临床常见循环衰竭的血流动力学类型和处理原则

Common hemodynamic classification of circulatory failure and therapy principles

通常按血流动力学变化将循环衰竭分为“暖休克”和“冷休克”，严重循环衰竭患儿往往这两种情况并存。小儿循环功能衰竭特点是血流动力学变化迅速，常伴有血管床的张力改变、血容量相对或绝对不足、心肌抑制、血流分布异常和细胞代谢障碍等。主要治疗手段是通过容量复苏、正性肌力药物和血管活性药物的应用，提高心输出量和组织灌注，实现SVO2〉70％和心脏指数达到3．3—6．0L／（min·Tn2），以保障血管内容量和心脏负荷的最佳化调节。

According to the hemodynamic changes, circulatory failure is divided into ＂warm＂ shock and ＂cold＂ shock, and severe circulatory failure often co-exist in both conditions in children. Circulatory fail- ure in children is characterized by rapid change on hemodynamic status, pathologic vasodilation, relative or absolute hypovolemia, myocardial depression, altered blood flow distribution, and metabolic disorders. Thera- peutic strategies include improving cardiac output and tissue perfusion, achieving SVO2 〉 70% and cardiac in- dex to 3.3 - 6. 0 L! （ min. m2 ）, ensuring the intravascular blood volume and cardiac load.