儿科休克的诊治深圳市儿童医院何颜霞第一页，共八十页。主要内容休克的定义氧运输及心血管功能复习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第二页，共八十页。ImprovedOutcomesAssociatedWithEarlyResuscitationinSepticShock:DoWeNeedtoResuscitatethePatientorthePhysician?AileenKirbyandBrahmGoldsteinPediatrics2003;112;976-977第三页，共八十页。Retrospectiveclinicalstudy(from1993–2001)91infantsandchildrenwithsepticshockfromlocalcommunityhospitalsandtransporttoChildren’shospital√Shockreversal(definedbyreturnofnormalSBPandCRT)√ResuscitationpracticeconcurrencewithACCMPALSGuidelines√HilliHan,etal.Pediatrics2003;112;793-799第四页，共八十页。ShockstateandmanagementwithsurvivalSurvivalincreasedoddsofsurvivalShockreversedatamediantimeof75min(n=24)96%>9-foldPersistentshock(n=67)63%ResuscitationconsistentwithACCM-PALSguidlines92%>6-foldincreasedResuscitationnotittithACCM62%Han,etal.Pediatrics2003;112;793-799第五页，共八十页。Shockstateandmanagementwithmortalityoddsofmortalitypassedeachhourofpersistentshock>2-foldeachhourofdelayininstitutionofresuscitationconsistentwithACCM-PALSGuidelines↑50%Unfortunately,resuscitationpracticewasconsistentwithACCM-PALSGuidelinesinonly27(30%)patientsHan,etal.Pediatrics2003;112;793-799第六页，共八十页。Comparedwithsurvivors,nonsurvivorstreatedwithmoreinotropictherapies,notincreasedfluidtherapy:√dopamine/dobutamine:42%vs20%√epinephrine/norepinephrine:42%vs6%√fluid:32.9mL/kgvs20.0mL/kgHan,etal.Pediatrics2003;112;793-799第七页，共八十页。休克的定义休克〔Shock)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核心问题：氧运输(oxygendelivery)不能满足代谢需要〔DO2
