休克之生理監測與臨床評估

Physiological Monitoring and Clinical Assessment of Patients in Shock

休克是以血壓低下為主要原因的危險狀態，對病人的危害性與存活者合併症的嚴重度決定於血壓下降的程度與恢復至正常灌流的快慢，以及血壓低下期間血中氧合濃度的高低。休克發生的啟動環節主要有四：血容量減少、周邊血管擴張血管容量的擴大、心搏無力與心搏出受限，使有效循環量減少，低灌流、微循環血液改變和各種毒性物質作用的結果，使細胞發生代謝障礙和功能與結構的損害，繼而造成重要器官功能衰竭。休克之醫療處置首要為盡快尋求與維持足夠而且有效之循環血量，也必須尋求最高帶氧能力，以使個體有充分氧合。本文敘述休克之發生與合併症之病理生理過程，提出生理監測與臨床評估的方法，供臨床病人照顧上之參考。

Shock is a life-threatening situation for which circulatory failure represents a major potential complication. While there are numerous disposing factors, the detrimental impacts on the human body are similar. Drop in blood pressure is a common clinical presentation. Severity of impact and chance of survival from shock depend heavily on the speed with which blood pressure recovers and tissue oxygenation is preserved. This article describes the types, pathophysiological process, and major complications of shock, along with relevant disposing factors, risk groups, assessment techniques, monitoring skills and nursing care.