ShockReviewMechani

ShockReview:MechanismsandTherapies

ShockReview(Part1of2)

(SeealsoShockReviewPart2:GoalsofTherapy)

Jean-LouisVincent,editorinchiefofCriticalCare,hasanewreviewarticleoncirculatoryshockinthe_NewEnglandJournalofMedicine_,wherehesalsotheeditoroftheirnewcriticalcaresection.DanielDeBackerco-authors.(SeealsothePulmCCMtopic,"Vasopressorsforsepticshock.")

Whats"circulatoryshock"?Justshock,withitsfourpathophysiologicmechanisms:什么是"循环休克"？就是休克，它有四种病理生理学机制：

MechanismsandDiagnosisofShock休克的机制和诊断

Distributiveshock(severesepsis,anaphylaxis),usuallywithhighcardiacoutput

Hypovolemicshock(bleeding,profounddehydrationfromvomiting,diarrhea,sweating),withlowcardiacoutput

Cardiogenicshock(myocardialinfarction,end-stagecardiomyopathy,arrhythmias),withlowcardiacoutput

Obstructiveshock(pulmonaryembolism,tensionpneumothorax,cardiactamponade,atrialmyxoma),withlowcardiacoutput

分布性休克（严重的败血症、过敏性休克），通常有高心输出量

低血容量性休克（出血，呕吐、腹泻、出汗造成的深度脱水），心输出量低

心源性休克（心肌梗死、晚期心肌病、心律失常），心输出量低

阻塞性休克（肺栓塞、张力性气胸、心脏填塞、心房肌瘤），心输出量低。

Assessmentofthecause(s)ofshockcanbechallenginginindividualpatients,butonestudyof1,patientsinshockconcludedthat62%hadsepticshock,16%hadcardiogenicshock,16%hypovolemicshock,anaphylaxisorothernon-septicdistributiveshockin4%,andonly2%hadobstructiveshock.评估休克的原因对个别病人来说是个挑战，但一项对1名休克病人的研究认为，62%的病人是脓毒性休克，16%是心源性休克，16%是低血容量休克，4%是过敏性休克或其他非脓毒性分布性休克，只有2%是阻塞性休克。

Importantly,thesemechanismsofshockcancoexist,suchasinsomeonewithsepticshock(distributive)resultinginmyocardialdepression(cardiogenic),orwhohascon

转载请注明：http://www.yaoshis.com/kfxqx/7139.html