儿科休克的诊治VIP免费

儿科休克的诊治深圳市儿童医院何颜霞主要内容主要内容休克的定义休克的定义氧运输及心血管功能复习氧运输及心血管功能复习休克分类和病因休克分类和病因不同休克的特点低灌注的临床判断和休克早期诊断休克的治疗休克诊治中应注意的问题ImprovedOutcomesAssociatedWithEarlyResuscitationinSepticShock:DoWeNeedtoResuscitatethePatientorthePhysician?AileenKirbyandBrahmGoldsteinPediatrics2003;112;976-977EarlyReversalshockandoutcomRetrospectiveclinicalstudy(from1993–2001)91infantsandchildrenwithsepticshockfromlocalcommunityhospitalsandtransporttoChildren’shospital√Shockreversal(definedbyreturnofnormalSBPandCRT)√ResuscitationpracticeconcurrencewithACCMPALSGuidelines√HospitalmortalityHan,etal.Pediatrics2003;112;793-799EarlyReversalshockandoutcomShockstateandShockstateandmanagementwithmanagementwithsurvivalsurvivalSurvivSurvivalalincreasedoddsofsurvivalShockreversedataShockreversedatamediantimeof75mediantimeof75min(n=24)min(n=24)96%96%>9-foldPersistentshock(n=67)Persistentshock(n=67)63%63%ResuscitationconsisteResuscitationconsistentwithntwithACCM-PALSguidguidlineslines92%92%>6-foldincreasedResuscitationnotconsResuscitationnotconsistentwithistentwithACCM-PALSguidlinesguidlines62%62%Han,etal.Pediatrics2003;112;793-799EarlyReversalshockandoutcomShockstateandShockstateandmanagementwithmanagementwithmortalitymortalityoddsofmortalitypassedeachhourofpersistentshock>2-foldeachhourofdelayininstitutionofresuscitationconsistentwithACCM-PALSGuidelines↑↑50%50%Unfortunately,resuscitationpracticewasconsistentwithACCM-PALSGuidelinesinonly27(30%)patientsHan,etal.Pediatrics2003;112;793-799EarlyReversalshockandoutcomComparedwithsurvivors,nonsurvivorstreatedwithmoreinotropictherapies,notincreasedfluidtherapy:√dopamine/dobutamine:42%vs20%√epinephrine/norepinephrine:42%vs6%√fluid:32.9mL/kgvs20.0mL/kgHan,etal.Pediatrics2003;112;793-799休克的定义休克的定义休克（休克（Shock)Shock)系因循环功能不全或衰竭导系因循环功能不全或衰竭导致组织灌注不良，脑及全身重要器官缺氧致组织灌注不良，脑及全身重要器官缺氧核心问题：氧运输核心问题：氧运输((oxygendeliveryoxygendelivery))不不能满足代谢需要（能满足代谢需要（DODO22