70mm Hg ， 脉 压小
表浅 静脉 塌陷 毛细 血管 充盈
尿 少
迟缓
意识 模糊， 甚至 昏迷
外科休克-研究生完整ppt课件
可编辑ppt
7
二、Hale Waihona Puke 克的分类可编辑ppt8
三、休克的病理生理
可编辑ppt
9
病理生理
微循环障碍 细胞代谢障碍 休克介质 脏器的继发改变
可编辑ppt
10
(一)微循环的变化
收缩期 扩张期(休克抑制期) 衰竭期(DIC)
可编辑ppt
11
微循环障碍
◆
休克早期（缺血缺氧期）
病因
多种缩血管体液因素（儿茶酚胺、肾
灌流失调
休克肺—ARDS
肾：滤过率 尿少 皮质坏死--肾衰
心：冠脉血流 心肌损害 酸中毒 高钾
心衰
肝：肝小叶中心坏死，肝衰
胃：消化道糜烂出血
脑：脑水肿、脑疝
可编辑ppt
17
四、常见的外科休克
可编辑ppt
18
失血性休克：
大血管破裂 腹部损伤致肝、脾、肾等实质性脏器破
裂 胃、十二指肠出血 门脉高压致食管、胃底曲张静脉出血 宫外孕出血 胆道出血 肿瘤破裂出血
供氧不足、糖酵解加强 局部酸中毒 乳酸中毒 能量不足、钾钠泵失灵、水钠内流 细胞膜的变化 线粒体的变化 肿胀 产生细胞因子 溶酶体的变化 细胞自溶
可编辑ppt
15
(三)休克介质
儿 茶 酚 胺 (Catecholamine)
肾素-血管紧张素系 统(RAS)
血 管 加 压 素 (vasopression)
可编辑ppt
23
休克早期 休克发展期 休克晚期
神经系统 神志清烦燥
体瘫痪、瞳孔、呼吸 变
烦燥或意识不清
昏迷,一性过性抽搐肢 改
循环系统 面色皮肤苍白,
皮肤湿冷发,呈花斑状
外科休克(surgical shock)课件-PPT文档资料
2019/2/13
休克的病理生理
微循环的变化 代谢变化 内脏器官的继发性损害
2019/2/13
2019/2/13
2019/2/13
休克的临床表现
休克代偿期的表现 精神紧张、兴奋 或烦躁不安、皮肤苍白、四肢厥冷、心率 加快、脉压差小、呼吸加快、尿量减少
2019/2/13
休克的临床表现
休克抑制期的表现 神情淡漠、反应迟钝、出冷汗、口唇肢端 发绀； 脉搏细速、血压进行性下降、尿少或无尿
2019/2/13
休克的监测
一般监测： ⒈精神状态 ⒉皮肤温度、色泽 ⒊血压 ⒋脉率 ⒌尿量
2019/2/13
休克的监测
特殊监测： ⒈中心静脉压（CVP） ⒉肺毛细血管楔压（PCWC） ⒊心排出量（CO）和心脏指数（CI） ⒋动脉血气分析 ⒌动脉血乳酸盐测定 ⒍DIC的检测 ⒎胃肠粘膜内pH值监测
外科休 克 （surgical shock）
2019/2/13
休 克（shock）的定义
是一个由多种病因引起、但最终
共同以有效循环血容量减少、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。
2019/2/13
休克的分类
低血容量性休克 感染性休克 心源性休克 神经性休克 过敏性休克
2019/2/13
2019/2/13
休克的治疗
一般紧急治疗 补充血容量 积极处理原发病 纠正酸碱平衡失调 血管活性药物的应用 治疗DIC改善微循环 皮质类固醇和其他药物的应用
2019/2/13
感染性休克的治疗
英文医学课件：休克课件
What is “SHOCK” ?
n ջظฎݱᐿܻࢩ᩸ํපሾᤅᰁٺ̵ᕟᕢᅆ ဳӧ᪃̵ᕡᙱդᨀᔯԤۑᚆݑഖጱየቘኞቘᬦᑕ̶
ҁӾ܅տ᯿ዩ܅ړտܖ҂
n Shock is defined as acute circulatory failure, a situation in which the circulation fails to provide cells with sufficient oxygen to be able to perform optimally.
Farewell.
In the ICU
n Shock is affecting about 30% patients in the ICU who were assigned to receive either dopamine or norepinephrine
n septic shock occurred in 62% n cardiogenic shock in 16% n hypovolemic shock in 16% n distributive shock in 4% n obstructive shock in 2%.
Obstructive Distributive
Hemorrhage҅Trauma Dehydration
Myocardial infarction Cardiomyopathy Valvular disease
Severe arrhythmias Pulmonary embolism
Tamponade Aortic dissection Inflammatory response (mediators)
[课件]外科休克(surgical shock)PPT
![[课件]外科休克(surgical shock)PPT](https://img.taocdn.com/s3/m/a665c3e00c22590102029d8d.png)
3
WHAT IS SHOCK?
Shock results from poor tissue perfusion and tissue hypoxia from inadequate circulatory compensations needed to sustain acutely increased body metabolism.
Blood volume Pump Peripheral resistance
5ቤተ መጻሕፍቲ ባይዱ
Causes of Shock
• Severe or sudden blood loss
• Large drop in body fluids
• Major infections
• High spinal injuries
2
Development of the concept of shock
• A history of the 200 years to recognize shock:
“shake”, “attack” From superficial syndrome to microcirculatory level , cellular level, molecular level
9
Compensatory mechanisms (early shock)
10
Compensatory mechanisms
precapillary resistance vessel to contract， to decrease capilary hydrostatic pressure.
• Circulatory level： blood pressure • Microcirculatory level： inadequate tissue perfusion • Cellular level and molecular level：
WHAT IS SHOCK?
Shock results from poor tissue perfusion and tissue hypoxia from inadequate circulatory compensations needed to sustain acutely increased body metabolism.
Blood volume Pump Peripheral resistance
5ቤተ መጻሕፍቲ ባይዱ
Causes of Shock
• Severe or sudden blood loss
• Large drop in body fluids
• Major infections
• High spinal injuries
2
Development of the concept of shock
• A history of the 200 years to recognize shock:
“shake”, “attack” From superficial syndrome to microcirculatory level , cellular level, molecular level
9
Compensatory mechanisms (early shock)
10
Compensatory mechanisms
precapillary resistance vessel to contract， to decrease capilary hydrostatic pressure.
• Circulatory level： blood pressure • Microcirculatory level： inadequate tissue perfusion • Cellular level and molecular level：
外科急诊创伤(英文)-休克及出血PPT课件
Constriction returns 20% (1 L) of blood to active circulation
Blood Vessels
Sympathetic innervation
Vasoconstriction Alpha 1 agonist
List some drugs that have alpha 1 agonsist/ blocker effects
Scar tissue, CHF Beta adrenergic blockers Calcium channel blockers
Positive
Beta adrenergic agonists, B1
List some B blockers, Ca channel blockers, B agonists
S/S represent compensation measures utilized by the body to maintain delivery of O2 to vital organs
Delay of appropriate therapy, cascade of events results in damage to organs
Delivery of CO2 to lungs
Components
Heart or pump Blood vessels or pipes Blood or fluid
Circulatory System
Heart
Parasympathetic Nervous System
Slows rate Vagus Nerve
Inadequate oxygen pathway Byproducts: Pyruvic Acid Lactic Acid Cellular death eventually occurs due to inadequate
休克-英语解读PPT课件
2021
7
II. Definition of shock
A syndrome that results from inadequate perfusion of tissues
insufficient to meet metabolic demand
lead to cellular dysfunction, elaboration of inflammatory mediators, and celluar injury
2021
6
Controversy on Lung & Kidney
ARDS
Introduction of the flow directed pulmonary artery catheter, in 1970
Noncardiogenic nature
Not due to volume overload
→ improvement
Hypovolemia
Eastern
邪毒内陷 气随血脱 阴亏气脱 气机郁闭 阴绝阳脱
2021
3
with the Rise of Physiology
Burgeoning of Cardiovascular physiology in the end of 19CN, Crile
aggregation, other intraluminal debris
preventing RBC from reaching the tissues
extrinsic obstruction of cap. Bed
local tissue inflammation, edema, or hemorrhage,lmonary embolism
外科急诊创伤(英文)-避免休克连锁反应-65页PPT精品文档
* Leads to poorer oxygenation of all organ systems
Clinical Signs
* Restlessness * Mental confusion * Agitation * Lethargy
treatments
SHOCK
• Think of the Engine as the Heart…. The Tracks as the blood vessels The cars as the RBC’s…. The Freight as the Oxygen and nutrients….
> Results in reduced or uneven microcirculatory blood flow and decreased O2 delivery to cells
Clinical Signs
> Usually there are few at this point
STAGES of SHOCK
YOUR GOAL:
Identify the type of shock and intervene at the earliest stage
possible
STAGES of SHOCK
Train Wreck of Shock
Early Stage
Pathophysiology
> Decrease in MAP
SHOCK -- Cardiogenic
• Heart Failure -- an old and tired Engine
SHOCK -- Cardiogenic
• Cardiogenic Shock - the heart (engine) no longer functions effectively
Clinical Signs
* Restlessness * Mental confusion * Agitation * Lethargy
treatments
SHOCK
• Think of the Engine as the Heart…. The Tracks as the blood vessels The cars as the RBC’s…. The Freight as the Oxygen and nutrients….
> Results in reduced or uneven microcirculatory blood flow and decreased O2 delivery to cells
Clinical Signs
> Usually there are few at this point
STAGES of SHOCK
YOUR GOAL:
Identify the type of shock and intervene at the earliest stage
possible
STAGES of SHOCK
Train Wreck of Shock
Early Stage
Pathophysiology
> Decrease in MAP
SHOCK -- Cardiogenic
• Heart Failure -- an old and tired Engine
SHOCK -- Cardiogenic
• Cardiogenic Shock - the heart (engine) no longer functions effectively
- 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)。
(2) cell autolysis, tissue necrosis;（细胞 自溶，组织坏死）
(3) the bleeding tendency （出血倾向）
Clinical manifestation(临床表现)
• Compensatory of shock
1, mental tension, irritability.
Types of shock
• Hypovolemic shock(低血容量性休克) • Cardiogenic shock(心源性休克) • Allergic shock（过敏性休克） • Neurogenic shock(神经性休克) • Septic shock(感染性休克)
Hypovolemic shock
3, thready and rapid pulse or stroke is not clear, blood pressure decreased (BP < 90mmHg) or undetectable, pulse pressure smaller.
4, decreased urine output or urine (per 25ml).
2, pale, cold clammy skin.
3, thready and rapid pulse, systolic blood pressure, diastolic blood pressure rise high, pulse pressure smaller.
4, normal or decreased urine volum微循环的变化 2.津液代谢的变化 3.炎症介质的释放和缺 血再灌注损伤
4.继发性损害
• Microcirculatory changes
compensation of shock
(1) to speed up the heart, cardiac output increased:
Inhibitory stage of shock(休克抑制期)
1, indifferent mind, unresponsive, or unconsciousness, coma.
2, systemic skin mucous membrane cyanosis, cold limbs, cold sweat
(2) a redistribution of blood:
(3) tissue hypoxia:
（1）心跳加快，心 排出量增加
（2）血液重新分配
（3）组织缺氧
（4）组织液明显减 少
(4) significantly reduced the tissue fluid
Decompensation of shock
Pathophysiology（病理生理学）
1. Microcirculatory changes
2. The changes of body fluid metabolism
3. Mediators of inflammation release and ischemical reperfusion injury
• The pump propels(推动) the fluid • The tubing distributes and collects it
Causes of shock
• Severe of sudden blood loss • Large drop in body fluids • Major infections • High spinal injuries • Myocardial infarction • anaphylaxis
起的综合症群。
introduction
• Shock is a sign of cardiovascular (心血管
的) insufficiency（不足） .
• The cardiovascular system is made up of
three key elements:a pump,tubing and a fluid
Hemorrhagic shock（失血性休克）
• Treatment: Supplement
blood capacity
Correction of acid-base and electrolyte imbalance
外科休克英文课件
Definition of shock
• Shock,regardless of the cause,may be
defined as a syndrome that results from inadequate perfusion of tissues.
• 休克乃各种原因导致的组织灌注不足所引
5, metabolic acidosis. 6, bleeding tendency often hint has occurred: DIC 7, respiratory distress syndrome:
(1) dyspnea were. (2) although to a large number of oxygen does not improve The symptoms and improve the oxygen partial pressure
• progressive stage of
shock( 休克进展期)
• Refractory stage of
shock(休克难治期）
(1) is larger than the flow of irrigation(灌大于流);
(2) the tissue edema（组织水肿）
(1) the formation of DIC（DIC形成）
• Inadequate blood volume
Clinical manifestation(临床表现)
• 1, hypotension.
2, heart rate.
3 changes, skin and mind.
1、低血压。 2、心率加快。 3、皮肤和神志的变
化。
4、器官功能不全。
4, organ dysfunction
(3) the bleeding tendency （出血倾向）
Clinical manifestation(临床表现)
• Compensatory of shock
1, mental tension, irritability.
Types of shock
• Hypovolemic shock(低血容量性休克) • Cardiogenic shock(心源性休克) • Allergic shock（过敏性休克） • Neurogenic shock(神经性休克) • Septic shock(感染性休克)
Hypovolemic shock
3, thready and rapid pulse or stroke is not clear, blood pressure decreased (BP < 90mmHg) or undetectable, pulse pressure smaller.
4, decreased urine output or urine (per 25ml).
2, pale, cold clammy skin.
3, thready and rapid pulse, systolic blood pressure, diastolic blood pressure rise high, pulse pressure smaller.
4, normal or decreased urine volum微循环的变化 2.津液代谢的变化 3.炎症介质的释放和缺 血再灌注损伤
4.继发性损害
• Microcirculatory changes
compensation of shock
(1) to speed up the heart, cardiac output increased:
Inhibitory stage of shock(休克抑制期)
1, indifferent mind, unresponsive, or unconsciousness, coma.
2, systemic skin mucous membrane cyanosis, cold limbs, cold sweat
(2) a redistribution of blood:
(3) tissue hypoxia:
（1）心跳加快，心 排出量增加
（2）血液重新分配
（3）组织缺氧
（4）组织液明显减 少
(4) significantly reduced the tissue fluid
Decompensation of shock
Pathophysiology（病理生理学）
1. Microcirculatory changes
2. The changes of body fluid metabolism
3. Mediators of inflammation release and ischemical reperfusion injury
• The pump propels(推动) the fluid • The tubing distributes and collects it
Causes of shock
• Severe of sudden blood loss • Large drop in body fluids • Major infections • High spinal injuries • Myocardial infarction • anaphylaxis
起的综合症群。
introduction
• Shock is a sign of cardiovascular (心血管
的) insufficiency（不足） .
• The cardiovascular system is made up of
three key elements:a pump,tubing and a fluid
Hemorrhagic shock（失血性休克）
• Treatment: Supplement
blood capacity
Correction of acid-base and electrolyte imbalance
外科休克英文课件
Definition of shock
• Shock,regardless of the cause,may be
defined as a syndrome that results from inadequate perfusion of tissues.
• 休克乃各种原因导致的组织灌注不足所引
5, metabolic acidosis. 6, bleeding tendency often hint has occurred: DIC 7, respiratory distress syndrome:
(1) dyspnea were. (2) although to a large number of oxygen does not improve The symptoms and improve the oxygen partial pressure
• progressive stage of
shock( 休克进展期)
• Refractory stage of
shock(休克难治期）
(1) is larger than the flow of irrigation(灌大于流);
(2) the tissue edema（组织水肿）
(1) the formation of DIC（DIC形成）
• Inadequate blood volume
Clinical manifestation(临床表现)
• 1, hypotension.
2, heart rate.
3 changes, skin and mind.
1、低血压。 2、心率加快。 3、皮肤和神志的变
化。
4、器官功能不全。
4, organ dysfunction