1、SHOCKDepartment of Surgery Ruijin Hospital, Medical College, Shanghai Jiaotong Universityn Western recordn violent impact or blow, 1743n physiologic instability, 1815n Eastern recordn 厥脱，内闭外脱I. Historical Aspect Initial records of shockInitial Explanation of shockn Westernn Thomas Latta, 1831n Patie
2、nts with Choleran Infusion of fluids improvementHypovolemian Easternn 邪毒内陷n 气随血脱n 阴亏气脱n 气机郁闭n 阴绝阳脱with the Rise of Physiologyn Burgeoning of Cardiovascular physiology in the end of 19CN, Crilen CVP dropped after hemorrhagen Animal survival was increased after the infusion of salinen the Use of Cardi
3、ac Catheterizationn Blood volume loss fall in Cardiac Outputwith the Combination of Physiology and Biochemistryn Toxin theory of shock, Cannon & Baylissn impairment of oxygen transportn development of acidosisn toxin in severe muscle injury loss of vasomotor tonevenous sequestration of bloodhypotens
4、ionAntedate the Era of Critical Care Medicinen Extensive physiologic research of Wigger, in early 1940sn integrating the Concepts of n impaired oxygen deliveryn oxygen debtn tissue injury / death n the concept of irreversible shockn progressive systemic circulatory decompensationControversy on Lung
5、& Kidneyn ARDS n Introduction of the flow directed pulmonary artery catheter, in 1970n Noncardiogenic nature Not due to volume overloadn ARF n More prompt and aggressive resuscitationn Incidence ATN happens: hypoperfusionARDS happens: Defects in Cell Membrane Function and Vascular PermeabilityHypovo
6、lemia / Toxin /CytokineHypoxiaARDSn A syndrome that results from inadequate perfusion of tissues n insufficient to meet metabolic demandn lead to cellular dysfunction, elaboration of inflammatory mediators, and celluar injuryn which may be limited, or widespreadn A continuum, ranging from subclinica
7、l deficits in perfusion to MODS or frank organ failure.n Tissue hypoxia due to hypoperfusionn Defectsn InjuryII. Definition of shock A. 组织低灌注所致细胞缺氧B. 低血压C. 酸中毒D. 心功能不全E. 以上都不对休克的 根本 问题是 :n Impaired tissue perfusion n Wider spectrum of shock presentations n Ranging from occult tissue hypoxia to full-blown cardiovascular collapse or Multiple organ dysfunctionn Implication n alarm earliern treat earlierExplanation
