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Prognosis and Treatment |
預(yù)后及治療 | |
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Untreated shock is usually fatal. Even when treated, mortality from cardiogenic shock after MI and from septic shock is high (60 to 65%). Prognosis depends on the cause, preexisting or complicating illness, time between onset and diagnosis, and promptness and adequacy of therapy. |
休克不治療可致命。即使加以治療，心肌梗塞后的心源性休克和敗血癥性休克的死亡率也很高（60－65%)。預(yù)后取決于病因、現(xiàn)有或并發(fā)癥、起病診斷間隔時(shí)間及治療的及時(shí)性和正確性。 | |
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General management: First aid involves keeping the patient warm. Hemorrhage is controlled, airway and ventilation checked, and respiratory assistance given if necessary. Nothing is given by mouth, and the patient's head is turned to one side to avoid aspiration if emesis occurs. |
一般處理：急救措施包括病人保暖、控制出血、檢查氣道及通氣，必要時(shí)提供呼吸支持；禁止口腔進(jìn)食，病人頭部轉(zhuǎn)向一側(cè)以避免吸入嘔吐物。 | |
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Treatment begins simultaneously with evaluation. Supplemental O2 by face mask is provided. In severe shock or if ventilation is inadequate, airway intubation with mechanical ventilation is necessary. Two large (16- to 18-gauge) IV catheters are inserted into separate peripheral veins. A central venous line or an intraosseous needle, especially in children, provides an alternative when peripheral veins cannot promptly be accessed.醫(yī)學(xué)全在線www.med126.com |
評(píng)估與治療要同步進(jìn)行。通過面罩補(bǔ)充氧氣。嚴(yán)重休克或換氣不足者有必要行氣管插管進(jìn)行機(jī)械通氣。將兩根大規(guī)格（16－18)靜脈管分別插入 外周靜脈。如無法獲取外周靜脈，可用中心靜脈插管或骨內(nèi)針（尤其是兒童)替代。 | |
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Typically, 1 L (or 20 mL/kg in children) of 0.9% saline is infused over 15 min. In major hemorrhage, Ringer's lactate is commonly used. Unless clinical parameters return to normal, the infusion is repeated. Smaller volumes (eg, 250 to 500 mL) are used for patients with signs of high right-sided pressure (eg, distention of neck veins) or acute MI. A fluid challenge should probably not be given to a patient with signs of pulmonary edema. Further fluid therapy is based on the underlying condition and may require monitoring of CVP or PAOP. |
十五分鐘注入0.9%生理鹽水1L（兒童20 mL/kg)。大出血時(shí)常用林格氏乳酸鹽。繼續(xù)輸液至臨床參數(shù)恢復(fù)正常。右側(cè)高壓（如頸靜脈怒張)或急性MI病人可用較小劑量（如250 - 500 mL)。肺水腫病人不宜輸液。根據(jù)潛在疾病決定是否繼續(xù)輸液，要進(jìn)行CVP或PAOP監(jiān)測(cè)。 | |
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Patients in shock are critically ill and should be admitted to an ICU. Monitoring includes ECG; systolic, diastolic, and mean BP, preferably by intra-arterial catheter; respiratory rate and depth; pulse oximetry; urine flow by indwelling bladder catheter; body temperature; and clinical status, including sensorium (eg, Glasgow Coma Scale—see Table 2: Stupor and Coma: Glasgow Coma Scale*), pulse volume, skin temperature, and color. Measurement of CVP, PAOP, and thermodilution cardiac output using a balloon-tipped pulmonary arterial catheter may be helpful for diagnosis and initial management of patients with shock of uncertain or mixed etiology or with severe shock, especially when accompanied by oliguria or pulmonary edema. Echocardiography (bedside or transesophageal) is a less invasive alternative. Serial measurements of ABGs, Hct, electrolytes, serum creatinine, and blood lactate are obtained. Sublingual CO2 measurement, if available, is a noninvasive monitor of visceral perfusion. A well-designed flow sheet is helpful. |
休克病人都屬危重病人，應(yīng)收住ICU病房。監(jiān)測(cè)內(nèi)容包括ECG；收縮、舒張和平均血壓，最好用動(dòng)脈內(nèi)插管測(cè)得；呼吸速率和深度；脈氧測(cè)定；內(nèi)置導(dǎo)尿管尿流測(cè)定；體溫；及臨床狀況，包括感覺（如Glasgow昏迷等級(jí)表－見表2：木僵和昏迷：Glasgow昏迷表)、脈量、皮膚溫度和膚色等。采用肺動(dòng)脈球囊導(dǎo)管測(cè)定CVP、PAOP和熱稀釋心排血量有助于病因不明或多種病因引起的休克病人或嚴(yán)重休克并伴少尿或肺水腫病人的診斷與初期處理。超聲心動(dòng)圖（床邊或經(jīng)食管)侵入性較小，連續(xù)測(cè)定ABG、Hct、電解質(zhì)、血清肌酸酐和血乳酸鹽。若可行，舌下CO2測(cè)定不失為測(cè)定內(nèi)臟灌注情況的一種非入侵性方法。設(shè)計(jì)良好的流程表很有用。 | |
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Because tissue hypoperfusion makes intramuscular absorption unreliable, all parenteral drugs are given IV. Opioids generally are avoided because they may cause vasodilation, but severe pain may be treated with morphine 1 to 4 mg IV given over 2 min and repeated q 10 to 15 min if necessary. Although cerebral hypoperfusion may cause anxiety, sedatives or tranquilizers are not routinely given. |
組織灌注不足造成肌內(nèi)吸收不可靠，非腸道藥物都經(jīng)靜脈輸入。阿片類藥物可引起血管擴(kuò)張，一般應(yīng)避免使用。疼痛劇烈時(shí)可用嗎啡1－4 mg，兩分鐘IV治療，必要時(shí)可每10－15分鐘重復(fù)一次。雖然大腦灌注不足可導(dǎo)致焦慮，但按常規(guī)也不使用鎮(zhèn)靜劑或安定藥。 | |
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After initial resuscitation, specific treatment is directed at the underlying condition. Additional supportive care is guided by the type of shock. |
初期復(fù)蘇后，特定療法主要針對(duì)潛在病情，其他支持性治療則根據(jù)休克類型而定。 |
