休克是重症患者的常见疾病，抢救治疗具有黄金时限性。而基层医院大多存在基础理念不夯实，缺乏血流动力学监测技术手段，治疗缺乏流程，随意性大的问题。制定适合基层医院大部分休克患者的诊断与治疗目标流程将有助于休克患者的同质化管理，提升基层医疗质量。通过皮肤、肾脏、意识改变3个观察"窗口"识别组织低灌注，并结合临床高乳酸血症（血乳酸>1.5 mmol/L）可早期识别休克。按照排除梗阻性休克、评估心脏功能和肺部情况明确心源性休克、了解容量状态和容量反应性鉴别低血容量性休克，评估心输出量是否增高识别分布性休克的流程可快速鉴别休克类型。同时基于乳酸、中心静脉压、上腔静脉血氧饱和度、动静脉二氧化碳分压差阶梯性应用理念的休克治疗目标流程，将有助于基层重症休克患者的临床管理。

Diagnosis and treatment of shock is the core of critical patient treatment. But problems such as fragile theoretical basis, lack of hemodynamics monitoring techniques and treatment protocols, and huge arbitrariness exist in primary hospitals. The target process of diagnosis and treatment for most of patients with shock in primary hospitals will contribute to the homogeneous management and improve the basic medical quality. Shock can be identified in early stage using three observationwindows: skin, kidney and alterations in consciousness, combining with hyperlactacidemia (>1.5mmol/L). The shock type can be identified with following protocol: screen and exclude obstructive shock, assess cardiac function and lung condition to determine cardiac shock, understand volume status and fluid responsiveness to identify hypovolemic shock and measure cardiac output to evaluate distributive shock. Meanwhile, it will contribute to better management of critical patients with shock at the primary level by the target process of shock treatment based on a concept of ladder application of lactic acid, central venous pressure, central venous oxygen saturation, and carbon dioxide partial pressure difference.