SurgicalShock外科休克DefinitionofshockShock,regardlessofthecause,maybedefinedasasyndromethatresultsfrominadequateperfusionoftissues.休克乃各種原因?qū)е碌慕M織灌注不足所引起的綜合癥群。introductionShockisasignofcardiovascular(心血管的)insufficiency（不足）.Thecardiovascularsystemismadeupofthreekeyelements:apump,tubingandafluidThepumppropels(推動(dòng))thefluidThetubingdistributesandcollectsitCausesofshockSevereofsuddenbloodlossLargedropinbodyfluidsMajorinfectionsHighspinalinjuriesMyocardialinfarctionanaphylaxisPathophysiology（病理生理學(xué)）1.Microcirculatorychanges2.Thechangesofbodyfluidmetabolism3.Mediatorsofinflammationreleaseandischemicalreperfusioninjury4.Secondarylesion1.微循環(huán)的變化

2.津液代謝的變化

3.炎癥介質(zhì)的釋放和缺血再灌注損傷

4.繼發(fā)性損害Microcirculatorychanges

compensationofshock(1)tospeeduptheheart,cardiacoutputincreased:

(2)aredistributionofblood:

(3)tissuehypoxia:

(4)significantlyreducedthetissuefluid（1）心跳加快，心排出量增加（2）血液重新分配（3）組織缺氧（4）組織液明顯減少Decompensationofshockprogressivestageofshock(休克進(jìn)展期)(1)islargerthantheflowofirrigation(灌大于流);

(2)thetissueedema（組織水腫）

Refractorystageofshock(休克難治期）(1)theformationofDIC（DIC形成）

(2)cellautolysis,tissuenecrosis;（細(xì)胞自溶，組織壞死）

(3)thebleedingtendency（出血傾向）Clinicalmanifestation(臨床表現(xiàn))Compensatoryofshock

1,mentaltension,irritability.

2,pale,coldclammyskin.

3,threadyandrapidpulse,systolicbloodpressure,diastolicbloodpressurerisehigh,pulsepressuresmaller.

4,normalordecreasedurinevolumeInhibitorystageofshock(休克抑制期)1,indifferentmind,unresponsive,orunconsciousness,coma.

2,systemicskinmucousmembranecyanosis,coldlimbs,coldsweat

3,threadyandrapidpulseorstrokeisnotclear,bloodpressuredecreased(BP<90mmHg)orundetectable,pulsepressuresmaller.

4,decreasedurineoutputorurine(per25ml).

5,metabolicacidosis.

6,bleedingtendencyoftenhinthasoccurred:DIC

7,respiratorydistresssyndrome:

(1)dyspneawere.

(2)althoughtoalargenumberofoxygendoesnotimprove

ThesymptomsandimprovetheoxygenpartialpressureTypesofshockHypovolemicshock(低血容量性休克)Cardiogenicshock(心源性休克)Allergicshock（過(guò)敏性休克）Neurogenicshock(神經(jīng)性休克)Septicshock(感染性休克)HypovolemicshockInadequatebloodvolumeClinicalmanifestation(臨床表現(xiàn))1,hypotension.

2,heartrate.

3changes,skinandmind.

4,organdysfunction

1、低血壓。2、心率加快。3、皮膚和神志的變化。4、器官功能不全。Hemorrhagicshock（失血性休克）Treatment:Supplementbloodcapacity

Correctionofacid-baseandelectrolyteimbalance

Thecauseofdiseasetreatmentandstopthecontinuedlossofblood

Andthelossoffluid治療：補(bǔ)充血容量糾正酸堿及水電解質(zhì)失衡

病因治療和制止繼續(xù)失血和失液Traumaticshock（損傷性休克）Treatment:Inadditiontothehemorrhagicfluidshocktreatment,shouldalsostrengthenthefollowingtreatment:

1,antiinfection

2,analgesia,sedation

3,thetreatmentofwounds治療：除按失血失液性休克治療外，還應(yīng)加強(qiáng)以下治療：1、抗感染2、鎮(zhèn)痛、鎮(zhèn)靜3、處理創(chuàng)傷

Septicshock(感染性休克)Treatment：1supplementbloodcapacity.

2controlofinfection.

3correctingacid-baseimbalance.

Applicationof4ca