外科におけるショックとその対策

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Shock is the considerable interests and important problems to the surgeon, but, recently increased attention has been devoted to it.<BR>We experienced thirteen shock patients postoperatively in the past 3 years.<BR>In the treatment of hypovolemic patients, the attention must be payed to maintenance the effective blood volume, which restores cardiac output, blood pressure, urine flow, and tissue perfusion as a guide to central venous pressure. Central venous pressure measurement, along with arterial blood pressure and urine output measurements, has greatly improved the care of the shock patients.<BR>Treatment is best based on giving enough volume replacement to achieve a reasonable arterial blood pressure, good urine output, and good peripheral perfusion as judged by palpable peripheral pulses and warms, dry skin without elevation of arterial pressure. This represents an effective circulating blood volume.<BR>If arterial pressure and urine output do not respond satisfactorily to volume replacement and central venous pressure rises, drugs which increase myocardial contractility, such as lsoproterenol, Dopamin and digitalis, should be considered. Drugs which produce vasoconstriction and increase myocardial contractility such as norepinephrine or aramine must be used cautionaly in attempts to produce primarily an inotropic effect on the heart. Other vasodilator, phenoxy benzamine or chlorpromazine are indicated as effective therapeutic agents upon the restoration of microcirculation.

外科におけるショックとその対策

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