《病理生理學教研室》演示PPT

1、1 病理生理學教研室病理生理學教研室 劉俊昌劉俊昌 2 休克是各種強烈致病因子作 用于機體引起的急性循環(huán)衰竭， 其特點是微循環(huán)障礙,重要臟器 的灌流不足和細胞功能代謝障礙， 由此引起的全身性危重的病理過 程. 3 1. 按病因分類按病因分類 (By etiology): 失血性休克失血性休克 (Hemorrhagic Shock) 燒傷性休克燒傷性休克(Burn Shock) 感染性休克感染性休克 (Infectious Shock) 過敏性休克過敏性休克(Anaphylactic Shock) 心源性休克心源性休克(Cardiogenic Shock) 神經(jīng)源性休克神經(jīng)源性休克(Neurog

2、enic Shock) 4 Clinical Signs of Acute Hemorrhagic Shock % Blood lossClinical Signs 50Refractory hypotension, refractory acidosis, death 5 Changes in CO and MAP in haemorrhage 6 Cardiogenic Shock The impaired ability of the heart to pump blood Pump failure of the right or left ventricle Most common c

3、ause is LV MI (Anterior) Occurs when 40% of ventricular mass damage Mortality rate of 80 % or 7 Neurogenic Shock Caused by: Spinal cord injury Certain drugs Brain stem, spinal or torso trauma Venous pooling and arteriolar dilatation Signs and Symptoms: Hypotension without tachycardia Warm pink skin

4、Low blood pressure 鈣 拮抗劑有降低胞漿游離Ca2+濃度，能減輕細胞 各種膜結構損傷. 損傷性體液因子拮抗劑的應用 (自由基清除劑, TNF-的單克隆抗體、酶抑制劑拮抗損傷性 因子作用, 可的松類制劑抑制細胞因子的過 量生成) 47 問問 題：題： 1 1、治療休克時為什么要貫徹、治療休克時為什么要貫徹需多少，需多少， 補多少補多少的原則？的原則？ 2 2、如何正確使用血管活性藥物？、如何正確使用血管活性藥物？ 48 ShockShock Hypovolemic Shock, Cardiogenic Shock, Hypovolemic Shock, Cardiogenic

5、Shock, Vasogenic Shock Vasogenic Shock Compensated shock, Decompensated shock, Compensated shock, Decompensated shock, Irreversible shock, Irreversible shock, Ischemic hypoxic phase, Stagnant hypoxic Ischemic hypoxic phase, Stagnant hypoxic phase, Refractory shock, phase, Refractory shock, Shock Kidney, Shock Kidney, Shock LungShock Lung Acute Respiratory Distress Syndrome, ARDSAcute Respiratory Distress Syndrome, ARDS