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護理雜誌 MEDLINEScopus

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篇名 休克之臨床治療現況與趨勢
卷期 57:1
並列篇名 the Current Situation and trends in the Clinical treatment of Shock
作者 黃國巡胡美華洪楠凱蔡建松劉天健廖文進
頁次 11-16
關鍵字 治療套餐(bundle)準則治療敗血症休克急重症shocktreatment packages bundlesguidelinestreatmentsepsisemergency and critical careMEDLINEScopusTSCI
出刊日期 201002

中文摘要

休克乃組織或器官灌注不良,初步急救的重點在於建立穩定的呼吸道、通氣和循環。藉由臨床表
現、身體檢查,並觀察治療之反應,可早期診斷或臆斷造成生命跡象不穩定的原因,並加以處
置。迅速找出休克的原因及適當的治療是挽回休克病人生命的重要關鍵,因為時間就是組織
(time is tissue) 。不論是哪一種休克,皆須同時評估及處理病人並擬定急救的先後順序,且立即急救危及生命的休克症狀。病人可能有二類以上的休克並存,其評估及處理就更為複雜了。在重症照顧方面,必須面面俱到,讓全身機能同時好起來,以避免因某器官的失能而引致其他的傷害。
在急救及重症處置當中,完成某階段處理後,必須持續反覆的評估病人是否有改善?若有改善,
可考慮維持治療。若無改善,則須考慮是否治療不夠、方向錯誤、或是病人的反應性不佳。除了
儘早急救、復甦以及加護中心面面俱到的照顧病人之外,再根據不同類休克之處理準則、標準流
程及以目標導向的方式,並將之化為 治療套餐以利臨床醫療之執行,且於限定時間內完成特定的目標,此為休克治療之趨勢,藉以減少休克引起之多重器官衰竭,甚至死亡。

英文摘要

Shock is defned as hypoperfusion of tissues and/or organs. The initial focus of resuscitation following shock is on establishing an open airway and ensuring adequate ventilation and circulation. Causes of shock can be recognized quickly via clinical manifestations. A professional physical examination and observation of response to therapy can result in early diagnosis of the causes of unstable vital signs. Identifcation of shock symptoms in order to administer appropriate treatment quickly is key to saving patient lives, because time is tissue. In all shock cases, treatments begin with an evaluation, resusci-tation and immediate treatment of life-threatening symptoms. Patients may experience more than one kind of shock simultaneously, which further complicates their assessment and treatment. The critical care of shock should be done thoroughly and systematically in order to assess and manage patients so
as to avoid dysfunctions in one organ damaging others. During emergency and critical management of shock patients, once a certain stage of assessment is completed, further evaluation is necessary to assess condition improvement.If improvement is confrmed,maintenance therapy may be considered.
If improvement is not confrmed,it should be considered whether treatment is inadequate or mis-focused, or whether the patient’s response is atypically poor. In addition to timely resuscitation and ICU care,there are specifc effective treatments for each type of shock. Such must be administered in accordance with guidelines, standard protocols and goal-oriented approaches. Trends in shock man-agement currently focus on integrating guidelines, standard protocols and goal-oriented approaches
into a treatment bundle, which facilitates the implementation of clinical medical care and completes specifc goals within a specifed time limit to reduce the risk of multiple organ failure and death due to shock.

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