上海交大外科学休克pbl

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1、外科休克ShockTerm“choc”–Frenchfor“push”orimpactwasfirstpublishedin1743bythephysicianLeDranAboutmyselfName:费健Email:feijian@hotmail.comMobile:137-0176-9798开始了大家要专心啊一个例子八大问题A22yearoldmanwasdrivingdrunkandwithouthisseatbeltfastenedwhenhewasinvolvedinasingle-

2、vehicleautomobileaccident.WhenattendedbyEMT（abbr.emergencymedicaltechnician急诊医士）personnel,noinformationwasavailableaboutthetimeoftheaccident.Hewasfoundagitatedandcomplainingofabdominalpain.Hisairwaywaspatent.Atthescene,hewasbreathingat20perminutewitha

3、bloodpressureof90/60andapulseof130.Hewasplacedinahardcervicalcollarandonabackboardandtransportedtoyouremergencyroom.Uponarrivalhisvitalsignsarethesame,withatemperatureof36oC.Hisabdomenismarkedlydistended.Hishandsandfeetarecold,hislegsmottled.Anasogast

4、rictuberevealsgreenliquid.Aurinarycatheterrevealsdarkyellowurine.Hishemoglobinis7.Hisabdominallavage（灌洗）revealsgrossblood.StudyQuestions1:Whattypeofshockdoesthispatientexhibit?Atthescene,hewasbreathingat20perminutewithabloodpressureof90/60andapulseo

5、f130.Uponarrivalhisvitalsignsarethesame,withatemperatureof36oC.Hisabdomenismarkedlydistended.Hishandsandfeetarecold,hislegsmottled.Anasogastrictuberevealsgreenliquid.Aurinarycatheterrevealsdarkyellowurine.Hishemoglobinis7.Hisabdominallavage（灌洗）reveal

6、sgrossblood.休克的原因和分类按病因学分类一、失血失液性休克:二、创伤性休克：三、感染性休克：四、心源性休克：五、过敏性休克：六、神经源性休克：大出血，腹泻，剧烈呕吐等疼痛和失血内毒素大面积心肌梗死，心包填塞青霉素，血清制剂或疫苗高位脊髓麻醉或损伤按血流动力学的特点低排高阻型休克（低动力型休克，冷休克）高排低阻型休克（高动力型休克，暖休克）低血容量性休克失血性休克损伤性休克感染性休克心源性休克神经源性休克过敏性休克休克的分类外科休克StudyQuestions2:Whataltera

7、tionsinoxygendeliveryarepresent?Atthescene,hewasbreathingat20perminutewithabloodpressureof90/60andapulseof130.Uponarrivalhisvitalsignsarethesame,withatemperatureof36oC.Hisabdomenismarkedlydistended.Hishandsandfeetarecold,hislegsmottled.Anasogastrictu

8、berevealsgreenliquid.Aurinarycatheterrevealsdarkyellowurine.Hishemoglobinis7.Hisabdominallavage（灌洗）revealsgrossblood.单位时间内通过心血管系统进行循环的血量--有效循环血量不包括贮存在肝、脾、淋巴血窦、淤滞于毛细血管中的血量依赖于充足的血容量有效的心排量良好的周围血管张力有效循环血量休克代谢障碍细胞受损组织血液灌注不足有效循环血量锐减微循环障碍微循环收缩期微循环扩张期