2022年医学专题—儿科休克的诊治.pptVIP免费

儿科休克儿科休克(xiūkè)(xiūkè)的诊治的诊治深圳市儿童医院深圳市儿童医院第一页，共八十页。第一页，共八十页。主要(zhǔyào)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(zhěnzhì)中应注意的问题第二页，共八十页。第二页，共八十页。ImprovedOutcomesAssociatedWithEarlyResuscitationinSepticShock:DoWeNeedtoResuscitatethePatientorthePhysician?AileenKirbyandBrahmGoldsteinPediatrics2003;112;976-977第三页，共八十页。第三页，共八十页。EarlyReversalshockandoutcomRetrospectiveclinicalstudy(from1993–2001)91infantsandchildrenwithsepticshockfromlocalcommunityhospitalsandtransporttoChildren’shospital√Shockreversal(definedbyreturnofnormalSBPandCRT)√ResuscitationpracticeconcurrencewithACCMPALSGuidelines√HospitalmortalityHan,etal.Han,etal.PediatricsPediatrics2003;112;793-7992003;112;793-799第四页，共八十页。第四页，共八十页。EarlyReversalshockandoutcomShockstateandShockstateandmanagementwithmanagementwithsurvivalsurvivalSurviSurvivalvalincreasedincreasedoddsofoddsofsurvivalsurvivalShockreversedataShockreversedatamediantimeof75mediantimeof75min(n=24)min(n=24)96%96%>9-fold>9-foldPersistentPersistentshock(n=67)shock(n=67)63%63%ResuscitationResuscitationconsistentwithconsistentwithACCM-PALSACCM-PALSguidlinesguidlines92%92%>6-fold>6-foldincreasedincreasedResuscitationnotResuscitationnot62%62%Han,etal.Han,etal.PediatricsPediatrics2003;112;7932003;112;793799799第五页，共八十页。第五页，共八十页。EarlyReversalshockandoutcomShockstateandShockstateandmanagementwithmanagementwithmortalitymortalityoddsofoddsofmortalitymortalitypassedeachhourofpassedeachhourofpersistentshockpersistentshock>2-fold>2-foldeachhourofdelayineachhourofdelayininstitutionofinstitutionofresuscitationconsistentresuscitationconsistentwithACCM-PALSwithACCM-PALSGuidelinesGuidelines↑↑50%50%Unfortunately,resuscitationpracticeUnfortunately,resuscitationpracticewasconsistentwithwasconsistentwithACCM-PALSACCM-PALSGuidelinesGuidelinesinonly...