成人患者中不明原因的低血压和休克的评估和初步处理
- Author
- David F Gaieski, MD
David F Gaieski, MD
- Associate Professor
- Sidney Kimmel Medical College at Thomas Jefferson University
- Section Editors
- Polly E Parsons, MD
Polly E Parsons, MD
- Editor-in-Chief — Pulmonary and Critical Care Medicine
- Section Editor — Critical Care
- Professor of Medicine
- University of Vermont College of Medicine
- Robert S Hockberger, MD, FACEP
Robert S Hockberger, MD, FACEP
- Section Editor — Adult Signs and Symptoms
- Emeritus Professor of Medicine
- David Geffen School of Medicine at UCLA
- Deputy Editor
- Geraldine Finlay, MD
Geraldine Finlay, MD
- Senior Deputy Editor — UpToDate
- Deputy Editor — Pulmonary, Critical Care, and Sleep Medicine
- Associate Professor
- Tufts University School of Medicine
- Translators
- 蒋国平, 主任医师，教授
蒋国平, 主任医师，教授
- 浙江大学医学院附属第二医院急诊医学科
引言
休克是一种最常表现为低血压的危及生命的循环衰竭状态。休克的效应最初是可逆的，但可快速变成不可逆的，从而导致多器官功能衰竭(multi-organ failure, MOF)和死亡。因此，当患者表现为原因不明的低血压和/或被怀疑有休克时，重要的是临床医生能快速识别病因以便能给予恰当的治疗以防止MOF和死亡[1,2]。
本专题将总结有不明原因的低血压和疑似休克(即未归类的休克)的成人患者的临床表现以及初步诊断和治疗方法。休克的定义、分类、病因和病理生理学将单独讨论。 (参见“成人休克的定义、分类、病因及病理生理学”)
定义和分类
休克定义为由氧输送减少和/或氧消耗增加或氧利用不当导致的一种细胞和组织缺氧状态。它最常发生在表现为低血压(即组织灌注减少)的循环衰竭时。“不明原因的休克”指休克被识别但原因不明。
虽然患者常常有一种以上类型的休克(混合型休克)，但已识别了4类休克(表 1)：
●分布性休克(如，脓毒性休克、全身炎症反应综合征、神经源性休克、过敏性休克、中毒性休克、内分泌性休克)
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