Shock

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?? Shock
???????????
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??(shock)
?????????????????????????,?????????,??????????
????????,???????????????.
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??(Types of Shock)
1. ????? (By etiology) ????? (Hemorrhagic
Shock) ?????(Burn Shock) ????? (Infectious
Shock) ?????(Anaphylactic Shock) ?????(Cardiog
enic Shock) ??????(Neurogenic Shock)
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Clinical Signs of Acute Hemorrhagic Shock
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Changes in CO and MAP in haemorrhage
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Cardiogenic Shock

• The impaired ability of the heart to pump blood
• Pump failure of the right or left ventricle
• Most common cause is LV MI (Anterior)
• Occurs when gt 40 of ventricular mass damage
• Mortality rate of 80 or gt

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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
• Low blood pressure minimal response to fluids

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2.?????????? Classified by Initial Changes

• ??????(Hypovolemic Shock) hemorrhage,burns,fluid
  loss
• ?????(Cardiogenic Shock) acute myocardial
  infarction, congestive heart failure, arrhythmias
• ??????(Vasogenic Shock) Sepsis,anaphylaxis,CNS
  damage to vasomotor center

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3. ??????????(Classification According to
Hemodynamic Characteristics)

• ?????? (Hypodynamic Shock)
• ???????????,????????????? ??????,??????,????????
  ?,???????
• ?????? (Hyperdynamic Shock)
• ???????????????????,?????????????????????????????
  ?,???????,???????,????????????,???,??,??????,?????
  ??

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???????????Microcirculation Structure and
Characteristics
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?????????????
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?????????? Conditions for a Normal
Microcirculation

• ?????? (adequate effective circulation volume)
• ?????? (adequate heart function)
• ????????? (adequate peripheral vascular
  resistance)

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?????Stages of shock

• ????(???,??????)
• (Compensated shock, ischemic hypoxic phase)
• ???(???????,??????)
• (Decompensated shock, stagnant hypoxic phase)
• ????(???????????)
• (Irreversible shock, refractory shock,
  microcirculation failure)

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???? (??????)
??? (??????)
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(?)??????Ischemic Hypoxic Phase
1??????????, ???? ??????????????????????????,???
????????????????????
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2??????? ????????
?????
Ang??ET?TXA2
??-??? ??????
????? ????
?-AR
???????
??? ????
?-AR
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3????????????????? Significance of
Compensational Changes in Microcirculation
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????????????????????????

• 1???????????????????????
• 2??????????????
• ??????????????,a?????
• ???? ß????????????a??????????

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4???????????Clinical Manifestations
????
??-???????
??????
?? ??
CNS ??
?? ?? ???
?????????????
??????
????
????
?? ??
???? ??
???? ????
??
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5????????????????
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1)??-?????-????? Renin-Angiotensin-Aldosterone
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2)????? Antidiuretic Hormone (ADH,?????)
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?? 1?????????????????? 2?????????????????
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(?)?????? Stagnant Hypoxic Phase
1??????????,???? ??????????????,?????,??????????
????????????????,????????
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2?????????
????????????
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3??????????? (Clinical Manifestations)
?????
????
???
????
?? ??? ??
????
????
???
??????
????
?????
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?? ?????????????????????
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(?)????? Irreversible Phase
1??????????,????? ????????????,????,????????????
???,?????,??????????????????????
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2?????????
1)????????(Disseminated Intravascular
Coagulation, DIC)
????
??????
??? (????)
?????
??
?????
????????
DIC ??????????????????,???????,??????,????????
??????????????
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2)????????(Important System Organ Failure)
??????,?????,?????????????
????????
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???????(Acute Renal Failure)
????????----???????
?????????????----???????
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????????
?????????(Acute Respiratory Distress Syndrome,
ARDS).???????,???????????????,????????????????
??? (Shock Lung) ????????,???????????????????????
?????????????????????????ARDS.
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?????
?? ???
????
????
?? ???
????,?? ???,????
???????
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???????
????????? (System Inflammatory Response Syndrome,
SIRS)
???????????
????????
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?????????(Multiple System Organ failure,MSOF)

• ?????????????????,??????????????????????

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?? 1?????????????? 2??????????????? 3?????????
??????
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???????
1. ????(cytokines)????
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???????
???? ??????? ???????? ??????
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2. ????????
?? ??? ??? ??? ????? ??????

• 3.??????
• ATP?????????,???????.???Na?Cl-?,?K?????????????
• ???????H????????,?????????,??????ATP?????
• ??H????H-Ca2??,??????????????,???????,?????????
  ???????????????????

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4. ????????
1)???????????????????,????????????????????????????
??????????????,????????????????? 2)?????????,??,?
???TNF?IL-1???????????,????????,???????????,?????,
?????????????
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??????
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?????
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(No Transcript)
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??????
??????????? ??????,?????? 1.???????,???????
?.????, ???,???? ?. ????????????
?. ???????????
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???????????
?????,???????
(1)???? ??????? ?????????????? ??????????????
??
(2)???? ?????????????? ???????????? BP??,?????
????
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2. ??????,?????? ? ?????? ? ??????
???????????(PGI2)??????????????
???????????Ca2??,????????????. ? ?????????????
(??????, TNF-a????????????????????,
?????????????????)
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? ?
1???????????????,??????? 2??????????????
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Key concepts
Shock Hypovolemic Shock, Cardiogenic Shock,
Vasogenic Shock Compensated shock, Decompensated
shock, Irreversible shock, Ischemic hypoxic
phase, Stagnant hypoxic phase, Refractory shock,
Shock Kidney, Shock Lung Acute Respiratory
Distress Syndrome, ARDS Multiple System Organ
Failure,MSOF