10 休克 病理生理

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1、Section1SummaryWhat’sshock？Justlossofconsciousness？Section1SummaryBP↓？ThedevelopmentofShock'theoryMicrocirculation阻力血管：参与调整全身血压和血液分配交换血管：血管内外物质交换容量血管：参与调整回心血量ConceptionofshockShock：adangeroussystemicpathologicprocessundertheeffectofvariousdrasticetiologicalfac

2、tors,characterizedbyacutecirculatoryfailureincludingdecreasedeffectivecirculatoryblodvolume,inadequatetissueperfusion,cellularmetabolismimpedimentanddysfunctionofmultipleorgans.目录MultipleorgandysfunctionsyndromeOrgandysfunctionPathogenesisofShockStagesofshockE

3、tiologyandclassificationofshockPathophysiologicbasisofpreventionandtreatment第一节EtiologyandClassification一、Etiology失血与失液烧伤创伤感染过敏强烈神经刺激心脏和大血管病变hemorrhagicshockburnshocktraumaticshockinfectiousshockanaphylacticshockneurogenicshockcardiogenicshockhemorrhagicshock一

4、、Etiologyaccordingtothepathogenesis二、Classification1.Sufficientbloodvolum2.Normalfunctionofvasoconstrictionandvasodilation3.NormalfunctionofheartpumpClassificationaccordingtocausesHypovolemicshockHemorrhageSurgeryBurnsortraumaVomitingordiarrhea血容量减少静脉回流不足心输出量减

5、少血压下降压力感受器负反馈减弱交感神经兴奋外周血管收缩组织灌流减少CVP,CO,BP↓TPR↑二、ClassificationvasogenicshockInflammation,allergy,sepsisandsuddenmentalhit----adequatecapacityofvascularbedarteriovenousshuntpre-capillarysphincterture-capillary二、Classification心源性休克心肌源性：(Direct)Myocardialinfarct

6、ion，cardiomyopathy非心肌源性：(Indirect)Congestiveheart,Arrhythmiascardiogenicshock二、ClassificationBloodand/orfluidlossBuriningTraumaInfectionAllergysuddenmentalhitCardiovasculardiseaseHypovolemicshockvasogenicshockcardiogenicshock二、Classification按血流动力血特点分类高排低阻型低排高阻

7、型低排低阻型心输出量增高降低降低总外周阻力降低增高降低血压稍降低稍降低降低脉压差增大减小------皮肤血管血管扩张血管收缩------皮温温度高温度低------暖休克冷休克第二节Stagesandmechanismofshock以失血性休克为例，按照休克的发展过程分为三期：StageⅠ：Ischemichypoxia/compensatorystageStageⅡ：Stagnanthypoxia/progressivestageStageⅢ：Organicfailure/refractorystage一、Isc

8、hemichypoxia/compensatorystageChangesofmicrocirculation一、Ischemichypoxia/compensatorystage少灌少流，灌少于流组织缺血、缺氧缺血缺氧期组织灌流状态：一、Ischemichypoxia/compensatorystageMechanismsofMicrocirculatio