于志伟副主任医师哈尔滨医科大学附属肿瘤医院结直肠外科.ppt

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1、于志伟副主任医师哈尔滨医科大学附属肿瘤医院，结直肠外科休克ShockSyndrome休克(Shock)的定义休克是指任何原因引起有效循环血量减少,导致组织和器官氧合血液灌流不足,从而发生的代谢障碍和功能细胞受损的病理过程Shockisaconditioninwhichthecardiovascularsystemfailstoperfusetissuesadequately.Inadequatetissueperfusioncanresultin:generalizedcellularhypoxia(starvation)

2、widespreadimpairmentofcellularmetabolismtissuedamageorganfailuredeath维持有效循环血量的必要因素:充足的血容量Sufficientbloodvolume有效的心排出量Effectivecardiacpump良好的周围血管张力UpstandingperipheralangiotasisEffectivecirculatingbloodvolume休克的分类（TypesofShock）分类疾病举例低血容量性休克创伤出血、上消化道出血（hypovolemicsh

3、ock）烧伤、肠梗阻感染性休克胆道感染等（SepticShock）心源性休克心梗（CardiogenicShock）过敏性休克青霉素过敏、血清过敏（Anaphylacticshock）神经源性休克疼痛刺激、脊髓损伤（NeurogenicShock）hemorrhageshockandtraumaticshock.PATHOPHYSIOLOGYOFSHOCKSYNDROME微循环改变MicrocirculationChange代谢变化MetabolismChange内脏器官的继发性损害Secondarydamageonint

4、ernalorgansMicrocirculationChangeDecompensatedphaseCompensatedphaseIrreversiblephaseDeathSympatheticnervoussystemactivatesCardiaceffectsIncreasedforceofcontractionsIncreasedheartrateIncreasedcardiacoutputPeripheraleffectsArteriolarconstrictionPre-/post-capillarysp

5、hinctercontractionIncreasedperipheralresistanceShuntingofbloodtocoreorgansDecreasedrenalbloodflowReninreleasedfromkidneyarterioleRenin&AngiotensinogencombineConvertstoAngiotensinIAngiotensinIconvertstoAngiotensinIIPeripheralvasoconstrictionIncreasedaldosteronerele

6、ase(adrenalcortex)PeripheralcapillariescontainminimalbloodStagnationAerobicmetabolismchangestoanaerobicCompensatoryMechanisms休克的病理生理过程--微循环的变化微循环收缩期(休克代偿期)的特点:心跳中枢、血管舒缩中枢、交感神经兴奋→心跳加快，心排出量增加，儿茶酚胺大量释放儿茶酚胺的作用：促使外周和内脏小、微血管和毛细血管前括约肌强烈收缩，动静脉短路和直捷通道开放收缩期结果:外周血管阻力增加和回心血量

7、增加；低灌注、缺氧状态。ContinuedanaerobicmetabolismRelaxationofprecapillarysphinctersContinuedcontractionofpostcapillarysphinctersPeripheralpoolingofbloodDecreasedbloodflowtothetissuescausescellularhypoxiaDecreasedcoronarybloodflowMyocardialischemiaDecreasedforceofcontractio

8、nDecreasedbloodpressureDecompensatedShock休克的病理生理过程--微循环的变化微循环扩张期(休克抑制期)的特点:组织灌流不足，乏氧代谢，酸性物质增多，微动脉和毛细血管前括约肌扩张，但毛细血管后静脉仍收缩肥大细胞释放组胺,缓激肽,毛细血管扩张范围增加扩张期结果：毛细