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1、ThenewenglandjournalofmedicinereviewarticlecriticalcaremedicineSimonR.Finfer,M.D.,andJean-LouisVincent,M.D.,Ph.D.,EditorsCirculatoryShockJean-LouisVincent,M.D.,Ph.D.,andDanielDeBacker,M.D.,Ph.D.FromtheDepartmentofIntensiveCare,hockistheclinicalexpressionofcirculatoryfailurethatE
2、rasmeHospital,UniversitéLibredeBrux-resultsininadequatecellularoxygenutilization.Shockisacommoncondi-elles,Brussels.AddressreprintrequeststoSDr.VincentattheDepartmentofIntensivetionincriticalcare,affectingaboutonethirdofpatientsintheintensivecareCare,ErasmeUniversityHospital,Rte
3、.deunit(ICU).1Adiagnosisofshockisbasedonclinical,hemodynamic,andbio-Lennik808,B-1070Brussels,Belgium,orchemicalsigns,whichcanbroadlybesummarizedintothreecomponents.First,atjlvincen@ulb.ac.be.systemicarterialhypotensionisusuallypresent,butthemagnitudeofthehypoten-NEnglJMed2013;36
4、9:1726-34.sionmaybeonlymoderate,especiallyinpatientswithchronichypertension.Typi-DOI:10.1056/NEJMra1208943cally,inadults,thesystolicarterialpressureislessthan90mmHgorthemeanCopyright©2013MassachusettsMedicalSociety.arterialpressureislessthan70mmHg,withassociatedtachycardia.Secon
5、d,thereareclinicalsignsoftissuehypoperfusion,whichareapparentthroughthethree“windows”ofthebody2:cutaneous(skinthatiscoldandclammy,withvasocon-strictionandcyanosis,findingsthataremostevidentinlow-flowstates),renal(urineoutputof<0.5mlperkilogramofbodyweightperhour),andneurologic(a
6、lteredmentalstate,whichtypicallyincludesobtundation,disorientation,andconfusion).Third,hyperlactatemiaistypicallypresent,indicatingabnormalcellularoxygenmetabolism.Thenormalbloodlactatelevelisapproximately1mmolperliter,butthelevelisincreased(>1.5mmolperliter)inacutecirculatoryfa
7、ilure.PathophysiologicalMechanismsShockresultsfromfourpotential,andnotnecessarilyexclusive,pathophysiologicalmechanisms3:hypovolemia(frominternalorexternalfluidloss),cardiogenicfac-tors(e.g.,acutemyocardialinfarction,end-stagecardiomyopathy,advancedvalvularheartdisease,myocardit
8、is,orcardiacarrhythmias),obstruction(e.g.,pulmo
