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中国科技核心期刊

中国科学引文数据库(CSCD)来源期刊

中华重症医学电子杂志 ›› 2017, Vol. 03 ›› Issue (04): 280 -285. doi: 10.3877/cma.j.issn.2096-1537.2017.04.010

所属专题: 中国重症基层诊疗流程 指南规范 文献资源库

基层诊疗流程 上一篇    下一篇

基层医院重症患者休克的诊断与治疗目标流程
张丽娜 1, 胡波 2, 郑瑞强 3, 翟茜 4, 杨向红 5, 虞文魁 6, 张丹 7, 尹海燕 8, 隆云 9 , ( ), 艾宇航 1 , ( ), 重症基层协作组   
  1. 1. 410008 长沙,中南大学湘雅医院重症医学科
    2. 430071 武汉大学中南医院重症医学科
    3. 225001 扬州,苏北人民医院重症医学科
    4. 250012 济南,山东大学齐鲁医院重症医学科
    5. 310014 杭州 浙江省人民医院重症医学科
    6. 210000 南京军区总医院重症医学科
    7. 400042 重庆医科大学附属第一医院重症医学科
    8. 510220 广州红十字会医院重症医学科
    9. 100730 中国医学科学院北京协和医院重症医学科
  • 收稿日期:2017-02-16 出版日期:2017-11-28
  • 通信作者: 隆云, 艾宇航
  • 基金资助:
    北京协和医学院2016年度教学质量工程项目(2016zlgc0713)

The protocol for diagnosis and treatment of shock in county hospital

Lina Zhang 1, Bo Hu 2, Ruiqiang Zheng 3, Qian Zhai 4, Xianghong Yang 5, Wenkui Yu 6, Dan Zhang 7, Haiyan Yin 8, Yun Long 9 , ( ), Yuhang Ai 1 , ( ), Critical Care County Working Group   

  1. 1. Department of Intensive Care Unit, Xiangya Hospital, Central South University, Changsha 410008, China
    2. Department of Intensive Care Unit, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
    3. Department of Critical Care Medicine, Northern Jiangsu Province People′s Hospital, Yangzhou 225001, China
    4. Department of Critical Care Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
    5. Department of Critical Care Medicine, Zhejiang Provincial people′s Hospital, Hangzhou 310014, China
    6. Department of Critical Care Medicine, Jinling hospital medical school of Nanjing University, Nanjing 210002, China
    7. Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, China
    8. Department of Critical Care Medicine, Guangzhou Red Cross Hospital, Guangzhou 510220, China
    9. Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing100730, China
  • Received:2017-02-16 Published:2017-11-28
  • Corresponding author: Yun Long, Yuhang Ai
  • About author:
    Correspondingauthor: Long Yun, Email:
    Ai Yuhang, Email:

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.

表1 如何判断容量是否充足
表2 如何鉴别高动力型休克与低动力型休克
图1 休克的诊断流程图
图2 休克的治疗目标流程图
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