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1、SurgicalShock外科休克DefinitionofshockShock,regardlessofthecause,maybedefinedasasyndromethatresultsfrominadequateperfusionoftissues.休克乃各种原因导致的组织灌注不足所引起的综合症群。introductionShockisasignofcardiovascular(心血管的)insufficiency（不足）.Thecardiovascularsystemismadeupofthreekeyelements:apum
2、p,tubingandafluidThepumppropels(推动)thefluidThetubingdistributesandcollectsitCausesofshockSevereofsuddenbloodlossLargedropinbodyfluidsMajorinfectionsHighspinalinjuriesMyocardialinfarctionanaphylaxisPathophysiology（病理生理学）1.Microcirculatorychanges2.Thechangesofbodyfluidmeta
3、bolism3.Mediatorsofinflammationreleaseandischemicalreperfusioninjury4.Secondarylesion1.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Microcirculatorychangescompensationofshock(1)tospeeduptheheart,cardiacoutputincreased: (2)aredistributionofblood: (3)tissuehypoxia: (4)signifi
4、cantlyreducedthetissuefluid（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Decompensationofshockprogressivestageofshock(休克进展期)(1)islargerthantheflowofirrigation(灌大于流); (2)thetissueedema（组织水肿）Refractorystageofshock(休克难治期）(1)theformationofDIC（DIC形成）(2)cellautolysis,tissuenecrosis
5、;（细胞自溶，组织坏死）(3)thebleedingtendency（出血倾向）Clinicalmanifestation(临床表现)Compensatoryofshock1,mentaltension,irritability. 2,pale,coldclammyskin. 3,threadyandrapidpulse,systolicbloodpressure,diastolicbloodpressurerisehigh,pulsepressuresmaller. 4,normalordecreasedurinevolumeI
6、nhibitorystageofshock(休克抑制期)1,indifferentmind,unresponsive,orunconsciousness,coma. 2,systemicskinmucousmembranecyanosis,coldlimbs,coldsweat 3,threadyandrapidpulseorstrokeisnotclear,bloodpressuredecreased(BP<90mmHg)orundetectable,pulsepressuresmaller. 4,decreasedurineo
7、utputorurine(per25ml).5,metabolicacidosis. 6,bleedingtendencyoftenhinthasoccurred:DIC 7,respiratorydistresssyndrome: (1)dyspneawere. (2)althoughtoalargenumberofoxygendoesnotimprove ThesymptomsandimprovetheoxygenpartialpressureTypesofshockHypovolemicshock(低血容量性休克)Car
8、diogenicshock(心源性休克)Allergicshock（过敏性休克）Neurogenicshock(神经性休克)Septicshock(感染性休克)HypovolemicshockInadequ
