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معلومات پزشکی - shock

shock

 

نوشته شده توسط:masouma ahmadi


shock
 

تعریفات


شاک عبارت از عدم کفایه سیستم دورانی برای تامین نیاز های انساج بدن مخصوصآ آکسیجن و مواد ضروری برای حجره میباشد.
شاک حالتیست که در آن کاهش شدید و وسیع پرفیوژن انساج که در اوایل منجر به تغیرات قابل برگشت و در صورت طولانی شدن به مرگ غیر قابل برگشت حجرات منتهی میشود.



شاک عبارت از عدم پرفیوژن کافی انساج به علت :1- نا کافی بودن حجم مایع داخل عروق یا Hypovolemic2- عدم کفایه کارایی قلب یا Cardiogenic Shock3-عدم کفایه تونیسیته یا فنکشن عروق Distributive Shock میباشد.

تقسیم بندی شاک از نظر میکانیزم و اسباب

Hypovolimic shoc
1-Loss of bloodA-External Hemorrhage
-Trauma
-Gastrointestinal bleedingB-Internal Hemorrhage
- Hematoma
- -Hemothorax or hemopneumothorax
2- Loss of Plasma
-Burns
-Exfoliative Dermatitis3-Loss of fluid and electrolytes
A-External
-vomiting , Diarrhea , Excessive sweating , DKA, Hyperosmolar Nonketotic coma
B-Internal (third space)
-Pancreatitis
-Ascitis
-Bowell obstruction

Cardiogenic Shock
-Dysrhythmia
-Acute valvular dysfunction
-Rupture of ventricular septum
Obstructive shock
-Tension Pnemothorax
-Pericardial disease
-Disease of pulmonary vascular (Massive Pulmonary Emboli)
-Cardiac tumor


Distributive Shock
-Septic shock
-Anaphylactic shock
-Neurologic shock
-Vasodilator drug
-Acute Adrinal insufficiency

اسباب و پتولوژی

1- مرحله Erectile یا تهیجی
2- مرحله Torpid یا استرخائی

1-مرحله تهیجی


2- مرحله استرخآئی
-شاک درجه اول:
شاک درجه دوم:
شاک درجه سوم:
شاک درجه چهارم:


پتوجنی شاک Hypovolimic


Acute hypovolemia


فعال شدن رسپتور های محیطی


تنبه سیستم سمپاتیک

Acute Hypovolemia

فعال شدن رسپتور های مرکزی

آزاد شدن ADH

فعال شدن سیستم رنین آنجیوتنسین

Oligurea


مرحله نهائی

وقتی فشار خون از 50mm/hg پائین تر شد

Hypoxia

اسکیمی دماغی،انحطاط مرکز وازوموتور

مرگ


تغیرات حاصله از شاک بالای حجره
کاهش اکسیژنیشن انساج برای مدت طولانی باعث تغییرات بیوشیمیایی جدی و بحرانی در حجره میشود که عبارتند از:
1- اختلال فعالیت پمپ یونی دیواره سلولی
2- اذیمای داخل حجروی
3- نشت محتویات داخل حجروی به فضای خارج سلولی
4- توانایی ناکافی حجره در تنظیم PH داخل حجروی


تشخیص تفریقی


nتهیجات
nمرحله تهیجی باید از Collapse تشخیص تفریقی شود.
n Coma , Head trauma

تداوی شاک هاپوولیمیک
تداوی وقتی موثر است که عامل سببی درشروع شاک ازبین برده شود:
1- قطع نمودن انتقال تنبهات از محیط به مرکز(انتقال درد از ناحیه ماوفه به سیستم عصب مرکزی):
انلجزیک- تثبیت کسورقبل از انتقال مریض- درصورت تهیج تطبیق آرام بخش ها

2- مجادله علیه فکتور های تشدید کننده شاک:
جهت جلوگیری از هایپوکسی و ضیاع خون و پلازما تطبیق مایعات وریدی – خون و آکسیجن
3- مجادله علیه تاثیرات شاک:
تطبیق مستحضرات مختلف جهت بلند بردن فشار شریانی مانندادویه مقوی قلبی(Dopamine )- ترانزفیوژن پلازما
4- تطبیق خون:
در حالات شاک با ضیاع خون استطباب داشته ولی در شاک ترضیضی بدون ضیاع خون استطباب ندارد صرف در صورتیکه با مایعات دیگر مریض احیا نگردد استطباب دارد.


5- در صورتیکه مریض عدم کفایه تنفسی داشته باشد:
ابتدا آکسیجن و درموارد شدید انتوبیشن نزدش اجرا گردد.
در بندش میخانیکی Trachiostomy
6- در حالاتیکه عدم کفایه غدوات داخلی :
-Adrenalin and Nor adrenalin
- Glucocorticoides

زمانی میتوان گفت که شاک ازبین رفته که بعد ازتطبیق مستحضرات شاک فشار خون مریض

تمایل به بلند رفتن را داشته و در صورتیکه فشار خون مریض در مدت 4-6 ساعت بلند

(حالت نورمال) باقی ماند شاک ازبین رفته است



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