休克之臨床治療現況與趨勢

The Current Situation and Trends in the Clinical Treatment of Shock

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。

Shock is defined 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. Identification 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, resuscitation 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 confirmed, maintenance therapy may be considered. If improvement is not confirmed, it should be considered whether treatment is inadequate or misfocused, or whether the patient’s response is atypically poor. In addition to timely resuscitation and ICU care, there are specific effective treatments for each type of shock. Such must be administered in accordance with guidelines, standard protocols and goal-oriented approaches. Trends in shock management 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 specific goals within a specified time limit to reduce the risk of multiple organ failure and death due to shock.