重症超声指导循环衰竭处理临床思维

Clinical thinking of management of circulatory failure guided by critcal ultrasonography

循环衰竭严重威胁患者生命,其病因多样,受累器官广泛,需要及时、准确地进行诊断和评估。重症医学科医师运用重症超声对循环衰竭患者进行目标导向检查,用以快速甄别休克类型和精准指导血流动力学治疗。对于循环极度衰竭患者,重症超声能迅速甄别休克类型和原因,及时明确治疗方案,识别假性无脉电活动(PEA),避免患者病情恶化,发生心脏骤停。对于一般循环衰竭的患者,重症超声则可以用流程进行休克快速评估,明确休克的类型,从而采取针对性的治疗方案,甚至可能为临床提供病因诊断的线索。在重症超声快速确定循环衰竭患者休克类型后,需要从下腔静脉、右心功能、左心收缩功能、左心舒张功能、血管张力、组织灌注等进行全方位的血流动力学六步法评估,精准指导临床治疗。

Circulatory failure（Shock）, with various etiological factors and multiple organ involved, severely threatens the lives of patients. So it needs accurate diagnosis and evaluation without delay. Critical ultrasound, used by critical care doctors to make goal-directed examination, can be used to discriminate the type of shock and guide the hemodynamic treatment precisely. Critical ultrasound can be used to diagnose pseudo PEA, avoiding deteriorating to cardiac arrest. It also can he applied to make quick evaluation on shock, and provide key diagnostic clue. When the type of shock is confirmed, critical ultrasound can be used to evaluate the whole hemodynamic status, following the sequence of IVC, right heart function, left systolic function, left diastolic function, iangiotasis and tissue perfusion, in order to guide the clinical treatment.